Background

Filum terminale lipomas (FTL) represent a sub-type of spinal lipomas, where there is fatty infiltration of the filum. It becomes a surgical entity when it manifests as clinical or radiological tethered cord syndrome. Intraoperative neuromonitoring (IONM) has been suggested as a valuable tool in children for tethered cord surgeries. FTL is distinct and cannot be compared with complex tethered cord syndrome (TCS). Untethering an FTL is a relatively straightforward microsurgical exercise, usually based on anatomical findings. Neurological morbidity in FTL untethering is extremely low. The necessity of IONM in FTL has not been evaluated. The objective of this study was to identify the role of IONM in untethering an FTL

Methods

Available electronic data and case files were interrogated to identify children (0–18 years) who underwent an untethering of FTL between 2008 and 2019. We had a shift in our policy and tried to use IONM as often as possible in all tethered cord surgery from 2014. All children were categorised under ‘IONM implemented’ or ‘no IONM’ group. Outcomes analysed were as follows: (1) Clinical status on short-term and long-term follow-up, (2) alteration of surgical course by IONM and (3) complications specifically associated with IONM

Results

Among 80 children included in this study, IONM was implemented in 37 children and 43 children underwent untethering without IONM. 32.5% of children were ‘syndromic’. Seventy-five percent of children were under age 3 years during surgery. Both groups (No IONM vs. IONM implemented) were well matched in most variables. Majority of ‘no IONM’ surgeries were performed prior to 2014. There was no neurological morbidity in the entire cohort. Mean duration of follow-up was 49.10 (± 33.67) months. Short-term and long-term clinical status remained stable in both cohorts. In 16 children, the filum was stimulated. Based on our protocol, majority had a negative response. One child showed a positive response, contradicted by thorough microscopic inspection. Despite a positive response, the filum was untethered. IONM was not associated with any complication in this study.

Conclusion

FTL untethering is an inherently low-risk microsurgery in experienced hands with rarely reported neurological morbidity. IONM may not be required for all FTL and may be used more judiciously.

中文翻译：

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腹膜脂肪瘤-术中神经监测的作用。

背景

终末脂肪瘤（FTL）代表脊柱脂肪瘤的一种亚型，其中脂肪进入了脂肪。当其表现为临床或放射学的系绳综合征时，它就成为外科手术实体。术中神经监测（IONM）已被建议作为儿童进行脊髓栓系手术的有价值的工具。FTL是独特的，无法与复杂的系绳综合征（TCS）进行比较。解除FTL的束缚是相对简单的显微外科手术，通常基于解剖学发现。FTL解除捆绑的神经系统发病率极低。FTL中IONM的必要性尚未评估。这项研究的目的是确定IONM在解除FTL束缚中的作用

方法

询问可用的电子数据和案例文件，以识别在2008年至2019年之间接受FTL解除绑定的儿童（0到18岁）。我们改变了政策，并尝试从所有2014年。所有儿童均归类为“已实施IONM”或“没有IONM”组。分析的结果如下：（1）短期和长期随访的临床状态，（2）IONM改变手术过程，以及（3）与IONM相关的并发症

结果

在这项研究中包括的80名儿童中，有37名儿童实施了IONM，其中有43名儿童在没有IONM的情况下接受了束缚。32.5％的儿童患有“综合症”。百分之七十五的儿童在手术期间不满3岁。两组（未实施IONM与IONM实施）在大多数变量中均匹配良好。2014年之前进行了大多数“无IONM”手术。在整个队列中没有神经系统疾病。平均随访时间为49.10（±33.67）个月。两组的短期和长期临床状况均保持稳定。在16名儿童中，该荷花受到刺激。根据我们的协议，大多数人的反应都是负面的。一个孩子表现出积极的反应，这与彻底的显微镜检查相矛盾。尽管做出了积极回应，但该公司并未受到束缚。

结论

FTL脱线术是经验丰富的手固​​有的低风险显微外科手术，很少报道神经系统疾病。并非所有FTL都需要IONM，因此可以更明智地使用IONM。