Fibrolipoma of the filum terminale the pain source makes. The filum disease cis a form of the neurocraniovertebral syndrome caused by a congenital abnormality of an apparently normal filum terminale, causing a tractive force on the spinal cord and the rest of the nervous system. Filum terminale synonyms, filum terminale pronunciation, filum terminale translation, english dictionary definition of filum terminale. Sectioning the filum terminale does not usually involve maneuvers that contribute to retethering of the spinal cord. Mri with gadolinium injection allows setting surgical strategies, but does not bring certainty in the diagnosis, which is obtained through an anatomopathology.
Histopathology of the filum terminale in children with and. Incidental isolated fibrolipoma of filum terminale in adult. Tethered cord syndrome associated with a thickened filum. Differential diagnoses included tethered cord syndrome and. There was no significant thickening of the filum terminale. The filum disease is an apparently hereditary condition, affecting one in every five individuals. The term filum terminale syndrome or cordtraction syndrome was first described by mckenzie kg in 1949, defined by garceau in 1953 3, and named tght. The emphasis on syndrome highlights a clinical diagnosis made by the synthesis of symptoms, neurologic exam signs, and laboratory tests such as urodynamics. Morphometric parameters and histological study of the filum. Wehby mc1, ohollaren ps, abtin k, hume jl, richards bj. A 49 yearoldman, whose presenting symptoms were low back pain and left leg weakness, was diagnosed as having a paraganglioma of the filum terminale. Lumbar stenosis multilevel spinal trauma including fractures15 herniated nucleus pulposus cause of 26% of cases of cauda equina syndrome 16, 17, 18 neoplasm, including metastases, astrocytoma, neurofibroma, and meningioma. Adult tethered cord syndrome atcs is a rare entity that usually presents with multiple neurological symptoms, including lower extremity pain, backache, lower extremity muscle weakness, and bowelbladder disturbances.
Filum terminale definition of filum terminale by medical. Yong rl, habrockbach t, vaughan m, kestle jr, steinbok p. A lipoma or fibrolipoma of the filum terminale is a somewhat uncommon 46% and usually incidental, asymptomatic finding on mris of the lumbar spine. Mri of conus medullaris, cauda equina, and filum terminale.
Spinal lipoma of the filum terminale lft is a congenital lumbosacral anomaly that can cause tethered cord syndrome. A family is described in which all 3 siblings manifested the syndrome of tight filum terminale in association with spina bifida occulta of the first sacral segment. In 1916, spiller 15, a neurologist, described two adolescent patients who presented with symptoms of tethered cord syndrome that developed subsequent to strenuous activity. Morphology and histology of filum terminale ft has a role in the pathophysiology of tethered cord syndrome tcs. All forms involve the pulling of the spinal cord at the base of the spinal canal, literally a tethered cord. Filum terminale lipoma ftl is known to cause various spinal symptoms collectively referred to as tethered cord syndrome tcs. Kesler at el5 reported that the conus virtually never ends below the mid l2 level. Filum terminale, tethered cord syndrome, ultrastructure introduction the filum terminale is a fibrous band, composed of two distinct segments intradural and extradural, that extends from the conus medul laris to the periosteum of the coccyx 1.
The filum terminale is an extension of the pia mater that is attached to the coccygeal segments. Filum terminale syndrome w tethered cord syndrome w. The histologic structure of the filum terminale is of neuroanatomic interest and clinical importance. On imaging, the entire length or a segment of the filum terminale. Fatty filum terminale, also known as lipoma of the filum terminale or filar lipoma, is a relatively common finding on imaging of the lumbar spine, and in most cases is an incidental finding of no clinical concern. Structure of the filum terminale archives of neurology. Subtle imaging findings in a case of tight filum terminale. This is also referred to as tethered cord syndrome with a tight filum terminale 1, 4 and has been reported only once previously in the veterinary literature.
