Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026
Large terminal syringomyelia associated with terminal lipoma: mid- to long-term outcomes after tethered cord release.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Masumoto Ai, Hirotsu Tatsuya, Nonaka Yuichiro, Murayama Yuichi
Аннотация
PURPOSE: The management of large terminal syringomyelia (TS) at initial surgery varies in clinical practice, and outcome data stratified by spinal dysraphism subtype remain limited. We evaluated the mid- to long-term clinical course after tethered cord release (TCR) for large TS associated with terminal lipoma.
METHODS: We retrospectively analyzed 12 patients with terminal lipoma (Morota Types 3-4) and large syrinx (syrinx index ≥ 0.5) who underwent TCR without routine additional syrinx procedures between 2012 and 2023. Patients with other spinal dysraphisms were excluded to evaluate a relatively homogeneous spinal dysraphism subtype. Radiological and clinical outcomes were assessed during follow-up.
RESULTS: Median MRI and clinical follow-up periods were 54 and 71 months, respectively. Postoperative syrinx reduction or resolution was observed in all patients. Neurological symptoms improved in symptomatic patients. One patient developed a new postoperative deficit, and no patient required reoperation for retethering or syrinx progression. The syrinx index decreased significantly from 0.67 to 0.00 (p = 0.00049). One holocord case underwent intraoperative minimal puncture for temporary pressure relief rather than definitive drainage.
CONCLUSION: In terminal lipoma-associated large TS, TCR without routine additional syrinx procedures was associated with a favorable clinical course during follow-up. These findings provide subtype-specific outcome data that may assist surgical decision-making, particularly when considering the need for additional syrinx procedures at initial surgery.
TRIAL REGISTRATION: Not applicable.
METHODS: We retrospectively analyzed 12 patients with terminal lipoma (Morota Types 3-4) and large syrinx (syrinx index ≥ 0.5) who underwent TCR without routine additional syrinx procedures between 2012 and 2023. Patients with other spinal dysraphisms were excluded to evaluate a relatively homogeneous spinal dysraphism subtype. Radiological and clinical outcomes were assessed during follow-up.
RESULTS: Median MRI and clinical follow-up periods were 54 and 71 months, respectively. Postoperative syrinx reduction or resolution was observed in all patients. Neurological symptoms improved in symptomatic patients. One patient developed a new postoperative deficit, and no patient required reoperation for retethering or syrinx progression. The syrinx index decreased significantly from 0.67 to 0.00 (p = 0.00049). One holocord case underwent intraoperative minimal puncture for temporary pressure relief rather than definitive drainage.
CONCLUSION: In terminal lipoma-associated large TS, TCR without routine additional syrinx procedures was associated with a favorable clinical course during follow-up. These findings provide subtype-specific outcome data that may assist surgical decision-making, particularly when considering the need for additional syrinx procedures at initial surgery.
TRIAL REGISTRATION: Not applicable.