Clinical characteristics and surgical outcome in 25 cases of childhood tight filum syndrome

Cornips, Erwin M. J.; Vereijken, Ilse M.P.; Beuls, E. A. M.; Weber, Jacobiene W.; Soudant, Dan; Rhijn, Lodewijk W. van; Callewaert, P.; Vles, Johan S.H.

doi:10.1016/j.ejpn.2011.07.002

Cited by 22 publications

(20 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The untethering of a tight filum not only for symptomatic patients but also for asymptomatic patients has been reported to prevent future neurological deficit, but a low complication rate is required to justify the prophylactic surgeries. [1][2][3][4][5]7,[9][10][11][12] Leakage of CSF can be a serious complication of untethering, after which poor wound healing, wound dehiscence, and meningitis potentially ensue. To prevent a CSF leak, patients are generally kept lying flat in the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Duration of the horizontal decubitus position for prevention of cerebrospinal fluid leakage following transection of a tight filum terminale

Ogiwara¹,

Joko²,

Takado³

et al. 2015

PED

View full text Add to dashboard Cite

OBJECT The untethering of a tethered spinal cord in patients with a tight filum terminale is a relatively simple procedure that can prevent or improve neurological symptoms. Postoperatively, patients are usually kept in the horizontal decubitus position to prevent a CSF leak. However, the optimal period for keeping patients flat has not been determined yet. The authors compared 2 cohorts with different periods of horizontal decubitus; one with 72 hours and the other with 8 days. METHODS The authors retrospectively analyzed surgical results in 2 cohorts of pediatric patients who had tethered spinal cord with a tight filum terminale. One cohort was maintained flat for 8 days and the other cohort for 72 hours postoperatively. The patients' charts were reviewed for demographic data, clinical presentation, surgical therapy, and clinical course. RESULTS Three hundred fifty-four patients underwent sectioning of a tight filum terminale. Of those, 238 were kept lying flat for 8 days postoperatively, and 116 were maintained flat for 72 hours. Magnetic resonance imaging was performed 1 to 2 weeks after the surgery. None of the patients in either cohort developed a CSF leak. Pseudomeningocele, which was confirmed by MRI, developed in 1 patient who had been kept flat for 8 days. The occurrence rates of a CSF leak and pseudomeningocele were not significantly different in either cohort. CONCLUSIONS Keeping patients flat for longer than 72 hours did not change the rate of postoperative CSF leakage or pseudomeningocele. Seventy-two hours or less would be an appropriate period for maintaining patients flat after transection of a tight filum terminale.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Complication rates are generally not very high, ranging from 0% to 13.2%. [1][2][3][4][5][6][7][9][10][11][12] In those complications associated with untethering of a tight filum terminale, CSF leakage can be serious, and meningitis can ensue. The occurrence rates of CSF leakage have been reported as up to 8%.…”

mentioning

confidence: 99%

Duration of the horizontal decubitus position for prevention of cerebrospinal fluid leakage following transection of a tight filum terminale

Ogiwara¹,

Joko²,

Takado³

et al. 2015

PED

View full text Add to dashboard Cite

show abstract

“…The rates of complications of this surgery have been reported to range from 0% to 13.2%. [1][2][3][4][5][6][7][8][9][10][11] A relatively serious complication of untethering surgery of a tight filum terminale is cerebrospinal fluid (CSF) leakage, which can be associated with meningitis. The rates of CSF leakage range from 0% to 8%.…”

Section: Introductionmentioning

confidence: 99%

Is the Postoperative Horizontal Decubitus Position Following Transection of a Tight Filum Terminale in Pediatric Patients Necessary? – A Retrospective Cohort Study