Split cord malformations scms are rare congenital anomalies of the vertebrae and the spinal cord. Pdf the proposed normal function of the terminal filum of the spinal cord is to fixate. Filum terminale medical definition merriamwebster medical. Tethered cord syndrome tcs refers to a group of neurological disorders that relate to malformations of the spinal cord. Occult tight filum terminale syndrome is the clinical condition in which the symptoms of spinal cord traction occur in conjunction with nondiagnostic lumbosacral mri findings. Prompt surgical treatment is often necessary to avoid permanent sequelae. Tethered spinal cord syndrome causes, diagnosis and. Thick filum terminale, intraduralfilar lipoma, dorsal dermal sinus, lipomyelocele, lipomyelomeningocele, diastematomyelia. We describe two patients, probably the fifth and sixth ever reported. We report a 63yearold man with suddenonset severe right chest and upper back pain, followed by. The cordtraction this information is current as of october 5, 2007 reprints and permissions permissions link. This syndrome is closely associated with spina bifida. Histopathology of the filum terminale in children with and without tethered cord syndrome with attention to the elastic tissue within the filum.
The filum terminale is the result of the empty cover of the spine cord at the lower back or lumbosacral region. Management of tight filum terminale syndrome with special emphasis on normal level conus medullaris nlcm mehmet selc. Original article scanning electron microscopy sem study. They occur in 16% of the population and are usually an incidental finding 95% of those detected by mri are asymptomatic cools et al. Tight filum terminale syndrome, or tight filum syndrome, is a subtype of the tethered cord syndrome that is attributed to a thick, short, andor otherwise inelastic filum terminale rather than other tethering agents. In such cases, it is usually associated with a thickened filum and a lowlying conus. It is considered as one of the causes in tethered cord syndrome tcs.
The pdf of the article you requested follows this cover page. Tight filum terminale syndrome radiology reference article. In 21 patients 84%, the level of the tip of the conus was below the mid l2 vertebral body. Commonly, it is referred to as the tethered spinal cord, a clinical syndrome, recognized by specific imaging abnormalities low conus, thickened filum, spina bifida and coupled with symptoms produced through pathological traction of the lower cord. Jul 29, 2011 a section of the filum terminale sft is used for the surgical treatment of isolated tethered cord or that resulting from neurulation disorders. Ependymomas of the filum terminale eft form a specific and relatively uncommon subtype of spinal cord ependymomas. Intramedullary tumors of spinal cord and gliomas of intradural portion of filum terminale. We treated one case of filum terminale paraganglioma invading the lumbar body and the spinal dura. There were no related symptoms and no evidence of tethering. The filum terminale has often been overlooked in the literature due to its historical lack of research on its true morphology. Spinal dural arteriovenous fistula sdavf is the most common vascular malformation of the spine in adults.
During subsequent growth, traction on the spinal cord causes stretching and deformity of the cord. The content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. Spinal arteriovenous fistulas of the filum terminale. The tight filum terminale syndrome is characterized by a varying array of neurological, urological, andor orthopedic signs and symptoms. Request pdf millerdieker syndrome associated with tight filum terminale an 8yearold female was diagnosed with millerdieker syndrome with typical facial presentation. Fatty filum terminale is sometimes demonstrated on mri incidentally. An unusual presentation of adult tethered cord syndrome. Tight filum terminale syndrome radiology reference. The causes of the tethering were spinal lipomas 72%, tight. Mr images of four patients with a thickened filum terminale showing a fat signal are presented. Retethering of sectioned fibrolipomatous filum terminales. The indications for sectioning the filum terminale in this situation are not well characterized and remain controversial. A section of the filum terminale sft is used for the surgical treatment of isolated tethered cord or that resulting from neurulation disorders.
Modern metallic methods have been utilized in this study to demonstrate the cytologic structure of the filum and its transition to the conus medullaris. Morphometric parameters and histological study of the. A diagnosis of an occult filum terminale syndrome was made based on. Tight filum terminale syndrome neurosurgery oxford. Differentiating tethered cord syndrome, neurocraniovertebral syndrome, and filum disease. To improve the understanding in pathology and provide steady proof for diagnosis and treatment of tethered cord syndrome tcs, the ultrastructure of filum terminale ft with tcs will be. Millerdieker syndrome is characterized by type i lissencephaly, severe mental deficiency. Tight filum terminale syndrome is a complex of neurologic and orthopedic deformities associated with a short, thick filum terminale and low lying conus medullaris with variable clinical manifestations. Few congenital anomalies of the nervous system are amenable to surgical intervention. Even more controversial appears to be the use of sft in patients with chiari type i malformation cim, which is. Filum terminale definition of filum terminale by the free. Although an ftl may be associated with tethered cord syndrome tcs, in many cases ftls are diagnosed incidentally in patients without any symptoms of tcs.
