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Volume 12 Supplement 1

Abstracts from Hydrocephalus 2015

  • Poster presentation
  • Open Access

Surgical treatment results and pathological features in pediatric occult tight filum syndrome

  • 1,
  • 2,
  • 3,
  • 4 and
  • 5Email author
Fluids and Barriers of the CNS201512 (Suppl 1) :P21

  • Published:


  • Clinical Syndrome
  • Neurological Sign
  • Consecutive Series
  • Radiographic Evidence
  • Bladder Dysfunction


Occult tight filum terminale syndrome (OTCS) is defined as a clinical syndrome of tethered cord and without “classic” radiographic evidence of low lying conus and/or fatty filum.


A consecutive series of 11 children (2-17 years) diagnosed with tethered cord syndrome (Triad of neurological, urological and orthopedic findings) since 2010, a non-diagnostic MRI, underwent microsurgical resection of the filum. Presenting symptoms and symptoms most responsive to surgery, imaging and pathology of the filum were analyzed.


OTSC show the overall improvement in all dimensions of the clinical syndrome, e.g. scoliosis, walking and falling spells, incontinence and overall activity level due to improved pain. Increased tone in the lower extremities and foot deformities appeared as a negative predictor of improvement. Associated syringohydromyelia did not show any change in the 1 year follow-up MRI despite marked clinical improvement. Pathology shows a variety of features including “nerve twigs”.


The accuracy of the clinical TRIAD consisting of symptoms in the dimensions of bowel and bladder dysfunction, orthopedic and neurological signs to define “occult filum terminale or occult tight filum syndrome” and the accuracy of the clinical TRIAD to predict surgical success of detethering has to be explored and proven in a prospective fashion.

Authors’ Affiliations

Neurosurgical Department, Rhode Island Hospital, USA
Neuropathology, Rhode Island Hospital, USA
Neuropathology, Rhode Island Hospital, USA
Neuropatholgy, Rhode Island Hospital, USA
Neurosurgical Department, Rhode Island Hospital, USA


  1. Wikkelso C, Hellstrom P, Klinge PM, Tans JT: European i NPHMSG: The European iNPH Multicentre Study on the predictive values of resistance to CSF outflow and the CSF Tap Test in patients with idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry. 2013, 84: 562-568. 10.1136/jnnp-2012-303314.View ArticlePubMedGoogle Scholar
  2. Brinker T, Stopa E, Morrison J, Klinge P: A new look at cerebrospinal fluid circulation. Fluids and barriers of the CNS. 2014, 11: 10-10.1186/2045-8118-11-10.PubMed CentralView ArticlePubMedGoogle Scholar


© Julian et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.