Prone Position Magnetic Resonance Imaging and Transhiatal Approach to Filum Terminale Externum Sectioning in Adolescents with Occult Tethered Cord Syndrome: Report of Four Cases

2021 ◽  
pp. 1-7
Author(s):  
Vanni Veronesi ◽  
Milena Calderone ◽  
Carlo Sacco ◽  
Roberto Donati
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Prone Position ◽  
Tethered Cord ◽  
Skin Incision ◽  
Morphological Parameters ◽  
Filum Terminale ◽  
Resonance Imaging ◽  
Lumbar Mri ◽  
Occult Tethered Cord

<b><i>Introduction:</i></b> Occult tethered cord syndrome (OTCS) and its surgical treatment are controversial. A previous study with lumbar magnetic resonance imaging (MRI) in the prone position had found statistically significant differences in morphological parameters between pediatric OTCS patients and a control group. Filum terminale internum (FTI) sectioning is currently the gold standard for the treatment of OTCS. <b><i>Case Presentation:</i></b> We present four cases of adolescents with OTCS, of which three cases were associated with low-lying cerebellar tonsils (LLCT). The patients presented various symptoms of OTCS from pain to sensory disturbances to alterations in sphincter functions, but none had disorders belonging to all three categories. A T2-weighted axial MRI in the prone position supported the clinical diagnosis of OTCS. The patients were treated with minimal skin incision and filum terminale externum (FTE) sectioning through the sacral hiatus under local anesthesia. <b><i>Discussion:</i></b> We describe for the first time the association between lumbar MRI in the prone position and FTE sectioning in OTCS. The FTE sectioning has resulted in the disappearance of the pain and sensory disturbance symptoms. The results on the sphincter function are mixed. Three of our four patients with OTCS had LLCT, and all three also reported headache episodes, which, surprisingly, disappeared postoperatively. This minimally invasive surgery involves only minimal discomfort for the patient and minimizes the risks related to skin incision only. The postoperative lumbar MRI in the prone position has shown that there is no mobilization of the FTI or changes in the other preoperative morphological parameters.

scholarly journals Magnetic Resonance Imaging of the Lumbar Spine in a Patient with a Spinal Cord Stimulator

2013 ◽  
Vol 3;16 (3;5) ◽  
pp. E295-E300
Author(s):  
Thomas T. Simopoulos
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Case Report ◽  
Lumbar Spine ◽  
Magnetic Resonance ◽  
Adverse Events ◽  
Spinal Cord Stimulation ◽  
Spinal Cord Stimulator ◽  
Resonance Imaging ◽  
Lumbar Mri

Background: The use of magnetic resonance imaging (MRI) is continuously escalating for the evaluation of patients with persistent pain following lumbar spine surgery (LSS). Spinal cord stimulation (SCS) therapy is being clinically applied much more commonly for the management of chronic pain following LSS. There is an increased probability that these 2 incompatible modalities may be accidentally used in the same patient. Objectives: The purpose of this case report is to: (1) summarize a case in which a patient with a thoracic spinal cord stimulator underwent a diagnostic lumbar MRI, (2) describe the 3 magnetic fields used to generate images and their interactions with SCS devices, and (3) summarize the present literature. Study design: Case report. Setting: University hospital. Results: Aside from mild heat sensations in the generator/pocket site and very low intensity shocking sensations in the back while in the MRI scanner, the patient emerged from the study with no clinically detected adverse events. Subsequent activation of the SCS device would result in a brief intense shocking sensation. This persisted whenever the device was activated and required Implantable Pulse Generator (IPG) replacement. Electrical analysis revealed that some of the output circuitry switches, which regulate IPG stimulation and capacitor charge balancing, were damaged, most likely by MRI radiofrequency injected current. Limitations: Single case of a patient with a thoracic SCS having a lumbar MRI study. Conclusion: This case demonstrates the lack of compatibility of lumbar MRI and the Precision SCS system as well as one of the possible patient adverse events that can occur when patients are exposed to MRI outside of the approved device labeling. Key words: Spinal cord stimulation devices, magnetic resonance imaging

Spinal intramedullary ependymal cyst and tethered cord in an adult

2006 ◽  
Vol 4 (6) ◽  
pp. 506-508 ◽  
Author(s):  
Erhan Takci ◽  
Goksin Sengul ◽  
Muzaffer Keles
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Tethered Cord ◽  
Pathological Examination ◽  
Resonance Imaging ◽  
Ependymal Cyst ◽  
Congenital Lesion ◽  
Post Surgery

✓ Spinal intramedullary ependymal cysts are extremely rare. Fourteen cases have been reported in the literature, and only one was associated with another congenital lesion. The authors describe the case of a 33-year-old man in whom an intramedullary ependymal cyst and filar lipoma were present. These lesions were diagnosed using magnetic resonance imaging and were treated surgically. Pathological examination confirmed the diagnosis. At 6 months post-surgery, there was no evidence of recurrence.

