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To explore the position change of fetal conus medullaris by ultrasound, and to propose gestational age-specific references for the lower limits of fetal conus medullaris level.We prospectively collected the imaging and clinical data of fetuses whose mothers accepted routine prenatal ultrasonic follow-ups in the Department of Medical Ultrasonics, Chinese PLA General Hospital, between November 2020 and April 2021. By assigning to the conus medullaris levels, calculating statistical data, and performing linear regression analysis, we determined the correlation between the conus medullaris level and gestational week, as well as between the 95th percentile of the conus medullaris level, i.e., the lower limit of the conus medullaris level, and gestational week.We included 1202 different fetuses at 17-40 gestational weeks in the study. Both the conus medullaris level and the 95th percentile of the conus medullaris level were linearly correlated with gestational week. We calculated the adjusted values of the lower limits of fetal conus medullaris levels, that is, the theoretical references of the lower limits, according to the linear regression equation, and composed a comparison table.The fetal conus medullaris position continues changing cranially with gestational weeks during the whole pregnancy. The conus medullaris of a term fetus should not lie below the L2 vertebra level at birth. We proposed reference criteria of fetal low-lying conus medullaris for each gestational week from 17 to 40 weeks of gestational age, which potentially help prompt diagnosis and improve prognosis of fetal tethered cord syndrome.

To investigate the efficacy of surgical intervention with antibiotic treatment for congenital dermal sinus (CDS) with central nervous system infection.Clinical data of 20 patients with CDS and central nervous system infection were retrospectively analyzed. All patients received early surgical treatment combined with postoperative antibiotic therapy after the diagnosis was confirmed. The infection control effect was evaluated according to the clinical symptoms, laboratory examination results, and improvement of neurological function.All 20 patients were treated with complete resection of the CDS and postoperative antibiotic therapy. No severe surgical complications occurred. Patients were followed for 3-81 months with a median follow-up time of 37.5 months. Postoperative infection was effectively controlled with no recurrence. Neurological dysfunction and related symptoms improved to varying extents after treatment, and the Spina Bifida Neurological Scale score at the final follow-up significantly increased.Patients with CDS and central nervous system infection should receive surgical management at an early stage with antibiotic treatment. This treatment algorithm was effective for control infection and protection of neurological function.

The conus medullaris is the distal tapering end of the spinal cord, and the filum terminale (FT) is regarded as a bundle of nonfunctional fibrous tissue; therefore, some scholars call it the spinal ligament, while others describe the human FT as "remnants of the spinal cord." It was later found that in the human spinal cord, the FT is composed of an intradural segment and an epidural segment, and the end of the FT is connected to the coccyx periosteum. Because some nerve tissue is also found in the FT, as research progresses, FT may have the potential for transplantation. A lack of exhaustive overviews on the FT in the present literature prompted us to conduct this review. Considering that a current comprehensive review seemed to be the need of the hour, herein, we attempted to summarize previous research and theories on the FT, elucidate its anatomy, and understand its pathological involvement in various diseases.

Background: This study aimed to investigate the treatment and curative effects of thoracic anterior spinal cord herniation. Methods: Clinical data of 7 patients with thoracic anterior spinal cord herniation were represented. All patients were diagnosed with a complete pre-operative examination and scheduled for surgical treatment. In addition, regular follow-up was performed after the surgery, and the operation’s efficacy was evaluated according to clinical symptoms, imaging findings, and improvement in neurological function. Results: All patients underwent spinal cord release with an anterior dural patch. Notably, no severe post-operative surgical complications were observed. 7 patients were followed up for 12–75 months, with an average duration of approximately 46.57 months. Post-operative pain symptoms were effectively controlled, neurological dysfunction and related symptoms improved to varying degrees, and anterior spinal cord herniation did not recur. The modified Japanese Orthopaedic Association score at the last follow-up was significantly higher than the pre-operative score. Conclusions: Clinicians should avoid misdiagnosing patients with thoracic anterior spinal cord herniation with intervertebral disc herniation, arachnoid cysts, and other related diseases, and patients should undergo surgical treatment as early as possible. In addition, surgical treatment can protect the neurological function of patients and effectively prevent the aggravation of clinical symptoms.

