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Ventral tethering in split cord malformation.

D Pang1

  • 1Department of Neurological Surgery, Kaiser Permanente Hospitals, Sacramento, California 95825, USA.

Neurosurgical Focus
|June 6, 2006
PubMed
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Ventral tethering in split cord malformation (SCM) type II is often missed. Surgical inspection is crucial for diagnosis, as imaging techniques like MRI and CT myelography have limited effectiveness in detecting this condition.

Area of Science:

  • Neurosurgery
  • Pediatric Neurosurgery
  • Spinal Cord Malformations

Background:

  • Split cord malformation (SCM) is a congenital anomaly of the spine.
  • Type II SCM involves the splitting of the spinal cord within a single dural sac.
  • Ventral tethering, where the spinal cord is abnormally attached to the ventral dura, is a specific complication.

Purpose of the Study:

  • To investigate the prevalence and characteristics of ventral tethering in type II SCM.
  • To evaluate the diagnostic efficacy of imaging modalities for ventral tethering.
  • To identify clinical predictors of ventral tethering in SCM.

Main Methods:

  • Retrospective analysis of 52 patients with type II SCM.
  • Classification of ventral septa into four categories based on their anatomical characteristics.

Related Experiment Videos

  • Review of diagnostic imaging (MRI, CT myelography) and surgical findings.
  • Correlation of clinical presentation with imaging and surgical outcomes.

    • Main Results:

    • Ventral tethering was identified in 21% of type II SCM patients.
    • Four types of ventral septa were described, some associated with dermal sinus tracts or intestinal malformations.
    • MRI was ineffective; CT myelography detected ventral tethering in only 50% of cases.
    • A combination of CT myelography and clinical predictors (dermal sinus tract, intestinal malformations) only suspected 60% of cases pre-operatively.

    Conclusions:

    • Ventral tethering is an under-recognized issue in type II SCM.
    • Thorough surgical inspection of the ventral spinal cord surface is essential for diagnosis.
    • Current imaging techniques have significant limitations in detecting ventral tethering.