The effect of filum terminale sectioning for Chiari 1 malformation treatment: systematic review

Milano, Jerônimo Buzetti; Barcelos, Alécio Cristino Evangelista Santos; Onishi, Franz Jooji; Daniel, Jefferson Walter; Botelho, Ricardo Vieira; Dantas, François; Neto, Eloy Rusafa; Mudo, Marcelo Luís; Brock, Roger Schmidt; Oliveira, Ricardo Santos de; Joaquim, Andrei Fernandes

doi:10.1007/s10072-019-04056-2

Cited by 15 publications

(5 citation statements)

References 31 publications

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“…We found strong consensus on this topic: (1) the association between CM1 and the “true” or “manifest” tethered cord is universally found to be very rare and occasional [ 53 ]; (2) in those rare instances where a tethered cord syndrome is present in CM1 subjects, a de-tethering procedure is successfully performed to cure the syndrome but does not produce effects on the CM1 [ 54 ]; (3) the occult tethered cord syndrome remains a controversial and questionable entity [ 55 ] and more than 80% of panelists questioned its existence; (4) in case of symptomatic tethered cord, an intradural section of the filum terminale is recommended. The patient and his/her family should be aware that this operation is not addressing the associated CM1 [ 56 , 57 ]; (5) the international experts were not aware of any evidence to support the use of the extradural section of the filum for either tethered cord syndrome or CM1.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document

et al. 2021

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Background Chiari malformation type 1 (CM1) is a rare condition where agreed classification and treatment are still missing. The goal of this study is to achieve a consensus on the diagnosis and treatment of CM1 in children. Methods A multidisciplinary panel formulated 57 provisional statements based on a review of the literature. Thirty-four international experts (IE) participated in a Delphi study by independently rating each statement on a 4-point Likert scale (“strongly disagree,” “disagree,” “agree,” “strongly agree”). Statements that were endorsed (“agree” or “strongly agree”) by < 75% of raters were re-formulated, or new statements were added, and another Delphi round followed (up to a maximum of three). Results Thirty-five IE were contacted and 34 agreed to participate. A consensus was reached on 30/57 statements (52.6%) after round 1. Three statements were added, and one removed. After round 2, agreement was reached on 56/59 statements (94.9%). Finally, after round 3, which took place during the 2019 Chiari Consensus Conference (Milan, Italy), agreement was reached on 58/59 statements (98.3%) about four main sections (Definition and Classification, Planning, Surgery, Isolated Syringomyelia). Only one statement did not gain a consensus, which is the “definition of radiological failure 24 month post-surgery.” Conclusions The consensus document consists of 58 statements (24 on diagnosis, 34 on treatment), serving clinicians and researchers following children with CM1. There is a clear need for establishing an international network and registry and to promote collaborative studies to increase the evidence base and optimize the long-term care of this patient population.

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Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document

et al. 2021

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“…The co-morbid relationship between EDS and TCS remains ill-defined. TCS has been reported in patients with Chiari malformations type I (CM-I) [9,[19][20]. In a large study of 2,813 subjects with CM-I, 357 (12.7%) were diagnosed with hereditary disorders of connective tissue (HDCT), predominantly hEDS [21].…”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Outcomes Following Sectioning of the Filum Terminale for Treatment of Tethered Cord Syndrome Associated With Ehlers-Danlos Syndrome

Zingman¹,

Tuchman²,

Henderson³

et al. 2022

Cureus

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IntroductionTethered cord syndrome (TCS) was first reported as a potential complication of Ehlers-Danlos Syndrome in 2009. However, there have been few publications on the subject since that time, and optimal treatment of TCS in the setting of the hypermobile Ehlers-Danlos Syndrome (hEDS) population remains unknown. The purpose of this study was to determine the safety and efficacy of surgical release of the filum terminale (FT) for the treatment of TCS in this patient population. MethodsWe performed a retrospective chart review of consecutive hEDS patients with TCS who were treated with surgical release after providing informed surgical consent over a 4.5-year period by a single neurosurgeon. Eighty-four patients were identified and asked to complete surveys with items regarding pre and postoperative symptoms, pain levels, and satisfaction. ResultsThirty patients with a mean age of 30.8 ± 11.9 years, all female, were included. Low back pain was significantly improved across the entire cohort. For patients with both pre and postoperative data available, the distance they were able to walk also improved significantly. The majority of patients were "highly satisfied" with surgery (66%), followed by 21% "satisfied", 10% "neutral", and one patient who was "dissatisfied". One patient required repair of a dural leak one week postoperatively, and no other complications were noted. ConclusionsSurgical release of the FT for TCS in patients with hEDS was safe and effective in this cohort. For most patients, there was a significant improvement in low back pain, urinary symptoms, and ability to ambulate distance. The majority of respondents reported subjective satisfaction with this operation. A further prospective study is warranted.

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“…Finally, the literature includes few, and poorly documented, references that support the efficacy of filum terminale sectioning. A recent systematic review found only two published series of EDS-FT, both from the same group, and concluded that this procedure has no scientific support in CM-1 patients without evidence of tethered cord [55].…”

Section: Group 2a (Patients Previously Undergoing Section Of the Filu...mentioning

confidence: 99%

Reoperation in Chiari-1 Malformations

Talamonti

Picano

Fragale

et al. 2023

JCM

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(1) Background: The issue of unsuccessful surgery for Chiari-1 malformation (CM-1), as well as its potential causes and possible solutions, remains poorly documented and studied. (2) Methods: From a retrospective review of a personal series of 98 patients undergoing treatment for CM-1 during the past 10 years, we created two study groups. Group 1: 8 patients (8.1%) requiring additional surgeries owing to postoperative complications (7 cerebrospinal fluid leakage, 1 extradural hematoma); 7 patients (7.1%) undergoing reoperations for failed decompression during the follow-up. Group 2: During the same period, we also managed 19 patients who had previously been operated on elsewhere: 8 patients who required adequate CM-1 treatment following extradural section of the filum terminale; 11 patients requiring reoperations for failed decompression. Failed decompression was managed by adequate osteodural decompression, which was associated with tonsillectomy (6 cases), subarachnoid exploration (8 cases), graft substitution (6 cases), and occipito-cervical fixation/revision (1 case). (3) Results: There was no mortality or surgical morbidity in Group 1. However, one patient’s condition worsened due to untreatable syrinx. In Group 2, there were two cases of mortality, and surgical morbidity was represented by functional limitation and pain in the patient who needed revision of the occipitocervical fixation. Twenty patients improved (58.8%), 6 remained unchanged (32.3%), 1 worsened (2.9%) and 2 died (5.9%). (4) Conclusions: The rate of complications remains high in CM-1 treatment. Unfortunately, a certain rate of treatment failure is unavoidable, but it appears that a significant number of re-operations could have been avoided using proper indications and careful technique.

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The effect of filum terminale sectioning for Chiari 1 malformation treatment: systematic review

Cited by 15 publications

References 31 publications

Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document

Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document

Patient-Reported Outcomes Following Sectioning of the Filum Terminale for Treatment of Tethered Cord Syndrome Associated With Ehlers-Danlos Syndrome

Reoperation in Chiari-1 Malformations

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