Brain Tumor Resection Aided with Markers Placed Using Stereotaxis Guided by Magnetic Resonance Imaging and Computed Tomography

Neurosurgery ◽  
1991 ◽  
Vol 28 (6) ◽  
pp. 801-806 ◽  
Author(s):  
Samuel J. Hassenbusch ◽  
James S. Anderson ◽  
Prem K. Pillay
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Tumor Resection ◽  
Skin Incision ◽  
Target Point ◽  
Resonance Imaging ◽  
Computed Tomographic ◽  
Stereotactic Frame ◽  
Visual Markers ◽  
Brain Tumor Resection

Abstract In the operative resection of brain tumors, defining and locating edges of deep-seated tumors or those with indistinct color and consistency can be difficult. This report presents a simple yet precise, alternative method, using the basic Brown-Roberts-Wells or Cosman-Roberts-Wells stereotactic frame, for placement of visual markers to aid in tumor resections. The method can also be extended to the Leksell system. Using routine computed tomographic scanning or magnetic resonance imaging after stereotactic frame application, multiple points along tumor edges were used as target points. In the operating room, standard techniques were used for the skin incision, removal of the bone flap, and opening the dura. At each target point, after opening the dura and using stereotactic coordinates and equipment, a microbiopsy forceps was used to place “micropatties” (each with a string tail) or small catheters with pledgets or catheter tips located at tumor edges. After removing the arc, the tumor resection was accomplished in a conventional nonstereotactic manner by simply following string tails or catheters to the tumor. Gross tumor edges were determined from positions of actual patties or catheter tips. These simple but accurate techniques offer the possibility of tumor resections under stereotactic guidance with equipment readily available to most neurosurgeons. The fidelity of marker placement is also maintained in relation to tumor edges despite shifts in the tumor and/or brain as cystic areas are drained or large amounts of the tumor are resected.

scholarly journals Magnetic Resonance Imaging Analysis of Caudal Regression Syndrome and Concomitant Anomalies in Pediatric Patients

2016 ◽  
Vol 6 ◽  
pp. 36 ◽  
Author(s):  
Deb K Boruah ◽  
Dhaval D Dhingani ◽  
Sashidhar Achar ◽  
Arjun Prakash ◽  
Antony Augustine ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Tethered Cord ◽  
Type I ◽  
Care Hospital ◽  
Resonance Imaging ◽  
Caudal Regression Syndrome ◽  
Caudal Regression

Objective: The aim of this study was to evaluate the magnetic resonance imaging (MRI) findings of caudal regression syndrome (CRS) and concomitant anomalies in pediatric patients. Materials and Methods: A hospital-based cross-sectional retrospective study was conducted. The study group comprised 21 pediatric patients presenting to the Departments of Radiodiagnosis and Pediatric Surgery in a tertiary care hospital from May 2011 to April 2016. All patients were initially evaluated clinically followed by MRI. Results: In our study, 21 pediatric patients were diagnosed with sacral agenesis/dysgenesis related to CRS. According to the Pang's classification, 2 (9.5%) patients were Type I, 5 (23.8%) patients were Type III, 7 (33.3%) patients were Type IV, and 7 (33.3%) patients were of Type V CRS. Clinically, 17 (81%) patients presented with urinary incontinence, 6 (28.6%) with fecal incontinence, 9 patients (42.9%) had poor gluteal musculatures and shallow intergluteal cleft, 7 (33.3%) patients had associated subcutaneous mass over spine, and 6 (28.6%) patients presented with distal leg muscle atrophy. MRI showed wedge-shaped conus termination in 5 (23.8%) patients and bulbous conus termination in 3 (14.3%) patients above the L1 vertebral level falling into Group 1 CRS while 7 (33.3%) patients had tethered cord and 6 (28.6%) patients had stretched conus falling into Group 2 CRS. Conclusion: MRI is the ideal modality for detailed evaluation of the status of the vertebra, spinal cord, intra- and extra-dural lesions and helps in early diagnosis, detailed preoperative MRI evaluation and assessing concomitant anomalies and guiding further management with early institution of treatment to maximize recovery.

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