Surgical outcomes by sectioning a filum terminale in patients with terminal syringomyelia
Surgical outcomes by sectioning a filum terminale in patients with terminal syringomyelia
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DOI：
10.1007/s00381-020-04615-5
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发表时间：
2020-04-21
影响因子：
1.4
通讯作者：
Ogiwara, Hideki
中科院分区：
文献类型：
--
作者：
Ishisaka, Eitaro;Usami, Kenichi;Ogiwara, Hideki
背景 尽管终末期脊髓空洞症提示脊髓栓系，但当没有相关异常或仅有轻微相关异常时，手术指征尚未达成共识。我们分析了终末脊髓空洞症患者终丝切断的手术结果，以阐明解绑手术的意义。方法 回顾性分析2007年至2018年接受终丝切断松解术的57例终末脊髓空洞症患儿。评估症状和 MRI 结果的术后结果。结果 57 名患者中，40 名患有其他可能导致脊髓栓系的相关异常（25 名患有丝状脂肪瘤，29 名患有低位髓圆锥）。十九名患者出现症状。手术时的平均年龄为 18 个月（3-96 个月）。平均随访期为 3.3 年（1-9 年）。 9 名患者 (47%) 手术后术前症状有所改善。手术后 1 年，19 名患者 (33%) 的脊髓空洞尺寸减小，4 名患者 (8%) 的脊髓空洞尺寸增大，34 名患者 (69%) 的脊髓空洞尺寸没有变化。在随访超过 3 年的 28 名患者中，17 名（61%）患者尺寸减小，1 名（4%）患者尺寸增大，10 名（35%）患者尺寸没有变化。结论 当通过切断终丝进行松解时，从长远来看，超过一半的患者的终末脊髓空洞尺寸有所减小。终丝切片证明了终末脊髓空洞症患者放射学和临床改善的可能性。
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.