Myolipoma in a tethered cord

2000 ◽  
Vol 92 (2) ◽  
pp. 214-216 ◽  
Author(s):  
Peter G. Brown ◽  
Ellen G. Shaver
Keyword(s):  
Spinal Cord ◽  
Striated Muscle ◽  
Muscle Fibers ◽  
Tethered Cord ◽  
Tethered Spinal Cord ◽  
Rare Tumor ◽  
Content Type ◽  
Striated Muscle Fibers ◽  
Fine Print

✓ The intradural myolipoma is a very rare tumor, consisting of fully differentiated striated muscle fibers mingled with fat. Only four previous cases have been identified. The authors present a case in which this tumor was associated with a symptomatic tethered spinal cord in an 18-year-old man.

Lumbosacral intramedullary myolipoma

1987 ◽  
Vol 66 (3) ◽  
pp. 457-459 ◽  
Author(s):  
David S. Knierim ◽  
Margaret Wacker ◽  
Norman Peckham ◽  
Antranik A. Bedros
Keyword(s):  
Spinal Cord ◽  
Electrical Stimulation ◽  
Striated Muscle ◽  
Muscle Fibers ◽  
Content Type ◽  
Lipomatous Tumor ◽  
Striated Muscle Fibers ◽  
Fine Print

✓ Intradural myolipoma is an unusual tumor. A case is described in which extramedullary and intramedullary striated muscle fibers caused gross contraction of a lipomatous tumor as well as of the spinal cord during electrical stimulation.

Congenital tethered spinal cord syndrome in adults

1998 ◽  
Vol 88 (6) ◽  
pp. 958-961 ◽  
Author(s):  
Bermans J. Iskandar ◽  
Benjamin B. Fulmer ◽  
Mark N. Hadley ◽  
W. Jerry Oakes
Keyword(s):  
Spinal Cord ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Early Surgery ◽  
Split Cord Malformation ◽  
Tethered Spinal Cord ◽  
Content Type ◽  
Fine Print

Object. The management of tethered spinal cord syndrome with onset of symptomatology occurring in adulthood remains controversial, although the necessity of early surgery in the pediatric tethered cord syndrome population is well established. To ascertain the results of surgery in adult patients with this anomaly, the authors undertook a retrospective review of 34 cases. Methods. The authors studied the hospital records of 34 consecutive patients who presented in adulthood with tethered cord syndrome and conducted follow-up phone interviews with 28 of them. The population consisted of 12 men and 22 women, ranging in age from 18 to 70 years (mean 34 years). The most common presenting feature was pain, followed by weakness and incontinence. All patients underwent surgery. The most common operative findings were tight filum terminale, split cord malformation, and lipomyelomeningocele, paralleling those observed in pediatric studies. Long-term surgical results and patient outcome ratings were encouraging. After a mean clinical follow-up period of 4 years, significant improvement occurred in 22 of 27 patients presenting with pain, 13 of 27 patients with motor or sensory dysfunction, and 11 of 18 patients with bowel and bladder disturbance. In addition, telephone interviews were obtained after a period of 8.6 years. Twenty-two (79%) of 28 patients called the operation a long-term success; 21 (75%) of 28 patients believed that they had significant postoperative improvement (and not just stabilization) in pain and/or neurological function. Surgical complications were generally minor. Nineteen (86%) of 22 employed patients returned to work after surgery. Two (33%) of six patients who were not employed before surgery worked full time postoperatively. Only two of the 28 patients interviewed had received Workers' Compensation benefits; both of these had good outcomes and returned to work. Conclusions. Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. Although surgery in adults involves greater risk of neurological injury than in children, it is a low-risk procedure with encouraging results. Because neurological deficits are generally irreversible, early surgery is recommended.

Medulloblastoma with striated muscle fibers

1973 ◽  
Vol 38 (5) ◽  
pp. 642-646 ◽  
Author(s):  
Anthony J. Lewis
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Striated Muscle ◽  
Muscle Fibers ◽  
Malignant Gliomas ◽  
The Body ◽  
Content Type ◽  
Striated Muscle Fibers ◽  
Fine Print ◽  
Stimulation Of

✓ A case is reported in which a medulloblastoma showed evidence of striated muscle fibers. Fifteen additional cases of primary central nervous system (CNS) tumor containing muscle fibers (excluding teratomas) are reviewed. These tumors appear to be of mesenchymal, rather than teratoid, origin, and to be related to embryonal sarcomas (mesenchymomas) in other parts of the body. It is postulated that the presence of such fibers in malignant gliomas may be due to rhabdomyoblast-inducing action of mesenchyme, analogous to the fibroblastic stimulation observed in desmoplastic medulloblastomas, and the massive stimulation of perivascular tissue often associated with undifferentiated astrocytomas.