OBJECTIVE This study aimed to explore the migration process of the conus medullaris (CM) in early infancy using infant MRI and to evaluate the application of MRI for locating the infant CM level. METHODS The authors retrospectively analyzed the CM level on the lumbosacral MR images of 26 term infants aged < 3 months who were classified into three groups according to age. The authors numbered the CM level in each patient and analyzed the range and average of the CM level of the cohort. The authors studied the linear correlation between CM level and postnatal days with linear regression analysis, 1-way ANOVA, and the least significant difference test. RESULTS The CM level ranged from the superior border of the L1 vertebra to the top third of the L3 vertebra. About 96.2% of infants had CM higher than the superior border of the L3 vertebra. On average, CM was located between the L1–2 intervertebral disc and the inferior border of the L2 vertebra (mean ± SD score 1.64 ± 1.14). The three groups had no significant statistical difference in CM level (F = 1.071 and p = 0.359; groups 1 and 2, p = 0.408; groups 1 and 3, p = 0.170; groups 2 and 3, p = 0.755). CM level had no linear regression correlation with postnatal days within the first month (r2 = 0.061, F = 0.654, p = 0.438) or within the first 3 months (r2 = 0.002, F = 0.056, p = 0.816). CONCLUSIONS The CM level reaches the normal adult level by birth in term infants and does not ascend during childhood. On average, the CM was between the L1–2 intervertebral disc and the inferior border of the L2 vertebra in term infants. Considering the possibility of physiologically low-lying CM, the authors agree that normal CM is located above the L3 level in term infants and CM at the L3 level could be equivocal and should be investigated with other clinical data. The study data suggest that MRI is an accurate and valuable method for determining the CM level in term infants.

To report two cases of type 1.5 split cord malformation (SCM), a subtype of SCM with combined characteristics of types I and II and to review the relevant literature and propose a new possible pathogenetic theory for type 1.5 SCM. A 52-year-old woman had hemicords within a single dural sac with a dorsal bony septum at the L5 level. A 9-year-old boy had hemicords within a single dural sac with a ventral bony septum and fibrous extension at the L3 level. Both patients underwent microsurgical treatments for removing the bony septum, detethering the spinal cord, and sectioning the filum terminale. The surgical procedure revealed an extradural partial bony septum and hemicords within an intact single dural sac in each patient. Both patients were discharged from the hospital without de novo nerve dysfunction. Published cases have validated that types I and II SCM can overlap. We recommend recent type 1.5 SCM as a normative terminology for this overlapping SCM and report two rare cases of this SCM. We propose an associated pathogenesis consisting of uneven distribution and regression to explain type 1.5 SCM. Furthermore, we postulate that the amount of condensing meninx primitiva might determine whether the left bony septum has fibrous extensions to the opposite dura in type 1.5 SCM.

OBJECTIVE To explore the migration process of the conus medullaris (CM) and propose a normal range of CM levels during the third trimester. METHOD We retrospectively collected the ultrasonographic and clinical data of 588 fetuses during the third trimester. We located the CM and assigned scores. One-way analysis of variance and linear regression analyses were used to statistically analyze CM migration. Statistical significance was set at p

