engleski

Tethered cord syndrome: Analysis of MRI and intraoperative findings

During last two years, at Department of Neurosurgery, School of Medicine Zagreb, Croatia, twenty children with occult spinal dysraphism were operated on. Among them, 15 cases of secondary tethered spinal cord following myelomeningocoele repair, 2 cases of spinal teratoma, 2 cases of spinal dermoid tumors, 2 cases of tight filum terminale, and one case of spinal lipoma. In all patients preoperative MRI of the entire neuroaxis established accurate morphologic diagnosis. All operations were performed by microsurgical technique. The aim of this work was to establish correlations between MRI images and intraoperative findings. Patients with secondary tethered cord syndrome clinically presented different grades of primary medullary lesions. Spinal lipoma and one case of teratoma were clinically asymptomatic with exception of local finding. Both cases of dermoid tumor presented with spinal meningitis, and one case of teratoma with enuresis nocturna. All microsurgical operations were monitored using evoked somatosensory potentials. In cases of secondary tethered cord syndrome, dugo-medullary and duro-caudal adhesions were found and resolved by adhesiolysis. Tight filum terminale was resected, while tumors were completely removed using CO2 laser and ultrasound aspirator. In all operated children, intraoperative findings clearly confirmed MRI- established diagnosis. We conclude that MRI examination is extremely accurate in diagnostic evaluation of spinal occult dysraphism. MRI should be performed in all infants when there is even slight doubt on occult spinal dysraphism, as well as following surgery for myelomeningocoele due to follow-up of desirable conal ascending, wich may eventually indicate preventive surgery before irreparable worsening in clinical status develop.

tethered cor ; magnetic resonance imaging

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