Intradural spinal teratoma: evidence for a dysembryogenic origin

1998 ◽  
Vol 89 (5) ◽  
pp. 844-851 ◽  
Author(s):  
Joseph L. Koen ◽  
Roger E. McLendon ◽  
Timothy M. George
Keyword(s):  
Spinal Cord ◽  
Germ Cells ◽  
Primordial Germ Cells ◽  
Split Cord Malformation ◽  
Rare Tumor ◽  
Content Type ◽  
Fine Print

✓ Intradural spinal teratoma is a rare tumor that can be associated with dysraphic defects. Although the origin of these tumors is traditionally thought to be secondary to primordial germ cells misplaced early in embryogenesis, the pathogenesis of intraspinal teratoma remains unclear. The authors present a series of patients in whom an intradural teratoma arose at the same site as a developmental spinal cord abnormality, including a split cord malformation, myelomeningocele, and lipomyelomeningocele. It is postulated that these lesions were the result of a dysembryogenic mechanism and were not neoplastic.

Evaluation of anorectal function in patients with tethered cord syndrome: saline enema test and fecoflowmetry

2003 ◽  
Vol 98 (3) ◽  
pp. 251-257 ◽  
Author(s):  
Hiroyuki Kayaba ◽  
Tatsuzo Hebiguchi ◽  
Yasunobu Itoh ◽  
Hiroaki Yoshino ◽  
Masaru Mizuno ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Fecal Incontinence ◽  
Contractile Activity ◽  
Tethered Cord ◽  
Anorectal Function ◽  
Tethered Cord Syndrome ◽  
Content Type ◽  
Asymptomatic Patients ◽  
Untethering Surgery ◽  
Fine Print

Object. Disturbance in anorectal function is a major factor restricting the activities of daily living in patients with spinal cord disorders. To detect changes in anorectal motilities due to a tethered spinal cord, anorectal functions were evaluated using a saline enema test and fecoflowmetry before and after patients underwent untethering surgery. Methods. The bowel functions in five patients with a tethered cord syndrome (TCS) were evaluated by performing a saline enema test and fecoflowmetry. The contractile activity of the rectum, the volume of infused saline tolerated in the rectum, anal canal pressure, and the ability to evacuate rectal content were examined. The characteristic findings in anorectal motility studies conducted in patients with TCS were a hyperactive rectum, diminished rectal saline-retention ability, and diminished maximal flow in saline evacuation. A hyperactive rectum was considered to be a major contributing factor to fecal incontinence. In one asymptomatic patient diminished anal squeezing pressure was exhibited and was incontinent to liquid preoperatively, but recovered after surgery. Two patients who underwent surgery for myeloschisis as infants complained of progressive fecal incontinence when they became adolescents. In one patient fecal incontinence improved but in another patient no improvement was observed after untethering surgery. Conclusions. Fecodynamic studies allow the detection of neurogenic disturbances of the anorectum in symptomatic and also in asymptomatic patients with TCS. More attention should be paid to the anorectal functions of patients with TCS.

Tethered cord syndrome from a choristoma of müllerian origin

1991 ◽  
Vol 74 (3) ◽  
pp. 497-500 ◽  
Author(s):  
Michael C. Molleston ◽  
Kevin A. Roth ◽  
Franz J. Wippold ◽  
Robert L. Grubb
Keyword(s):  
Spinal Cord ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Review Of The Literature ◽  
Lumbosacral Junction ◽  
Content Type ◽  
Fine Print

✓ The authors report a case of tethered cord syndrome due to a choristoma of müllerian origin located in the spinal cord at the lumbosacral junction. Two similar cases were found upon review of the literature. The embryology of this lesion is discussed.

Dorsal midline proboscis associated with diastematomyelia and tethered cord syndrome

1996 ◽  
Vol 85 (4) ◽  
pp. 709-712 ◽  
Author(s):  
Shokei Yamada ◽  
George T. Mandybur ◽  
Joseph R. Thompson
Keyword(s):  
Spinal Cord ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Dorsal Midline ◽  
Content Type ◽  
First Report ◽  
Therapeutic Measures ◽  
Fine Print

✓ There have been sporadic reports on tail proboscis, a vestigial appendage, as part of sacrococcygeal dysraphism. The case the authors present, different from the tail proboscis, is the first report linking a proboscis containing a hemilipomyelomeningocele with tethered cord syndrome, associated with diastematomyelia. Tethering was caused by the diastematomyelia that anchored the split spinal cord. The authors emphasize the importance of prompt diagnostic and therapeutic measures for treatment of this condition.

Tethered cervical spinal cord

1987 ◽  
Vol 67 (4) ◽  
pp. 600-602 ◽  
Author(s):  
Theodore W. Eller ◽  
Lawrence P. Bernstein ◽  
Richard S. Rosenberg ◽  
David G. McLone
Keyword(s):  
Spinal Cord ◽  
Young Adult ◽  
Evoked Potentials ◽  
Clinical Improvement ◽  
Somatosensory Evoked Potentials ◽  
Imaging Technique ◽  
Cervical Spinal Cord ◽  
Tethered Spinal Cord ◽  
Content Type ◽  
Fine Print

✓ A case of congenital tethered cervical spinal cord is presented in a young adult. Metrizamide computerized tomography was the most useful imaging technique for identifying the tethered spinal cord. Intraoperative somatosensory evoked potentials correlated well with clinical improvement following surgery.

