Rajpal Sharad, Salamat M Shahriar, Tubbs R Shane, Kelly David R, Oakes W Jerry, Iskandar Bermans J
Department of Neurosurgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin 53792, USA.
J Neurosurg Spine. 2007 Sep;7(3):315-22. doi: 10.3171/SPI-07/09/315.
The goal of the present study goal was to systematically confirm the previously recognized nomenclature for tethering tracts that are part of the spectrum of occult spinal dysraphic lesions.
The tethering tract in 20 patients with spina bifida occulta underwent histological examination with H & E staining and epithelial membrane antigen (EMA) immunolabeling, and additional selected specimens were stained with Masson trichrome.
All tethering tracts contained fibrous connective tissue. Four tracts were lined with epithelial cells and either originated within a dermoid cyst, terminated at a skin dimple/sinus opening, or had both of these characteristics. No tethering tracts exhibited EMA positivity or meningeal elements. Although all tethering tracts originated in juxtaposition to the spinal cord, their termination sites were variable.
Based on histological findings and presumed embryological origin, the authors broadly classified tethering tracts terminating within the dura mater, epidural space, or lamina as "short tethering tracts" (STTs). The STTs occurred mostly in conjunction with split cord malformations and had a purely fibrous composition. Tethering tracts terminating superficial to the overlying lamina were classified as "long tethering tracts" (LTTs), and the authors propose that these are embryologically distinct from STTs. The LTTs were of two varieties: epithelial and nonepithelial, the former being typically associated with a skin dimple or spinal cord (epi)dermoid cyst. In fact, analysis of the data suggested that not every tethering tract terminating in or on the skin should be classified as a dermal sinus tract without histological confirmation, and because no evidence of meningeal tissue-lined tracts was detected, the use of the term "meningocele manqué" may not be appropriate.
本研究的目的是系统地确认隐匿性脊柱发育不良病变谱系中作为一部分的束带的先前公认的命名法。
对20例隐性脊柱裂患者的束带进行苏木精-伊红（H&E）染色和上皮膜抗原（EMA）免疫标记的组织学检查，另外选取的标本用马松三色染色。
所有束带均含有纤维结缔组织。4条束带内衬上皮细胞，要么起源于皮样囊肿内，要么终止于皮肤酒窝/窦口，或者具有这两种特征。没有束带表现出EMA阳性或脑膜成分。尽管所有束带都起源于脊髓旁，但它们的终止部位各不相同。
基于组织学发现和推测的胚胎学起源，作者将终止于硬脑膜内、硬膜外间隙或椎板内的束带大致分类为“短束带”（STT）。STT大多与脊髓纵裂畸形同时出现，且具有纯纤维成分。终止于覆盖椎板浅层的束带被分类为“长束带”（LTT），作者提出这些在胚胎学上与STT不同。LTT有两种类型：上皮性和非上皮性，前者通常与皮肤酒窝或脊髓（表皮样）囊肿相关。事实上，数据分析表明，并非每条终止于皮肤内或皮肤上的束带在未经组织学确认时都应被分类为皮窦道，并且由于未检测到脑膜组织内衬束带的证据，使用“潜在脊膜膨出”这一术语可能不合适。
