Two cases of retained medullary cord running parallel to a terminal lipoma

Surgical Neurology International - Tập 12 - Trang 112
Ai Kurogi1, Nobuya Murakami1, Takato Morioka2, Nobutaka Mukae3, Takafumi Shimogawa3, Kyoko Kudo4, Satoshi Suzuki5, Masahiro Mizoguchi3
1Department of Neurosurgery, Fukuoka Children’s Hospital, Saga, Japan.
2Department of Neurosurgery, Harasanshin Hospital, Saga, Japan.
3Department of Neurosurgery, Kyushu University, Saga, Japan.
4Department of Dermatology, Fukuoka Children’s Hospital, Saga, Japan.
5Department of Psychiatry, Shourai Hospital, Saga, Japan.

Tóm tắt

Background:

Retained medullary cord (RMC) is a newly defined entity believed to originate from the late arrest of secondary neurulation. Some RMCs contain varying amounts of lipomatous tissues, which need to be differentiated from spinal lipomas, such as filar and caudal lipomas (terminal lipomas).

Case Description:

We surgically treated two patients with a nonfunctional cord-like structure (C-LS) that was continuous from the cord and extended to the dural cul-de-sac, and ran parallel to the terminal lipoma. In both cases, untethering surgery was performed by resecting the C-LS with lipoma as a column, under intraoperative neurophysiological monitoring. Histopathological examination confirmed that the central canal-like ependyma-lined lumen with surrounding neuroglial and fibrocollagenous tissues, which is the central histopathological feature of an RMC, was located on the unilateral side of the resected column, while the fibroadipose tissues of the lipoma were located on the contralateral side.

Conclusion:

Our findings support the idea proposed by Pang et al. that entities such as RMC and terminal lipomas are members of a continuum of regression failure occurring during late secondary neurulation, and the coexistence of RMC and terminal lipoma is not a surprising finding. Therefore, it may be difficult in clinical practice to make a distinct diagnosis between these two entities.

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Tài liệu tham khảo

Kim, 2020, Secondary neurulation defects-1: Retained medullary cord, J Korean Neurosurg Soc, 63, 314, 10.3340/jkns.2020.0052

Morioka, 2007, Dynamic morphological changes in lumbosacral lipoma during the first months of life revealed by constructive interference in steady-state (CISS) MR imaging, Child Nerve Syst, 23, 415, 10.1007/s00381-006-0272-7

Morioka, 2020, Retained medullary cord with sacral subcutaneous meningocele and congenital dermal sinus, Childs Nerv Syst, 36, 423, 10.1007/s00381-019-04301-1

Morota, 2017, New classification of spinal lipomas based on embryonic stage, J Neurosurg Pediatr, 19, 428, 10.3171/2016.10.PEDS16247

Mukae, 2020, Two cases of large filar cyst associated with terminal lipoma: Relationship with retained medullary cord, World Neurosurg, 142, 294, 10.1016/j.wneu.2020.07.026

Murakami, 2018, Retained medullary cord extending to a sacral subcutaneous meningocele, Childs Nerv Syst, 34, 527, 10.1007/s00381-017-3644-2

Murakami, 2018, Ependyma-lined canal with surrounding neuroglial tissues in lumbosacral lipomatous malformations: Relationship with retained medullary cord, Pediatr Neurosurg, 53, 387, 10.1159/000494029

Pang, 2020, Secondary neurulation defects-1: Thickened filum terminale, retained medullary cord, Textbook of Pediatric Neurosurgery, 1st ed, 10.1007/978-3-319-72168-2_112

Pang, 2011, Retained medullary cord in humans: Late arrest of secondary neurulation, Neurosurgery, 68, 1500, 10.1227/NEU.0b013e31820ee282

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Shirozu, 2018, Enlargement of sacral subcutaneous meningocele associated with retained medullary cord, Childs Nerv Syst, 34, 1785, 10.1007/s00381-018-3812-z

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Surgical Neurology International

Tập 12

112

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