脊髓圆锥和终丝的研究进展

脊髓栓系综合征为严重的先大性疾病,治疗主要是手术切除病变的终丝、囊肿、脂肪瘤等,解除对脊髓圆锥的损伤.终丝为什么会病变增粗?是切断内终丝还是外终丝?低位置的或正常位置的圆锥受损伤的机制是什么?因此,对脊髓圆锥及终丝的成分和结构的研究将可能给予明确的原因.     

类似腰椎间盘突出的成人脂肪型脊髓栓系综合征1例

患者,男,22岁,因左下肢放射痛伴麻痹无力2个月于2019年7月23日入院就诊.查体:轻度左下肢跛行,无腰痛,左下肢T12水平以下皮肤痛觉减退,左下肢股四头肌肌力4 级,直腿抬高试验阴性,病理反射未引出,膝、踝反射存在.腰椎X 线片显示腰椎骨质未见异常.腰椎CT 显示:① L4～5椎间盘轻度膨隆,L5 ～S1 椎间盘轻...     

大鼠改良脊髓栓系综合征模型的建立及评估

目的探讨SD大鼠改良脊髓栓系综合征模型的有效性和可靠性。方法 2020年9月在新疆医科大学第一附属医院选取清洁级SD大鼠60只, 按照体重随机分为实验组和对照组, 每组各30只, 实验组采用改良慢性牵拉法建立大鼠脊髓栓系综合征模型。分别检测大鼠后肢行为学功能、膀胱功能、运动诱发电位及脊髓病理生理变化, 应用SPSS 20.0软件进行分析。结果实验组大鼠术后7 d残余尿量为(1.94±0.23) ml, 明显高于对照组[(0.18±0.16) ml, t=3.886, P<0.05], 术后30 d实验组大鼠出现严重的膀胱功能障碍[(2.92±0.32) ml], 明显高于对照组[(0.19±0.21) ml, t=7.542, P<0.05]。同时, 与对照组比较, 实验组大鼠Tarlov评分降低, 运动诱发电位(MEP)中的P波潜伏期延长、波幅下降(χ2=4.876, t=3.468, P<0.05);病理检测发现, 脊髓末端组织观察到不同程度的神经细胞坏死、胞浆内尼氏体淡然, 数量明显减少并分布不均匀。结论 SD大鼠改良脊髓栓系综合征模型为脊髓栓系综合征的基础及临...     

成人脊髓栓系综合征的显微手术治疗--附8例临床分析

目的：探讨成人脊髓栓系综合征(TCS)的临床特点和显微手术治疗效果。方法：回顾性分析了8例成人TCS的诊断情况和显微手术治疗的效果。结果：本组病例从发病到确诊最长时间为33年，最短4年，平均26年。手术对疼痛症状的效果明显，运动感觉功能的效果欠佳，最差的是泌尿系统症状，所有病例神经功能损害未再进一步加重。结论：TCS的早期诊断和手术是提高疗效的关键，而术中应用显微外科技术是保证手术成功、提高手术效果和防止再栓系的有力手段。     

脊髓

20050560脊髓发育不良的外科病理解剖学研究／李金良…∥中华神经外科杂志．-2004，20(5)．-392～394     

脊髓纵裂患者脊髓栓系综合征的手术疗效分析

目的分忻双管型脊髓纵裂患者脊髓栓系综合征的手术疗效。方法对34例行手术治疗的双管型脊髓纵裂TCS患者进行回顾性分析。结果通过手术后观察和3个月～5年的随访发现．手术的总有率可达91％，尤其是疼痛为主诉的患者恢复最为明显，术后恢复似乎与术前病程无关。结论双管型脊髓纵裂合并TCS的患者一旦确诊．无手术禁忌证就应尽早手术。只要手术操作细致，大多患者症状可缓解．不会出现明显的神经并发症。     