Background: This study aimed to investigate the treatment and curative effects of thoracic anterior spinal cord herniation. Methods: Clinical data of 15 patients with thoracic anterior spinal cord herniation were retrospectively analysed. All patients were diagnosed with a complete pre-operative examination and scheduled for surgical treatment. In addition, regular follow-up was performed after the surgery, and the operation’s efficacy was evaluated according to clinical symptoms, imaging findings, and improvement in neurological function. Results: All 15 patients underwent spinal cord release with an anterior dural patch. Notably, no severe post-operative surgical complications were observed. All patients were followed up for 3–108 months, with an average duration of approximately 52.9 months. Post-operative pain symptoms were effectively controlled, neurological dysfunction and related symptoms improved to varying degrees, and anterior spinal cord herniation did not recur. The modified Japanese Orthopaedic Association score at the last follow-up was significantly higher than the pre-operative score. Conclusions: Clinicians should avoid misdiagnosing patients with thoracic anterior spinal cord herniation with intervertebral disc herniation, arachnoid cysts, and other related diseases, and patients should undergo surgical treatment as early as possible. In addition, surgical treatment can protect the neurological function of patients and effectively prevent the aggravation of clinical symptoms.

Objective: To compare the diagnostic accordance rate between prenatal ultrasonography and fetal magnetic resonance imaging (MRI) for varied neural tube defects (NTDs), and introduce detailed prenatal imaging characteristics of multiple NTDs. Design: A prospective observational study Setting: Chinese PLA General Hospital Population: The fetuses developing possible NTDs. Method: We prospectively followed up the fetuses and collected their data of prenatal ultrasonography, fetal MRI, and postnatal MRI examinations. Fisher’s exact test was used to perform the statistical analysis. A P value of < 0.05 was considered statistically significant. Main Outcome Measures: The diagnostic accordance rate of prenatal ultrasonography and fetal MRI for each involved NTD, prenatal imaging characteristics of each involved NTD. Results: We included 119 fetuses with 11 NTDs. Ultrasonography revealed a significant advantage in diagnosing spina bifida (P < 0.05) and a relative advantage in diagnosing intraspinal cyst, dermal sinus, and skin mass. MRI demonstrated intraspinal lipoma better (P < 0.05), and was appropriate for identifying complex malformations. Both could accurately diagnose tethered cord syndrome (without intraspinal lesions), meningocele/myelomeningocele, and sacrococcygeal teratoma. Conclusions: Prenatal ultrasonography and fetal MRI have different advantages in diagnosing NTDs. To ensure a prompt and accurate diagnosis, it is crucial for clinicians to raise awareness of the prenatal imaging characteristics of various NTDs, which will lay a solid foundation for better fetal prognosis. Funding: This study was supported by the Capital’s Funds for Health Improvement and Research (CFH2022-2-5022). Keywords: prenatal ultrasonography, fetal magnetic resonance imaging, neural tube defects, pregnancy, diagnosis, fetus

Cerebellar medulloblastomas are the most common malignant tumors of the posterior fossa in childhood that frequently metastasize. Leptomeningeal dissemination and distant metastasis have been associated with medulloblastomas; however, intramedullary metastases are rare with very few case reports in the literature available. We present a case of a 3-year-old girl with a medulloblastoma who underwent surgical resection of spinal intramedullary metastases. Histopathology revealed the tumor to be an anaplastic medulloblastoma similar to the intracranial lesions. The patient subsequently underwent postoperative chemotherapy followed by radiotherapy. Following the surgery and subsequent follow-up, the patient showed a good recovery without any new neurological dysfunction. Intramedullary metastasis of medulloblastoma remains a rare disease. Surgical resection could play a possible role in the management in addition to radiation and chemotherapy.

