Surgical histopathology of a filar anomaly as an additional tethering element associated with closed spinal dysraphism of primary neurulation failure

Surgical Neurology International - Tập 12 - Trang 373
Takato Morioka1,2, Nobuya Murakami1, Satoshi Suzuki3, Nobutaka Mukae4, Takafumi Shimogawa5, Ai Kurogi1, Tadahisa Shono2, Masahiro Mizoguchi4
1Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan
2Department of Neurosurgery, Harasanshin Hospital, Karatsu, Saga,
3Department of Psychiatry, Shourai Hospital, Karatsu, Saga,
4Department of Neurosurgery, Graduate School of Medical Sciences, Fukuoka, Japan.
5Department of Neurosurgery, Kyushu University, Fukuoka, Fukuoka, Japan.

Tóm tắt

Background: Closed spinal dysraphism of primary neurulation failure could be associated with filar anomalies, such as filar lipoma or thickened and tight filum terminale (TFT), resulting from impaired secondary neurulation. Retained medullary cord (RMC) is a remnant of the cavitary medullary cord originating from the secondary neurulation failure. Some filar lipomas are known to contain a central canal-like ependyma-lined lumen with surrounding neuroglial tissues (E-LC w/NGT), that is, a characteristic histopathology of RMC. To clarify the embryological background of these filar anomalies, we evaluated the histopathological findings. Methods: Among 41 patients with lesions of primary neurulation failure who underwent initial untethering surgery, the filum including cord-like structure (C-LS) was additionally resected in 10 patients (five dorsal and transitional lipomas; five limited dorsal myeloschisis). We retrospectively analyzed the clinical, neuroradiological, intraoperative, and histopathological findings. Results: Among 10 patients, two patients were diagnosed with RMC based on morphological features and intraoperative neurophysiological monitoring. The diagnosis of filar lipoma was made in six patients, since various amounts of fibroadipose tissue were histopathologically noted in the filum. Two patients were diagnosed with TFT, since the filum was composed solely of fibrocollagenous tissue. E-LC w/NGT was noted not only in both C-LSs of RMCs but also in two out of six fila both with filar lipomas and fila with TFTs. Conclusion: These findings provide further evidence for the idea that entities, such as filar lipoma, TFT, and RMC, can be considered consequences of a continuum of regression failure occurring during late secondary neurulation.

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Tài liệu tham khảo

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Surgical Neurology International

Tập 12

373

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