脊髓栓系综合征术后尿动力学的测定及临床意义

目的　探讨脊髓栓系综合征 (TCS)患儿术后尿动力学表现及其临床意义。　方法　对4 0例TCS患儿术后行尿动力学测定 ,分析影响术后下尿路症状改善及尿动力学结果的因素。　结果　 4 0例患儿中 5例手术前后均无下尿路症状 ,术前 35例有尿失禁伴夜间遗尿者中术后 8例尿失禁减轻 ,2 4例无变化 ,3例加重。尿动力学测定示膀胱顺应性降低 2 1例 ,剩余尿增加 2 1例 ,逼尿肌无力19例 ,膀胱容量减小 15例 ,逼尿肌反射亢进 13例 ,逼尿肌括约肌协同失调 8例 ,漏尿点压力 >4 0cmH2 O (1cmH2 O =0 .0 98kPa) 4例。自述无下尿路症状 5例中 ,膀胱逼尿肌反射亢进 2例 ,逼尿肌括约肌协同失调 2例 ,基本正常 1例。术后尿失禁改善率原发性TCS(2 8.6 % ,8/ 2 8)高于继发性(0 % ,0 / 7,P =0 .0 4 8) ,非脂肪瘤型 (10 0 % ,3/ 3)高于脂肪瘤型者 (15 .6 % ,5 / 32 ,P =0 .0 0 4 ) ,脊膜膨出型 (36 .4 % ,8/ 2 2 )高于脊髓脊膜膨出型 (0 % ,0 / 6 ,P =0 .0 4 7) ,出生时无泌尿系症状者 (80 % ,4 / 5 )高于出生时有泌尿系症状者 (17.4 % ,4 / 2 3,P =0 .0 19)。尿动力学测定示术后原发性TCS逼尿肌反射亢进的发生率 (2 4 .2 % ,8/ 33)低于继发性TCS(71.4 % ,5 / 7,P =0 .0 15 ) ,非脂肪瘤型 (12 .5 % ,1/ 8)低于脂肪瘤型TCS(5 6 .3%     

脊髓栓系综合征的研究现状

脊髓栓系综合征的研究现状石志才，李家顺，贾连顺脊髓栓系综合征（Ｔｅｔｈｅｒｅｄｃｏｒｄｓｙｎｄｒｏｍｅ，ＴＣＳ）是由于各种先天和后天原因牵拉圆锥，使圆锥位置下降并产生一系列神经功能障碍和畸形的症侯群。１９５３年首次临床报告。现就其病因、病理、临床表现...     

脊髓栓系综合征的手术疗效观察

目的 探讨利用显微神经外科手术技术,治疗脊髓栓系综合征的疗效。方法 对１９９４年～１９９７年共收治２２例脊髓栓系综合征的患者,术前均行ＭＲＩ检查,脊髓、圆锥尖闻风而动匀位于Ｌ２椎体下缘以下,骶尾部椎管内脂肪瘤４例皮毛窦５例、单纯终丝增粗变短１３例。虱均采用腰骶部正中切口,手术范围包括圆锥下缘和终丝远端与骶部附着处。镜下分离中连,找出终丝,在圆锥下端切断终丝,并进行马尾神经梳理。对有脂肪瘤和皮毛窦应     

显微手术治疗脊髓栓系综合症22例

显微手术治疗脊髓栓系综合症２２例李景荣，郑立高１９８８年１月至１９９２年１２月我们应用改进的手术方法，包括显微外科技术治疗脊髓栓系综合症患者２２例，取得一定疗效，现报告如下：临床资料本组男１０例，女１２例。年龄１．５月～５７岁。＜１岁５例，１～１０岁...     

Duplicated filum terminale in non-split cord malformations: An underrecognized cause for treatment failure in tethered cord syndrome

Context: Anatomical variations of the filum terminale (FT) have been described in association with split cord malformations (SCM) but they appear to be a rare finding in its absence. We report the first case in literature of a duplicated FT in a patient presenting with tethered cord syndrome (TCS) without any radiological evidence of SCM.

Findings: A 47-year-old man presented with invalidating back pain radiating to both legs. Magnetic resonance imaging revealed an intradural dorsal lipoma in a low-lying conus. Intraoperatively two distinct fibrous bands were anatomically and electrophysiologically identified as the FT and both were sectioned. The diagnosis of FT was confirmed for both specimens by histology.

