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The effect of filum terminale sectioning for Chiari 1 malformation treatment: systematic review

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Abstract

Purpose

Symptomatic Chiari type I malformation (CM) is treated with posterior fossa decompression with/ without duroplasty. Few authors suggested cerebellar tonsil caudal migration due to a supposed “caudal traction” of cranial nerve structures in a so-called occult tethered cord syndrome. For these authors, filum terminale (FT) sectioning may improve CM symptoms. The objective of this review is to evaluate the effect of FT sectioning on the treatment of CM.

Methods

Using the PRISMA guidelines for systematic reviews, we reviewed studies to evaluate patient’s outcomes with CM who underwent FT sectioning. The MINORS instrument was used for methodological quality assessment. The included studies’ levels of evidence (LOE) were classified according to the Oxford Centre of Evidence-Based Medicine.

Results

Two studies from the same group of authors were included. We cannot assure if the cited cases in the first study were also included in their latter published study. The described results suggest that outcomes were not collected in a standardized fashion. Outcomes are described vaguely as a percentage of improvement. Case series samples were small and included not only patients with CM but also patients with scoliosis and syringomyelia. The MINORS score reported that both studies had low methodological quality. Both included studies were classified as level 4 of evidence.

Conclusion

There is no scientific support for filum terminale sectioning in patients with CM without evidence of tethered cord. This procedure may be considered experimental and should be validated in a strict criterion of inclusion clinical trial comparing outcomes in posterior fossa decompression.

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Abbreviations

MINORS:

Methodological index analysis for non-randomized studies

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

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Author information

Authors and Affiliations

  1. Neurological Institute of Curitiba, Curitiba, PR, Brazil

    Jerônimo Buzetti Milano

  2. Federal University of Paraíba (UFPB), João Pessoa, PB, Brazil

    Alécio Cristino Evangelista Santos Barcelos

  3. Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil

    Franz Jooji Onishi

  4. Santa Casa de São Paulo, São Paulo, SP, Brazil

    Jefferson Walter Daniel

  5. Hospital do Servidor Público Estadual, São Paulo, SP, Brazil

    Ricardo Vieira Botelho & Eduardo de Freitas Bertolini

  6. Hospital Biocor – Belo Horizonte-MG, and Post-Graduation Program, Hospital do Servidor Público Estadual, São Paulo, SP, Brazil

    Fernando Rolemberg Dantas

  7. University of São Paulo (USP), São Paulo, SP, Brazil

    Eloy Rusafa Neto & Roger S. Brock

  8. Hospital São Camilo de Itu-SP, Itu, SP, Brazil

    Marcelo Luís Mudo

  9. University of São Paulo (USP), Ribeirão Preto, SP, Brazil

    Ricardo Santos de Oliveira

  10. Department of Neurology, State University of Campinas (UNICAMP), Campinas, SP, Brazil

    Andrei Fernandes Joaquim

Authors
  1. Jerônimo Buzetti Milano
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  2. Alécio Cristino Evangelista Santos Barcelos
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  12. Andrei Fernandes Joaquim
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Correspondence to Ricardo Vieira Botelho or Andrei Fernandes Joaquim.

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Milano, J.B., Barcelos, A.C.E.S., Onishi, F.J. et al. The effect of filum terminale sectioning for Chiari 1 malformation treatment: systematic review. Neurol Sci 41, 249–256 (2020). https://doi.org/10.1007/s10072-019-04056-2

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  • DOI: https://doi.org/10.1007/s10072-019-04056-2

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