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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2023; 42(02): e114-e120
DOI: 10.1055/s-0043-1769780
Review Article | Artigo de Revisão

Sectioning of the Filum Terminale in Patients with Chiari Malformation Type 1 Associated with Occult Tethered Cord Syndrome: Literature Review

Secção do filum terminale em pacientes com malformação de chiari tipo 1 associado a síndrome oculta da medula presa: revisão de literatura
José Nazareno Pearce de Oliveira Brito 
1   Department of Neurology and Neurosurgery, Hospital São Marcos, State University of Piaui, Teresina, PI, Brazil
2   Department of Neurology and Neurosurgery, Hospital São Marcos, Teresina, PI, Brazil
,
Patryck Araújo Dantas 
3   Health Sciences Center, Federal University of Piaui, Teresina, PI, Brazil
,
Pedro Borges Bomfim Júnior
4   Health Sciences Center, UNINOVAFAPI University Center, Teresina, PI, Brazil
,
Cléciton Braga Tavares
2   Department of Neurology and Neurosurgery, Hospital São Marcos, Teresina, PI, Brazil
,
Leonardo Augusto Martins 
6   Department of Radiology, Hospital São Marcos, Teresina, PI, Brazil
,
Emerson Brandão Sousa
5   Department of Neurology and Neurosurgery, University Hospital of Piaui, Teresina, PI, Brazil
,
Michele Medeiros da Cunha
6   Department of Radiology, Hospital São Marcos, Teresina, PI, Brazil
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Abstract

Approximately 125 years ago, a group of pathologies now known as Chiari malformations was described for the first time. However, some mechanisms of its formation still remain unknown. A bibliographic survey was performed through a search in PubMed. In 1938, it was already theorized that an increase in spinal cord tension could be the cause of Chiari malformation type 1 (CM1) tonsillar herniation. In 1953, a condition known for the anchoring of the filum terminale to the vertebral canal was described for the first time and would later be known as tethered cord syndrome (TCS). Some studies have shown that it is associated with increased tension in the spinal cord, and this formed the basis for a possible pathophysiological explanation of tonsillar herniation. Case series emerged reporting that treatment for TCS with the sectioning of the filum terminale (SFT) could provide clinical improvement of patients with CM1. A new pathological entity emerged when it was realized that patients with the clinical picture of TCS could have the medullary cone in its normal position, differing from the caudal migration expected for the TCS. This condition became known as occult tethered cord syndrome (OTCS). Case series attempted to demonstrate its association with the origin of CM1, a non-intuitive association, since the cone in the normal position contradicts traction as a source of tonsillar herniation. To this day, the absence of randomized control trials limits any conclusions regarding the effectiveness of SFT for the treatment of patients with CM1.

Resumo

Há cerca de 125 anos, era descrita pela primeira vez um grupo de patologias hoje conhecidas como malformações de Chiari. No entanto, alguns mecanismos de sua formação ainda permanecem desconhecidos. Um levantamento bibliográfico foi feito através do PubMed. Em 1938, já se teorizava que um aumento da tensão medular poderia ser a causa da herniação tonsilar da malformação de Chiari tipo 1 (MC1). Em 1953, foi descrita pela primeira vez uma condição conhecida pelo ancoramento do filum terminale ao canal vertebral e que mais tarde viria a ser conhecida como síndrome da medula presa (SMP). Alguns estudos demonstraram que ela estava associada à tensão aumentada na medula espinhal, e a partir disso estava formada a base para uma possível explicação fisiopatológica da herniação tonsilar. Séries de casos surgiram relatando que o tratamento para a SMP com a secção do filum terminale poderia proporcionar melhora clínica aos pacientes com MC1. Uma nova entidade patológica surgiu quando se percebeu que pacientes com o quadro clínico de SMP poderiam ter o cone medular em sua posição normal, diferente da migração caudal esperada para a SMP. Essa condição ficou conhecida como SMP oculta. Séries de casos tentaram demonstrar sua associação com a origem da MC1, uma associação nada intuitiva, visto que o cone na posição normal contradiz a tração como fonte da herniação tonsilar. A ausência de ensaios randomizados controlados até o dia de hoje não permite concluir a eficácia do método de secção do filum no tratamento de pacientes com MC1.

Keywords

Arnold-Chiari malformation - cauda equina - tonsillar herniation - tethered cord syndrome; spinal cord

Palavras-chave

Malformação de Arnold-Chiari - Cauda Equina - Herniação Tonsilar - Síndrome da Medula Presa - Medula Espinhal

Contribution Details

Acquisition of data: J.N.P.O.B., P.A.D., P.B.B.J.,


Analysis and interpretation of data: J.N.P.O.B., P.A.D., P.B.B.J.


Drafting the article: J.N.P.O.B., P.A.D., P.B.B.J.


Critically revising the article: J.N.P.O.B., P.A.D., J.B.B.J., C.B.T., L.A.M., E.B.S., M.M.C.


Reviewed submitted version of manuscript: J.N.P.O.B., P.A.D., J.B.B.J., C.B.T., L.A.M., E.B.S., M.M.C.


Study supervision: JNPOB, PAD




Publication History

Received: 29 July 2022

Accepted: 24 January 2023

Article published online:
28 June 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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