Conclusion: In absence of SCM, a duplicated FT has not been previously described as a cause of TCS. It may be a cause of treatment failure for TCS if unrecognized on preoperative imaging and during surgery if one filum remains intact. We highlight the importance of a meticulous cauda equina dissection supported by intraoperative nerve stimulation to identify this rare anomaly. We hypothesize that this entity may represent a variant of SCM involving the caudal neural tube but which requires further validation at an embryological level.     

Ependymoma of the filum terminale: Treatment and prognostic factors in a series of 28 cases

Summary A series of 28 ependymomas arising in the filum terminale was divided into two groups based on the presence/absence of connections with the conus medullaris and/or roots of the cauda equina. Group A comprised ependymomas having no connections with the contiguous structures and group B those either infiltrating or adhering to such structures.Factors having a positive influence on the prognosis (risk of recurrence) were: 1) clinical history under one year (p<0.01); 2) confinement of tumour to the filum terminale (p<0.01); 3) total tumour removal (p<0.05). Postoperative radiotherapy had no appreciable effect on outcome. The combination of significant factors was in turn significantly influenced by the mode of tumour growth, which proved to be the cardinal factor in prognosis. This point is examined in the light of the pulished work.     

Acute onset of paraganglioma of filum terminale: A case report and surgical treatment

IntroductionParagangliomas of filum terminale are rare benign tumors, arising from the adrenal medulla or extra-adrenal paraganglia. These lesions usually present with chronic back pain and radiculopathy and only two cases of acute neurological deficit have been reported in literature.Presentation of caseA case with an acute paraplegia and cauda equina syndrome due to an hemorrhagic paraganglioma of the filum terminale is described. Magnetic resonance imaging showed an intradural tumor extending from L1 to L2 compressing the cauda equina, with an intralesional and intradural bleed. An emergent laminectomy with total removal of the tumor was performed allowing a post-operative partial sensory recovery. Histopathological examination diagnosed paraganglioma.DiscussionParagangliomas are solid, slow growing tumors arising from specialized neural crest cells, mostly occurring in the head and neck and rarely in cauda equina or filum terminale. MRI is gold standard radiological for diagnosis and follow-up of these lesions. They have no pathognomonic radiological and clinical features and are frequently misdiagnosed as other spinal lesions. No significant correlation was observed between the duration of symptoms and tumor dimension. Acute presentation is unusual and emergent surgical treatment is fondamental. The outcome is very good after complete excision and radiotherapical treatment is recommended after an incomplete resection. Conclusion: Early radiological assessment and timely surgery are mandatory to avoid progressive neurological deficits in case of acute clinical manifestation of paraganglioma of filum terminale.     

Pathomorphological description of the shunted portion of a filum terminale arteriovenous fistula

Background contextThe clinical morphology of a filum terminale arteriovenous fistula (f-AVF) is well known; however, pathological details of the fistulized portion are unknown. Herein, we report the pathological findings of the f-AVF.Study designCase report and literature review.PurposeTo present a detailed pathological examination of the fistulized portion of the f-AVF.MethodsA 71-year-old man presented with gradually worsening bilateral foot paresthesias and anal dysesthesia. T2-weighted magnetic resonance imaging showed flow voids surrounding an edematous conus medullaris and cauda equina with spinal stenosis at L3–L4 and L4–L5. Spinal digital subtraction angiography demonstrated an f-AVF fed by the left T9 intercostal artery.ResultsWe performed laminotomies of L3 and L4 to open the dura mater and found a hypertrophic filum terminale. It was resected, leaving a length of 2 cm between the abnormal proximal end and normal distal end. The f-AVF completely disappeared after the surgery. On pathological examination, the filum terminale included two vessels at the proximal end and one at the distal end. At the proximal end, immunostaining showed one vessel that was definitively an artery with both an internal elastic membrane (IEM) and smooth muscle. The other was a vein and lacked an IEM. On the distal side, the collagen fibers gradually increased, the IEM partially disappeared from the arterial wall, and the vein became arterialized with a thin IEM. At the distal end the two vessels joined. Therefore, we speculated that the fistulized portion of the f-AVF was not a fistula point but had some lengths where the artery had characteristics of a vein and there was venous arterialization.ConclusionsThe filum arteriovenous shunting occurred at the portion where there was venous arterialization and the artery had the characteristics of a vein. Therefore, resecting the filum terminale requires more proximal from the normal distal end.     

