Sim Jungbo, Shim Youngbo, Kim Kyung Hyun, Kim Seung-Ki, Lee Ji Yeoun
Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea.
J Korean Neurosurg Soc. 2021 Jul;64(4):585-591. doi: 10.3340/jkns.2020.0223. Epub 2020 Dec 30.
Filum transection is one of the most commonly performed operative procedure in pediatric neurosurgery. However, the clinical and pathological features as well as the surgical indication are not well-established. This study aimed to analyze the characteristics of patients who underwent transection of the filum during the last 10 years in a single institute.
A total of 82 patients underwent transection of the filum during the period. As a general rule, we performed the transection in patients who are symptomatic or have abnormality in the urologic or neuromuscular evaluations. There were exceptions as asymptomatic patients who only fit the definition of thickened filum (width greater than 2.0 mm or conus level below L3 vertebral body) were operated by parent's wish or surgeon's preference according to radiological findings, etc.
Seventy-six out of 82 patients had fibrous tissue in the pathologic specimen of filum. Interestingly, patients who had glial cells were more correlated with no preoperative syrinx, and no progression of syrinx even for those who did have syrinx initially. Also, larger percentage of symptomatic patients had peripheral nerve twigs than asymptomatic patients. No difference in conus level or thickness of filum was found between patients with or without preoperative syrinx. Significantly more patients with syrinx (56%) were chosen to be operated without any symptom or abnormality in study i.e., solely based on radiological findings than those without syrinx (21%). The surgical outcome for syrinx was favorable, as all but one patient had either improved or static syrinx. The exceptional case had increase in size due to the upward displacement of the proximal end of the cut filum.
This study evaluated the pathological, clinical, radiological features of patients who underwent transection of the filum. Interesting correlations between pathological findings and clinical features were found. Excellent outcome regarding preoperative syrinx was also shown.
脊髓终丝切断术是小儿神经外科最常施行的手术之一。然而，其临床和病理特征以及手术指征尚未完全明确。本研究旨在分析某单一机构过去10年中接受脊髓终丝切断术患者的特征。
在此期间共有82例患者接受了脊髓终丝切断术。一般来说，我们对有症状或泌尿系统或神经肌肉评估异常的患者进行切断术。也有例外情况，即仅符合终丝增厚（宽度大于2.0 mm或圆锥位于L3椎体以下水平）定义的无症状患者，根据影像学检查结果等，经家长要求或外科医生的偏好而进行手术。
82例患者中有76例在终丝病理标本中发现纤维组织。有趣的是，有神经胶质细胞的患者与术前无脊髓空洞症以及即使最初有脊髓空洞症但无脊髓空洞症进展的情况更相关。此外，有症状患者的周围神经分支比例高于无症状患者。术前有或无脊髓空洞症的患者在圆锥水平或终丝厚度方面未发现差异。与无脊髓空洞症的患者（21%）相比，有脊髓空洞症的患者（56%）更多是在无任何症状或异常（即仅基于影像学检查结果）的情况下被选择进行手术。脊髓空洞症的手术效果良好，除1例患者外，所有患者的脊髓空洞症均有所改善或保持稳定。该例外病例是由于切断的终丝近端向上移位导致空洞增大。
本研究评估了接受脊髓终丝切断术患者的病理、临床和影像学特征。发现了病理结果与临床特征之间有趣的相关性。还显示出术前脊髓空洞症的良好预后。
