Skip to main content

Advertisement

SpringerLink
Log in

Surgical outcomes by sectioning a filum terminale in patients with terminal syringomyelia

  • Original Article
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Background

Although terminal syringomyelia suggests a tethered spinal cord, a consensus has still not been established for surgical indications, when there are no associated abnormalities or only minor associated abnormalities. We analyzed surgical outcomes of sectioning a filum terminale in patients with terminal syringomyelia to elucidate the significance of untethering surgery.

Methods

Fifty-seven pediatric patients with terminal syringomyelia who underwent untethering via sectioning the filum terminale between 2007 and 2018 were retrospectively analyzed. Postoperative outcomes of symptoms and MRI findings were evaluated.

Results

Of 57 patients, 40 had other associated abnormalities (25 with filar lipoma and 29 with low conus medullaris) that could be responsible for tethered cord. Nineteen patients had symptoms. The mean age at the time of surgery was 18 months (3–96 months). The mean follow-up period was 3.3 years (1–9 years). Preoperative symptoms improved in 9 patients (47%) after surgery. At 1 year after the surgery, the size of syringomyelia decreased in 19 (33%), increased in 4 (8%), and did not change in 34 (69%) patients. Of 28 patients who were followed up for more than 3 years, the size decreased in 17 (61%), increased in 1 (4%), and did not change in 10 (35%).

Conclusion

When untethering was performed by sectioning a filum terminale, the size of terminal syringomyelia decreased in more than half of patients in the long term. Sectioning the filum terminale demonstrated the possibility of radiological and clinical improvement in patients with terminal syringomyelia.

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

Similar content being viewed by others

References

  1. Batzdorf U (2000) Primary spinal syringomyelia: a personal perspective. Neurosurg Focus 8:3E7

    Article  Google Scholar 

  2. Blegvad C, Grotenhuis JA, Juhler M (2014) Syringomyelia: a practical, clinical concept for classification. Acta Neurochir 156(11):2127–2138

    Article  CAS  PubMed  Google Scholar 

  3. Coleman LT, Zimmerman RA, Rorke LB (1995) Ventriculus terminalis of the conus medullaris: MR findings in children. AJNR Am J Neuroradiol 16:1421–1426

    CAS  PubMed  PubMed Central  Google Scholar 

  4. du Boulay G, Shah SH, Currie JC, Logue V (1974) The mechanism of hydromyelia in Chiari type 1 malformations. Br J Radiol 47:579–587

    Article  PubMed  Google Scholar 

  5. Gardner WJ, Angel J (1958) The cause of syringomyelia and its surgical treatment. Cleve Clin Q 25:4–8

    Article  CAS  PubMed  Google Scholar 

  6. Klekamp J (2002) The pathophysiology of syringomyelia—historical overview and current concept. Acta Neurochir 144:649–664

    Article  CAS  PubMed  Google Scholar 

  7. Koyanagi I, Houkin K (2010) Pathogenesis of syringomyelia associated with Chiari type 1 malformation: review of evidences and proposal of a new hypothesis. Neurosurg Rev 33:271–284 discussion 284–275

    Article  PubMed  Google Scholar 

  8. Kulwin CG, Patel NB, Ackerman LL, Smith JL, Boaz JC, Fulkerson DH (2013) Radiographic and clinical outcome of syringomyelia in patients treated for tethered cord syndrome without other significant imaging abnormalities. J Neurosurg Pediatr 11(3):307–312

    Article  PubMed  Google Scholar 

  9. Levine DN (2004) The pathogenesis of syringomyelia associated with lesions at the foramen magnum: a critical review of existing theories and proposal of a new hypothesis. J Neurol Sci 220:3–21

    Article  PubMed  Google Scholar 

  10. Magge SN, Smyth MD, Governale LS et al (2011) Idiopathic syrinx in the pediatric population: a combined center experience clinical article. J Neurosurg Pediatr 7:30–36

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neurosurgery, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan

    Eitaro Ishisaka, Kenichi Usami & Hideki Ogiwara

Authors
  1. Eitaro Ishisaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenichi Usami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hideki Ogiwara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideki Ogiwara.

Ethics declarations

After the study was approved by the institutional review board, we conducted a retrospective review of all patients with terminal syringomyelia who underwent untethering via sectioning of the filum terminale at the National Center for Child Health and Development between January 2007 and June 2018.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ishisaka, E., Usami, K. & Ogiwara, H. Surgical outcomes by sectioning a filum terminale in patients with terminal syringomyelia. Childs Nerv Syst 36, 3035–3039 (2020). https://doi.org/10.1007/s00381-020-04615-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-020-04615-5

Keywords

Search

Navigation