Results of the section of the filum terminale in 20 patients with syringomyelia,scoliosis and Chiari malformation

Summary Background. Spinal cord traction caused by a tight filum terminale may be considered a pathogenic mechanism involved in the development of syringomyelia, the Chiari malformation (type I) and scoliosis. Section of the filum terminale is proposed as a useful surgical approach in these conditions.Methods. Between April 1993 and July 2003, a total of 20 patients (8 men and 12 women) with a mean age of 33.5 years underwent section of the filum terminale with or without opening of the dural sac through a standard sacrectomy. Eight patients suffered from scoliosis, 5 from syringomyelia, 2 from Chiari malformation and 5 with a combination of these conditions.Finding. After section of the filum terminale, patients with syringomyelia showed an early clinical improvement of dysaesthesia, thermo-anaesthesia, hypo-aesthesia and walking difficulties. Rising of the medullary conus was also observed. In patients with scoliosis, back pain improved dramatically and a curve reduction was noticed, although progression of the curve was observed in one case. In patients with Chiari malformation, headache, dysaesthesia and paraparesis disappeared.Conclusions. Section of the filum terminale is a useful strategy in the treatment of scoliosis, syringomyelia and the Chiari malformation, and offers a new aetiological basis for the understanding of these three disorders.     

Syrinx of the conus medullaris and filum terminale in association with multiple hemangioblastomas

A patient with multiple hemangioblastomas and syrinxes of the cerebellum and spinal cord is presented. An additional mass imaged at the L-3 vertebral level was identified by percutaneous syringography as a bilobular syrinx extending from the conus medullaris into the filum terminale. At surgery the syrinx was opened into the caudal cerebrospinal fluid space and the several hemangioblastomas excised. These spinal tumors all appeared to arise in juxtaposition to the posterolateral sulcus and dorsal sensory roots.     

Prognostic factors for progression-free survival of the filum terminale ependymomas in adults

ObjectiveTo define the prognostic factors for progression and to determine the impact of the histological grading (according to the World Health Organization) on the progression-free survival (PFS) of filum terminale ependymomas.MethodsA retrospective chart review of 38 patients with ependymoma of the filum terminale was performed, focusing on demographic data, preoperative symptoms, tumor size, quality of resection, presence of a tumor capsule, and histological grade.ResultsGross total resection (GTR) was achieved in 30 patients (78.9%). Histopathological analysis found 21 (55.3%) myxopapillary grade I ependymoma (MPE), 16 (42.1%) ependymoma grade II (EGII), and 1 (2.6%) ependymoma grade III. There was no significant difference between the mean ± SD volume of MPE (5840.5 ± 5244.2 mm³) and the one of EGII (7220.3 ± 6305.9 mm³, p = 0.5). The mean ± SD follow-up was 54.1 ± 38.4 months. At last follow-up, 30 (78.9%) patients were free of progression. In multivariate analysis, subtotal resection (p = 0.015) and infiltrative tumor (p = 0.03) were significantly associated with progression. The PFS was significantly higher in patients with encapsulated tumor than in patients with infiltrative tumor (log-rank p = 0.01) and in patients who had a GTR in comparison with those who had an incomplete resection (log-rank p = 0.05). There was no difference in PFS between patient with MPE and EGII (p = 0.1).ConclusionThe progression of ependymoma of the filum terminale highly depends on the quality of resection, and whether the tumor is encapsulated. Except for anaplastic grade, histopathological type does not influence progression.     

Paraganglioma of the filum terminal: Case report and review of the literature

Paraganglioma of the filum terminal/cauda equina is a rare slow growing tumor which originates from the ectopic sympathetic neurons. Surgically, total excision may be difficult for this well demarcated tumor surrounded by couple of rootlets but is usually possible in nearly all cases. Actually, final diagnosis cannot be determined intraoperatively, but is possible only after an immunohistochemical staining. Herein, the authors present a middle age woman whose initial symptoms were lower back pain and radiculopathy. Her MRI was found to be compatible with a cauda equina tumor. During her excisional surgery a hard and relatively vascular tumor was fully removed. The Immunohistochemical results were compatible with paraganglioma of the filum terminale. In addition to case presentation, thorough review of the literature is also done.