Filum terminale paraganglioma with associated cyst. Filum terminale lipomas represent the most common intraspinal lipoma. Frontiers dynamic lumbosacral magnetic resonance imaging in. The entity of an occult tight filum terminale syndrome, characterized by clinical findings consistent with a tethered cord syndrome, but with the conus ending in a normal position, has been recognized recently. Ta a long connective tissue pia mater strand extending from the extremity of the medullary cone to the inner aspect of the spinal dural sac pial part of filum terminale ta, filum terminale internum. These attachments cause an abnormal stretching of the spinal cord. The literature yielded thirtytwo cases of paraganglioma in this site. Mar 01, 2006 read millerdieker syndrome associated with tight filum terminale, pediatric neurology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. We also performed research of the latest literature. In conclusion, avfs of the filum terminale, in general, are singlehole communications of 1 feeding artery that is a continuation of the anterior spinal artery and a single draining vein. Duration of horizontal decubitus after section of a tight.
Two boys, 14 and 18 years of age, presented with leg weakness and. Various forms include tight filum terminale, lipomeningomyelocele, split cord malformations diastematomyelia, dermal sinus tracts, and dermoids. Pdf cutting filum terminale is very important in split cord. Occult spinal dysraphism spinal lipoma fibrolipoma of the filum terminale intradural lipoma lipomyelocelelipomy elomeningocele. Termed caudal agenesis or dysgenesis, these congenital malformations in volve abnormal or incomplete formation of cau dal elements of the embryo. Its protean manifestations, diagnosis and treatment.
Tethered spinal cord syndrome is a neurologic disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. Fatty filum terminale on mri t iizuka citation t iizuka. Preoperative predictors for improvement after surgical. The thickened fatty filum terminale seemed to be a developmental anomaly and without clinical significance. Thirtytwo pediatric patients presenting with symptoms of urinary dysfunction, stool. Most series in the literature are small, spanning a large time period. Millerdieker syndrome associated with tight filum terminale. Up to date no consensus has been reached about the optimal treatment of these lesions. The filum terminale is a delicate strand of fibrous tissue, about 20 cm in length, proceeding downward from the apex of the conus medullaris. Wehby mc, ohollaren ps, abtin k, hume jl, richards bj. Pain, dysesthesias, neurogenic bladder and spasticity are the common clinical presentations of tethered cord and tight filum terminale.
Pdf we report a case of 56yearold patient suffering from myxopapillary ependymoma of filum terminale at the level of the fifth lumbar vertebra. Aug 18, 2017 however, in the majority of human patients, tethered cord syndrome is associated with an abnormal short, thickened, and inelastic filum terminale without other spinal malformations. Paragangliomas affecting the filum terminale are extremely rare, benign tumors. Regardless of the epidemiology, ces is a spinal emergency necessitating quick and effective care to mitigate permanent neurological sequelae. This research was implemented to investigate the morphometric parameters and histological structure of normal ft in adult human cadavers and magnetic resonance imaging mri scans to correlate them with the pathophysiology of tcs. Terminal filum definition of terminal filum by medical. Gross anatomy the filum terminale is continuous with the pia mater and is described as having two sections. Filum terminale lipomas ftls are being identified with increasing frequency due to the increasing utilization of mri. Tethered cord syndrome tcs is a condition where the spinal cord tissue attaches abnormally to the bones of the spine.
Annually, cauda equina syndrome ces is believed to newly affect between 1 person per 33,000 100,000. Paraganglioma of the filum terminale is a rare tumor, often disclosed by lumbago and sciatica that are sometimes complicated by cauda equina syndrome. Subtle imaging findings in a case of tight filum terminale syndrome. The filum terminale is a structure usually less than 2 mm in diameter. In sacrum vertebra, but its continuation, the filum terminale, can be traced through the sacrum to the first coccygeal vertebra. The proximal structure of the filum is similar to spi. Purposes of this study are to clarify preoperative characteristics of. Introduction to the tethered cord syndrome thieme medical. The first was a 33 yearold female who underwent surgical cord detethering. More recently, it has been proposed for the management of the occult tethered cord syndrome otcs, though it is still under debate. Introduction to the tethered cord syndrome shokei yamada 1 1 the word tether means to restrain, an example of which is an animal held to the maximal range of.