Study design Retrospective case series. Objective Anterior sacral meningocele (ASM) is a rare disorder. We reviewed 11 cases of congenital ASM and classified them into three types based on the anatomy and relationship between the cyst and sacral nerve roots. Summary of background data The cohort with ASM is relatively large; the classification is novel and has not been previously reported. Methods Eleven consecutive patients with ASM who underwent surgery between February 2014 and January 2019 were retrospectively analyzed. They included four males and seven females. The dorsal transsacral approach was adopted in all cases. The follow-up time was at least 3 months. Results We attempted to classify ASM into three types. Of the 11 cases, six were caudal type, two were paraneural type, and three were nerve-root type. The meningocele was ligated after exploring no nerve involvement, in Type I and II. For Type III, the herniating sac and involved nerve roots were ligated when the nerve roots were indicated as nonfunctional on neurophysiological monitoring; otherwise, the sacral nerve roots were protected and imbricated on the residual sac like a hand-in-glove, and sutured to reconstruct the nerves sleeve. Eight cases were accompanied by tethered cord syndrome (TCS); spinal cord detethering was done with one-stage operation. Ten patients' presenting symptoms improved at 3 to 6 months' follow-up; notably, constipation significantly improved. Only one case accompanied by an epidermoid cyst had a second laparoscopic surgery by a general surgeon. Conclusion Aim of surgical treatment is to obliterate the communication between the subarachnoid space and herniated sac, detether the spinal cord, and resect the congenital tumor. The new classification helps to recognize the relationship between the meningocele and sacral nerve roots, and subsequently adopt different surgical strategies. We consider the dorsal transsacral approach relatively feasible, safe, and with lower complication. Level of evidence 4.

Objective : Dermoid cysts are uncommon in spinal cord tumors, and the phenomenon of their spontaneous rupture into the syrinx cavity is quite rare. We aimed to analyze the imaging characteristics and etiologies, and propose some surgical strategies, for this uncommon phenomenon.Methods : We retrospectively reviewed 14 cases with spinal dermoid cysts that ruptured into the cervical and thoracic syrinx cavity. There were six male and eight female cases, aged 21 to 46 years, who had lipid droplets in the syrinx cavity from C1 to L3. The dermoid cysts were always located at the conus. Based on patients’ complaints, clinical manifestations, and imaging results, we adopted tumor excision and/or syrinx cavity aspiration in one stage or multiple stages.Results : Three patients had only a syrinx cavity aspiration surgery due to a history of dermoid cyst excision. Eight patients had dermoid cyst resection and syrinx cavity aspiration in one stage. One patient was operated upon in two stages due to the development of new symptoms at nine months follow-up. Two patients underwent only tumor resection since they did not show similar symptoms or signs caused by the cervicothoracic syrinx. The axial magnetic resonance imaging indicated that the lipid droplets were always not at the center but were eccentric. The clinical effect was satisfactory during the follow-up period in this group.Conclusion : The lipid droplets filled the spinal syrinx cavity, not entirely confined to the central canal. Based on the chief complaints and associated signs, we adopted different surgical strategies and had satisfactory clinical results.

Study Design: Retrospective cohort study. Objectives: We aimed to evaluate the effectiveness of terminal ventriculostomy in treating tethered cord syndrome (TCS) combined with terminal syringomyelia (TS) and describe “V”-type ostomy as an effective surgical method to avoid relapsing syringomyelia based on terminal ventriculostomy. Methods: We retrospectively analyzed the clinical and radiological data of 28 patients admitted to the Department of Neurosurgery, PLA General Hospital who had been diagnosed with TCS combined with TS and underwent terminal ventriculostomy-associated “V”-type ostomy between January 2011 and January 2016. We classified patients’ clinical outcomes into 4 levels according to the Spinal Bifida Neurological Scale: markedly improved, improved, stable, and deteriorated. The size of the syrinx cavity was quantified using the syrinx index, and there was a difference in syrinx cavity size between pre-operation and post-operation. Results: Twenty-eight patients were followed up for 36 months. We found that each syrinx cavity shrunk by at least 50%. More than 90% of patients had achieved “markedly improved” and “improved” outcomes during the follow-up visit. Moreover, no patient relapsed for up to 36 months post-surgery. Conclusion: Terminal ventriculostomy has a beneficial effect on TS, particularly on the syrinx cavity extending to the filum terminale. For this special cavity, we advocate the use of terminal ventriculostomy-associated “V”-type ostomy to avoid potential relapse. As a safe, convenient, and persistently effective approach, terminal ventriculostomy-associated “V”-type ostomy can be considered a promising alternative method for treating TCS combined with TS in clinical practice.

