Spinal cord detethering in children with tethered cord syndrome and Chiari type 1 malformations

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Spinal Cord Disorders

Background:

• The association between tethered cord syndrome (TCS) and Chiari type 1 malformation (CM1) remains unclear.
• TCS involves the spinal cord being abnormally attached to surrounding tissue, restricting movement.
• CM1 is a condition where brain tissue extends into the spinal canal.

Purpose of the Study:

• To investigate the surgical outcomes of children with coexisting CM1 and TCS who underwent filum terminale sectioning (SFT).
• To analyze the relationship between filum terminale characteristics and tonsillar herniation in this patient group.

Main Methods:

• Retrospective review of 170 spinal cord detethering surgeries performed between 2008 and 2012.
• Identification and analysis of 17 pediatric patients with both CM1 and TCS who underwent SFT.
• Evaluation of clinical presentation, radiographic findings, surgical procedures, and post-operative outcomes.

Main Results:

• A mean tonsillar herniation of 10.0mm was observed in patients with CM1 and TCS.
• Fatty or thickened filum terminale correlated with greater tonsillar displacement (p<0.005).
• All 17 children experienced improvement in preoperative symptoms following SFT, with no neurological decline.

Conclusions:

• Filum terminale sectioning is an effective treatment for pediatric patients with CM1 and TCS, even those without classic Chiari symptoms.
• SFT can lead to symptomatic improvement in this specific patient population.
• Post-operative MRI showed stable tonsillar position in most patients, indicating the safety and efficacy of the procedure.