Tethered cord syndrome tcs represents a spectrum of congenital anomalies characterized by an abnormal caudal position and traction of the conus medullaris. However, the coincidence of tethered cord syndrome, lipoma, and sdavf on the sacral level is exceptionally rare. T2weighted mri hyperintense though not nearly as obvious clinical significance. The treatment of these conditions is neurosurgical. Historical aspects tulpuis in 1641 was the first to use the term spina bifida. Case report a case report of filum terminale paraganglioma. It is the simplest form of conditions causing tethered cord syndrome tcs and the filum terminale can be thickened, normally with lipomatous tissue1,3.
It gives longitudinal support to the spinal cord and consists of two parts. The clinical, histological and radiological characteristics of this case, that brings the. The filum terminale helps to anchor the spinal cord in place. The term tight filum terminale syndrome is synonymous with tethered cord syndrome secondary to a tight filum terminale. Minimally invasive surgical approach to filum sectioning.
Watch this 2minute neuroscience video to learn more about the exterior of the spinal cord and this video to learn more about the interior of the spinal cord. The treatment of a tethered spinal cord caused by a fibrolipomatous filum terminale is a straightforward procedure that achieves good results and minimal morbidity 7. In a similar way to scoliosis and chiari i syndromein the case of syringomyelia the sectioning of the filum terminale stops the disease. Spinal dysraphism dys bad, raphe seam nonspecific term for congenital abnormalities in the development of. Sem study on filum terminale with tethered cord syndrome. Ultrasound of the spine was performed and showed the conus medullaris at the l23 level. The upper part, or filum terminale internum, is about 15 cm long and reaches as far as the lower border of the second sacral vertebra. The filum terminale terminal thread is a delicate strand of fibrous tissue, about 20 cm in length, proceeding downward from the apex of the conus medullaris. With the increasing use of magn we use cookies to enhance your experience on our website.
This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Paraganglioma of the filum terminale mimicking neurinoma. Sep 27, 2018 spinal dural arteriovenous fistula sdavf is the most common vascular malformation of the spine in adults. The fatty filum involves fatty infiltration of the whole length or of part of the filum terminale. Mri of conus medullaris, cauda equina, and filum terminale lesions rami eldaya, md, mba, omar eissa, md, gabriel calles, md, jorge leediaz, md, and tomas uribe, md after participating in this educational activity, the radiologist should be better able to diagnose conus medullaris, cauda equina, and. Filum disease fd is the congenital form of ncvs or when the cause of the cord traction can be due to a congenital anomaly of an apparently normal filum terminale, without that any anomalies of the ligament or of other conventional neurovertebral malformations can be seen on the neuroimaging. Symptomatic retethering of the spinal cord after section of a tight filum terminale. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease. Pdf pathophysiology and clinical features of tethered cord.
Abnormal secondary neurulation can lead to a variety of other complex spinal dysraphisms in the caudal region. Fibrolipoma of the filum terminale the pain source. However, in some patients it may be associated with signs and symptoms of tethered cord syndrome. Filum terminale fibrolipoma benign, congenital, asymptomatic fat within otherwise normalappearing filum terminale incidental finding found in 46% of autopsy patients no significant epidemiological differences key is to assess if conus is normal in position. It is possible that the fistula affected perfusion of the filum terminale, interrupting normal function as in the tight filum terminale syndrome. In a small number of cases such anatomic malformations are compatible with normal or near normal function until changes in growth produce locomotive or sphincteric disturbances or both. The indications for sectioning the filum terminale in this situation are not well characterized and are controversial. The most common causes of cauda equina and conus medullaris syndromes are the following. Following a detailed diagnostic assessment and the latter application of the minimally invasive surgical sectioning of the filum terminale, the cause for the disease is eliminated, which on top of eliminating the diseases cause and halting its progression does not have any harmful collateral. Frontiers coincidence of tethered cord, filum terminale. It is only recently that the true anatomy and pathological involvement of the filum terminale in the tethered cord syndrome have been elucidated. The upper part, or filum terminale internum, is about 15 cm long and reaches as far as the lower border of the.
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