Objective: To study the compatibility of traditional tracers and viral tracers with tissue clearing technology and to provide guidance in choosing suitable tracing methods for a specific tissue clearing technique. Method: Experiment 1: In this study, two different types of representative tracers, namely fluorescent dye tracers (Fluoro-Gold and Fluoro-Ruby) and viral tracers carrying fluorescent proteins (rAAV9-hSyn-mCherry-WPRE-pA and rAAV9-hSyn-EGFP-WPRE-pA), were selected to trace the cerebrospinal tract of the animals by microinjection. Furthermore, we presented the signal changes after using the three representative transparentizing methods, which included FRUIT (aqueous tissue clearing), 3DISCO (solvent-based tissue clearing), and uDISCO (solvent-based tissue clearing), were compared after slicing. Experiment 2: Based on the research mentioned above, Fluoro-Ruby was microinjected unilaterally into the primary motor cortex of rats, directly tracing the pyramidal tract to the spinal cord. Then, the entire brain and spinal cord were collected for tissue transparency using the 3DISCO method, after which three-dimensional imaging was performed using optical microscopic imaging equipment. Results: Experiment 1 indicated that Fluoro-Gold and Fluoro-Ruby displayed better compatibility with the three transparent methods. The viral tracer exhibited higher compatibility with the FRUIT method, while its compatibility with 3DISCO and uDISCO was low. Furthermore, GFP was quenched more quickly and seriously than cherry protein under the same experimental conditions. Experiment 2: The Fluoro-Ruby tag displayed the presence of long-distance axons. For microscopic imaging, light sheet microscopy and two-photon microscopy were both used to identify the signals of tracers in transparent tissue. Results: Both Fluoro-Gold and Fluoro-Ruby displayed excellent compatibility with tissue clearing technology, which, with dehydration and delipidation at its core, lead to quenching of fluorescence proteins, while exhibiting poor compatibility with viral tracers. In combination with tissue clearing technology and optical microscopy, the anterograde tracer Fluoro-Ruby could stereoscopically display the complete neural conduction pathway.

Background Quite a few cases of intramedullary meningioma have been described in previously reported studies. We have presented a rare case of intramedullary thoracic meningioma, which was quite different from subdural extramedullary meningioma, and the preliminary diagnosis was mistakenly given as hemangioblastoma. Case Description A 46-year-old man with complaints of gait problems and pain in the right lower extremity was admitted to our hospital. The neurological examination revealed 3 of 5 motor strength, spastic paraparesis, hyperreflexia, increased tone, and sensory deficits in the right lower extremity. Contrast-enhanced images showed a T6-T7 intramedullary lesion and an evident and homogeneously enhanced lesion with clearly defined borders on the sagittal, coronal, and axial views. The preliminary diagnosis was hemangioblastoma. However, he underwent tumor resection, and the histopathological examination findings confirmed the diagnosis of intramedullary meningioma. Conclusion Intramedullary thoracic meningiomas are extremely rare and differ from the common subdural extramedullary meningiomas. Clinicians should be aware of this when diagnosing intramedullary tumors. Gross total resection using a microsurgical technique will be the best treatment strategy.

Copy number variations have been found in patients with neural tube abnormalities. In this study, we performed genome-wide screening using high-resolution array-based comparative genomic hybridization in three children with tethered spinal cord syndrome and two healthy parents. Of eight copy number variations, four were non-polymorphic. These non-polymorphic copy number variations were associated with Angelman and Prader-Willi syndromes, and microcephaly. Gene function enrichment analysis revealed that COX8C, a gene associated with metabolic disorders of the nervous system, was located in the copy number variation region of Patient 1. Our results indicate that array-based comparative genomic hybridization can be used to diagnose tethered spinal cord syndrome. Our results may help determine the pathogenesis of tethered spinal cord syndrome and prevent occurrence of this disease.