Skip to main content
SpringerLink
Log in

Retained medullary cord confirmed by intraoperative neurophysiological mapping

  • Case Report
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Introduction

A retained medullary cord (RMC) is a rare dysraphic malformation, recently described as a late arrest of secondary neurulation. RMC is also a severely tethering lesion. The critical role of intraoperative neurophysiology to safely manage a RMC has been only anecdotally reported.

Case report

We describe the case of a RMC in a 1.5-year-old child with Currarino syndrome. At surgery, an apparently normal-looking spinal cord, stretched and tethered by a lipoma to the level of S2-S3, was observed. The border between the functional conus and the non functional RMC was defined through neurophysiological mapping. The cord was sharply interrupted at this level and untethered. A specimen was sent for pathology, which confirmed the presence of glial and neural elements. The post-operative neurological exam was normal.

Conclusion

Neurosurgical procedure for RMC should only be rendered with intraoperative neurophysiological mapping, as the anatomical judgment would not suffice to allow a safe cutting of these “normal-looking” neural structures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

RMC:

Retained medullary cord

ION:

Intraoperative neurophysiology

SEPs:

Somatosensory-evoked potentials

mMEPs:

Muscle motor-evoked potentials

BCR:

Bulbocavernosus reflex

CMAPs:

Compound muscle action potentials

References

  1. Deletis V, Vodusek DB (1997) Intraoperative recording of the bulbocavernous reflex. Neurosurgery 40:88–93

    CAS  PubMed  Google Scholar 

  2. Hoving EW, Haitsma E, Oude Ophuis CM, Journée HL (2010) The value of intraoperative neurophysiological monitoring in tethered cord surgery. Childs Nerv Syst 27:1445–1452

    Article  Google Scholar 

  3. James HE, Mulcahy JJ, Walsh JW, Kaplan GW (1979) Use of anal sphincter electromyography during operations on the conus medullaris and sacral nerve roots. Neurosurgery 4:521–523

    Article  CAS  PubMed  Google Scholar 

  4. Kothbauer KF, Deletis V (2010) Intraoperative neurophysiology of the conus medullaris and cauda equina. Childs Nerv Syst 26:247–253

    Article  PubMed  Google Scholar 

  5. Krassioukov AV, Sarjeant R, Arkia H, Fehlings MG (2004) Multimodality intraoperative monitoring during complex lumbosacral procedures: indications, techniques, and long-term follow-up review of 61 consecutive cases. J Neurosurg Spine 1:243–253

    Article  PubMed  Google Scholar 

  6. Krieger D, Sclabassi RJ (1995) Neurophysiologic assessment in the management of spinal dysraphism. Neurosurg Clin N Am 6:219–230

    CAS  PubMed  Google Scholar 

  7. Kumar GS, Rajshekhar V, Babu KS (2006) Intraoperative mapping of sacral nervous system (S2-4). Br J Neurosurg 20:396–402

    Article  PubMed  Google Scholar 

  8. Legatt AD, Schroeder CE, Gill B, Goodrich JT (1992) Electrical stimulation and multichannel EMG recording for identification of functional neural tissue during cauda equina surgery. Childs Nerv Syst 8:185–189

    Article  CAS  PubMed  Google Scholar 

  9. Pang D, Zovickian J, Oviedo A (2009) Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode: part I-surgical technique. Neurosurgery 65:511–528, discussion 528-9

    Article  PubMed  Google Scholar 

  10. Pang D, Zovickian J, Moes GS (2011) Retained medullary cord in humans: late arrest of secondary neurulation. Neurosurgery 68:1500–1519, discussion 1519

    Article  PubMed  Google Scholar 

  11. Pouratian N, Elias WJ, Jane JA Jr, Phillips LH 2nd, Jane JA Sr (2010) Electrophysiologically guided untethering of secondary tethered spinal cord syndrome. Neurosurg Focus 29:E3

    Article  PubMed  Google Scholar 

  12. Rodi Z, Vodusek DB (2001) Intraoperative monitoring of the bulbocavernosus reflex: the method and its problems. Clin Neurophysiol 112:879–883

    Article  CAS  PubMed  Google Scholar 

  13. Sala F, Krzan MJ, Deletis V (2002) Intraoperative neurophysiological monitoring in pediatric neurosurgery: why, when, how? Childs Nerv Syst 18:264–287

    Article  PubMed  Google Scholar 

  14. von Koch CS, Quinones-Hinojosa A, Gulati M, Lyon R, Peacock WJ, Yingling CD (2002) Clinical outcome in children undergoing tethered cord release utilizing intraoperative neurophysiological monitoring. Pediatr Neurosurg 37:81–86

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Neurosurgery, Pediatric Neurosurgery, University Hospital, Piazzale Stefani 1, 37124, Verona, Italy

    Francesco Sala, Giovanni Barone & Pasquale Gallo

  2. Division of Neurology, University Hospital, Verona, Italy

    Vincenzo Tramontano

  3. Division of Pathology, University Hospital, Verona, Italy

    Claudio Ghimenton

Authors
  1. Francesco Sala
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Barone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vincenzo Tramontano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pasquale Gallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claudio Ghimenton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Sala.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sala, F., Barone, G., Tramontano, V. et al. Retained medullary cord confirmed by intraoperative neurophysiological mapping. Childs Nerv Syst 30, 1287–1291 (2014). https://doi.org/10.1007/s00381-014-2372-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-014-2372-0

Keywords

Search

Navigation