gms | German Medical Science

61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010
Joint Meeting mit der Brasilianischen Gesellschaft für Neurochirurgie am 20. September 2010

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21. - 25.09.2010, Mannheim

Congenital cervical tethered cord in an adult – utility of spinal diffusion tensor MR imaging

Meeting Abstract

  • Nils Ole Schmidt - Neurochirurgische Klinik, Universitäts-Krankenhaus Eppendorf, Deutschland
  • Frank Raimund - Neurochirurgische Klinik, Universitäts-Krankenhaus Eppendorf, Deutschland
  • Ann-Freya Foerster - Klinik und Poliklinik für Radiologie, Universitäts-Krankenhaus Eppendorf, Deutschland
  • Jens Fiehler - Klinik und Poliklinik für Radiologie, Universitäts-Krankenhaus Eppendorf, Deutschland
  • Dietrich Winkler - Neurochirurgische Klinik, Universitäts-Krankenhaus Eppendorf, Deutschland
  • Manfred Westphal - Neurochirurgische Klinik, Universitäts-Krankenhaus Eppendorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1811

DOI: 10.3205/10dgnc282, URN: urn:nbn:de:0183-10dgnc2823

Veröffentlicht: 16. September 2010

© 2010 Schmidt et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Tethering of the spinal cord rarely occurs in the cervical region and the presentation in adulthood is extremely rare. Here, we report the case of a 30-year old female with a progressive symptomatic cervical tethered cord presenting with paresthesia and episodic spasmodic pain of the left arm. In patients with a tethered cord conventional MR imaging frequently fails to detect stretched-induced pathological changes of the myelon despite the presence of spinal cord dysfunction.

Methods: As recent developments in neuroimaging suggest that diffusion tensor MR imaging (DTI) may be more sensitive to detect spinal cord injuries we included DTI in our pre- and postoperative work up.

Results: Neuroradiological evaluation of the spine revealed a dorsal extension of the myelon at level C2/3 which merged into a restiform structure stretching out to the nuchal skin. Changes in diffusion tensor MR imaging parameters allowed the visualization of tethering-induced abnormalities of the myelon. We performed a microsurgical intradural detethering of the myelon and excised a firm, string-like structure consisting of fibrous connective tissue with a chronic inflammatory tissue response as assessed by histolopathologic analysis. Postoperatively the patient reported an immediate relief of symptoms with no recurrence during the follow up period. DTI-MR imaging one year after surgery demonstrated a clearly normalized cranial-caudal fiber orientation at the detethered level.

Conclusions: Spinal dysfunction in our patient was clearly the result of tethering of the cervical cord by a histologically regressed congenital dermal sinus tract. Conventional MR imaging revealed no pathological intramedullary signal changes which could explain the progressive neurology. In contrast, DTI revealed abnormal parameters at the level of tethering. This case demonstrates that DTI in patients with a tethered cord is feasible and has the potential to add valuable information.