Surgical management of tethered spinal cord in adults: report of 54 cases

2001 ◽  
Vol 95 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Sabine Hüttmann ◽  
Juergen Krauss ◽  
Hartmut Collmann ◽  
Niels Sörensen ◽  
Klaus Roosen
Keyword(s):  
Spinal Cord ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Neurological Deficits ◽  
Split Cord Malformation ◽  
Content Type ◽  
Adult Age ◽  
Pregnancy And Childbirth ◽  
Pain Status ◽  
Fine Print

Object. The clinical features specific to tethered cord syndrome (TCS) in adults as well as factors determining outcome and prognosis have rarely been addressed systematically. The authors studied 56 patients, 54 of whom were treated surgically over the last 16 years. Methods. In 17 patients who had been asymptomatic during childhood, TCS was diagnosed 8 years after onset of symptoms. Tethered cord syndrome was diagnosed 4 years after worsening in 39 patients with neurological signs or symptoms since childhood. The patients were followed for an average of 8 years. Features specific to adult-age presentation included nondermatomal pain aggravated by movement in 34 patients and conditions such as pregnancy and childbirth (in five of 11 pregnant patients). The most frequent tethering lesions were lipoma in 32, tight terminal filum in 28, and split cord malformation and secondary adhesions in 12 patients, respectively. Improvement or stabilization of symptoms at 6 months after surgery was noted in 46 (85%) of 54 patients. Improvement in pain status was most frequent (86%) followed by improvements in spasticity (71%), bladder dysfunction (44%), and sensorimotor deficits (35%). Factors associated with adverse outcome included preoperative duration of neurological deficits more than 5 years and incomplete untethering. On average, 8 (80%) of 10 patients with incomplete untethering developed recurrent symptoms 5 years after surgery compared with only seven (16%) of 44 patients in whom complete untethering was achieved. Seven patients underwent reoperation and in five of them stabilization of symptoms was attained. At a mean follow up of 8 years, 46 (85%) of the 54 surgically treated patients were in stable neurological condition, including those in whom reoperation was performed. Conclusions. Surgery for TCS is as beneficial in adults as it is in children. Its success depends on early diagnosis and complete untethering of the spinal cord.

Outcome after surgical treatment of progressive posttraumatic cystic myelopathy

2000 ◽  
Vol 92 (2) ◽  
pp. 149-154 ◽  
Author(s):  
Thomas T. Lee ◽  
Gustavo J. Alameda ◽  
Erika B. Gromelski ◽  
Barth A. Green
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Treatment Protocol ◽  
Tethered Cord ◽  
Cyst Formation ◽  
Tethered Cord Syndrome ◽  
Intraoperative Ultrasonography ◽  
Cyst Size ◽  
Content Type ◽  
Fine Print

Object. Progressive posttraumatic cystic myelopathy (PPCM) can occur after an injury to the spinal cord. Traditional treatment of PPCM consists of inserting a shunt into the cyst. However, some authors have advocated a more pathophysiological approach to this problem. The authors of the present study describe their surgical treatment protocol and outcome in a series of patients with syringomyelia. Methods. Medical records of 34 patients undergoing surgical treatment for PPCM were reviewed. Laminectomies and intraoperative ultrasonography were performed. In patients without focal tethering of the spinal cord and in whom only a confluent cyst had been revealed on ultrasonography, a syringosubarachnoid shunt was inserted; in those with both tethering and a confluent cord cyst, an untethering procedure was performed first. When a significant reduction (> 50%) in the size of the cyst was shown after the untethering procedure, no shunt was inserted. When no changes in cyst size were demonstrated on ultrasonography, a short syringosubarachnoid shunt was used. The mean follow-up period was 28.7 months (range 12–102 months). The interval between the mechanism of injury and the operation ranged from 5 months to 37 years (mean 11 years). Pain was the most frequent symptom, which was followed by motor deterioration and spasticity. Postoperative improvement was noted in 55% of patients who experienced motor function deterioration and in 53% of those who demonstrated worsening spasticity. In 14 of 18 patients with an associated tethered spinal cord, tethering alone caused significant collapse of the cyst. Postoperative magnetic resonance imaging demonstrated cyst collapse in 92% of patients who had undergone untethering alone and in 93% of those who underwent syringosubarachnoid shunt placement. Treatment failure was observed in 7% of the former group and in 13% of the latter. Conclusions. Posttraumatic cystic myelopathy can occur with or without the presence of tethered cord syndrome. Intraoperative ultrasonography can readily demonstrate this distinction to aid in surgical decision making. Untethering alone in patients with tethered cord syndrome and cyst formation can reduce the cyst size and alleviate symptoms and signs of posttraumatic cystic myelopathy in the majority of these cases. Untethering procedures in which duraplasty is performed to expand the subarachnoid space may be a more physiologically effective way of treating tethered cord with associated syringomyelia.

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