Kanematsu

Hirokawa

Usami

et al. 2020

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

After untethering surgery of a tethered spinal cord of a tight filum terminale, patients are usually kept in the horizontal decubitus position to prevent cerebrospinal fluid (CSF) leakage. However, the optimal period for keeping these patients in this position has not been established yet. Surgical results in two groups of pediatric patients with a tight filum terminale were retrospectively analyzed. Group A was maintained in the horizontal decubitus position for 72 h and group B was managed without being kept in this position postoperatively. A total of 313 patients underwent sectioning of a tight filum terminale. Of these patients, 144 were maintained horizontally for 72 h postoperatively (group A) and 169 were managed without this position (group B). Among the patients who were maintained horizontally for 72 h, one (0.7%) developed pseudomeningocele. No patients experienced CSF leakage in this group. Among the patients who were not horizontal, one (0.6%) developed CSF leakage and one (0.6%) developed pseudomeningocele. Maintaining patients without restriction of their position does not appear to change the rate of postoperative CSF leakage or pseudomeningocele. This suggests that maintaining patients horizontally after transection of a tight filum terminale is not necessary for preventing CSF leakage.

show abstract

“…22 A recent case series of FTL sectioning identified complication rates as high as 12%, including wound infections, CSF leaks, pseudomeningocele, and meningitis. 2,6,7,19,34 Although retethering following sectioning of an FTL was considered rare in the past, 6,16 recent series with longer follow-up periods have found retethering rates between 2.7% and 8.6%. Retethering occurs both in symptomatic patients and in those who underwent prophylactic sectioning of the filum.…”

Section: 23mentioning

confidence: 99%

“…Retethering occurs both in symptomatic patients and in those who underwent prophylactic sectioning of the filum. 7,18,19,24,26,34 While these studies address the outcomes for asymptomatic patients undergoing surgical untethering, they do not address the natural history for asymptomatic patients with FTLs who do not undergo surgical untethering. We believe that the natural history of an FTL, as well as its prevalence in those undergoing imaging, does not justify prophylactic surgery in most asymptomatic cases.…”

Section: 23mentioning

confidence: 99%

Filum terminale lipomas: imaging prevalence, natural history, and conus position

Cools¹,

Al-Holou²,

Stetler³

et al. 2014

PED

View full text Add to dashboard Cite

Object Filum terminale lipomas (FTLs) are being identified with increasing frequency due to the increasing utilization of MRI. Although an FTL may be associated with tethered cord syndrome (TCS), in many cases FTLs are diagnosed incidentally in patients without any symptoms of TCS. The natural history of FTLs is not well defined. Methods The authors searched the clinical and imaging records at a single institution over a 14-year interval to identify patients with FTLs. For patients with an FTL, the clinical records were reviewed for indication for imaging, presenting symptoms, perceived need for surgery, and clinical outcome. A natural history analysis was performed using all patients with more than 6 months of clinical follow-up. Results A total of 436 patients with FTL were identified. There were 217 males and 219 females. Of these patients, 282 (65%) were adults and 154 (35%) were children. Symptoms of TCS were present in 22 patients (5%). Fifty-two patients underwent surgery for FTL (12%). Sixty-four patients (15%) had a low-lying conus and 21 (5%) had a syrinx. The natural history analysis included 249 patients with a mean follow-up time of 3.5 years. In the follow-up period, only 1 patient developed new symptoms. Conclusions Filum terminale lipomas are a common incidental finding on spinal MRI, and most patients present without associated symptoms. The untreated natural history is generally benign for asymptomatic patients.

show abstract

Clinical characteristics and surgical outcome in 25 cases of childhood tight filum syndrome

Cited by 22 publications

References 37 publications

Duration of the horizontal decubitus position for prevention of cerebrospinal fluid leakage following transection of a tight filum terminale

Duration of the horizontal decubitus position for prevention of cerebrospinal fluid leakage following transection of a tight filum terminale

Is the Postoperative Horizontal Decubitus Position Following Transection of a Tight Filum Terminale in Pediatric Patients Necessary? – A Retrospective Cohort Study

Filum terminale lipomas: imaging prevalence, natural history, and conus position

Contact Info

Product

Resources

About