Meningocele Manqué Discovered During Filum Terminale Resection in Occult Tethered Cord Syndrome.

BACKGROUND: Meningocele manqué (MM) is characterized by tethering of the spinal cord, nerve roots, or filum terminale by fibrous attachments formed by atrophic or incomplete meningoceles. Patients with MM can present with symptoms of tethered cord syndrome (TCS). CASE DESCRIPTION: We present the case of an MM discovered incidentally during microsurgical resection of filum terminale for occult TCS. The MM was not visible on the preoperative magnetic resonance imaging (MRI) studies. After L2-L3 laminotomy, an extradural mass was appreciated adherent to the spinal dura, which was found to be an MM. The nerve roots of the cauda equina were found to protrude through the dura, consistent with tethered cauda equina. After microsurgical resection of the filum terminale, the tethered cauda nerve roots were stimulated, and redundant electromyographic signals were detected at both the left- and the right-sided muscles of the lower extremities. Microsurgical repair of the MM was performed, assuming that the patient's symptoms of TCS would also be explained by the MM and that her symptoms would likely have been incompletely addressed by filum terminale release alone. A review of the preoperative 3-dimensional constructive interference in steady state MRI sequence revealed pathological features at the L2-L3 level suspicious for our intraoperative findings of an MM. CONCLUSIONS: Surgeons planning filum terminale release for occult TCS should always be aware of the possibility of associated pathological features of tethering that might be overlooked. In retrospect, the detection of MM was enabled by the high-resolution 3-dimensional constructive interference in steady state MRI sequence. This finding advocates for the use of high-resolution MRI for patients undergoing evaluation for occult TCS to detect pathological features that might otherwise be undetected.

Analysis of surgical effect of adult lipomatous tethered cord syndrome / 中国医师进修杂志

Objective To discuss the surgical effect of adult lipomatous tethered cord syndrome (TCS). Methods The clinical data of 29 patients with adult lipomatous TCS were systematically analyzed. Eleven of male and 18 of female,who ranged from 20 to 59 years. All patients were performed filum terminale release and lipoma excision, the clinical outcome after operation was analyzed according to Hoffman grading criteria and visual analog scale (VAS). Results According to Hoffman grading criteria, 9 cases were obviously improved in leg muscle weakness, including 1 case with urination disturbance improved significantly. Also the lower back pain of patients were improved obviously: (2.63 ± 1.30) scores vs. (8.67±0.30) scores, there was significant difference (P<0.05). Conclusions Filum terminale release and lipoma excision can effectively improve the symptom of lower back pain of adult lipomatous TCS patients, meanwhile the symptom of paraparesis can improve appropriate postoperatively. But urinary deficits do not show a significant change.