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01-03-2021 | Lipoma | Original Article

Filum terminale lipomas—the role of intraoperative neuromonitoring

Authors: Harishchandra Lalgudi Srinivasan, Pablo Valdes-Barrera, Ariel Agur, Jehuda Soleman, Margaret Ekstein, Akiva Korn, Irina Vendrov, Jonathan Roth, Shlomi Constantini

Published in: Child's Nervous System | Issue 3/2021

Abstract

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.

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Title: Filum terminale lipomas—the role of intraoperative neuromonitoring
Authors: Harishchandra Lalgudi Srinivasan
Pablo Valdes-Barrera
Ariel Agur
Jehuda Soleman
Margaret Ekstein
Akiva Korn
Irina Vendrov
Jonathan Roth
Shlomi Constantini
Publication date: 01-03-2021
Publisher: Springer Berlin Heidelberg
Keywords: Lipoma
Lipoma
Motor Evoked Potential
Electromyographic
Spina Bifida Occulta
Spina Bifida Occulta
Motor Evoked Potential
Neuromonitoring
Published in: Child's Nervous System / Issue 3/2021
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-020-04856-4

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Filum terminale lipomas—the role of intraoperative neuromonitoring

Abstract

Background

Methods

Results

Conclusion

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Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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