Occult filum terminale syndrome

Area of Science:

• Pediatric Neurology
• Urology
• Neurosurgery

Background:

• Occult filum terminale syndrome (OFTS) presents with varied symptoms like urinary dysfunction, incontinence, and pain.
• Neurogenic etiology is often suspected in pediatric patients with these symptoms.
• Standard imaging may not reveal abnormalities in OFTS, complicating diagnosis.

Purpose of the Study:

• To describe a cohort of pediatric patients diagnosed with OFTS based on clinical presentation.
• To evaluate the efficacy of surgical sectioning of the filum terminale in managing OFTS symptoms.
• To discuss the diagnostic and management strategies for OFTS in children.

Main Methods:

• Retrospective review of 32 pediatric patients with symptoms of urinary dysfunction, incontinence, and/or pain.
• Urodynamic testing to assess for neurogenic bladder.
• Magnetic resonance imaging (MRI) to evaluate the conus medullaris and filum terminale.
• Surgical sectioning of the filum terminale for diagnosed cases of OFTS.

Main Results:

• All patients presented with symptoms suggestive of tethered cord, including urinary dysfunction, incontinence, and/or pain.
• Urodynamic testing indicated a neurogenic cause for urological dysfunction.
• Imaging revealed normal filum terminale diameter (<2 mm) and conus medullaris position (above L2).
• 97% of patients experienced significant symptom relief (>50%) after surgical intervention.

Conclusions:

• OFTS can be diagnosed clinically in pediatric patients with neurological symptoms, even with normal imaging findings.
• Surgical sectioning of the filum terminale is an effective treatment for OFTS, leading to substantial symptom improvement.
• A multidisciplinary approach is crucial for managing pediatric patients with OFTS.