Drop foot and adult onset tethered cord syndrome caused by filum terminal ependymoma: A case report

Dewa Putu Wisnu Wardhana; Made Agung Yudistira Permana; Steven Awyono; Rani Paramitha Iswari Maliawan; Novita; Rohadi Muhammad Rosyidi

doi:10.15562/bmj.v11i3.3179

Drop foot and adult onset tethered cord syndrome caused by filum terminal ependymoma: A case report

Dewa Putu Wisnu Wardhana ,

Made Agung Yudistira Permana ,

Steven Awyono ,

Rani Paramitha Iswari Maliawan ,

Novita ,

Rohadi Muhammad Rosyidi ,

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DOI: https://doi.org/10.15562/bmj.v11i3.3179 |
Published: 2022-10-11

Abstract

Introduction: Filum terminal is a fibrous tissue to stabilize the position of the spinal cord, located in both intradural and extradural sections anchored caudally to the coccyx. Tumors located at the filum terminal are a rare case. Filum terminal does not have any spinal cord component, but tumours in that area can directly cause a significant neurological disorder.

Case Presentation: Presenting 43 years old man with chief complaints of drop left foot and tethered cord syndromes. MR Image revealed 9,4x10mm intradural extramedullary mass at L1 with L1-L5 disc desiccation. The patient was untethered by laminectomy and underwent total mass excision. The sample was analyzed pathologically, and the results matched myxopapillary ependymoma. Pain sensation and sensory disturbance immediately improved after surgery. The urinary disorder also gradually improved. The patient was discharged without any urinary problems. After six months of follow-up, painless, mild left lower drop foot and mild gait disturbance was found without residual urinary and other neurological disorder.

Conclusion: Filum terminal ependymomas need to be considered for differential diagnoses in patients with drop foot and adult-onset tethered cord syndromes.

References

Huynh T, Lu C, Drazin D, Lekovic G. Myxopapillary ependymoma with anaplastic features: A case report with review of the literature. Surg Neurol Int. 2018;9(1):191.
World Health Organization. WHO classification of tumours of the central nervous system. Revised 4th edition. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, editors. Lyon: International Agency for Research on Cancer; 2016. 408 p. (World Health Organization classification of tumours).
Sudhan M, Satyarthee G, Joseph L, Sharma M, Kakkar A, Sharma B. Management and outcome analysis of conus and filum ependymoma: A tertiary center study. Asian J Neurosurg. 2019;14(3):821.
Westhout FD, Pare LS, Linskey ME. Central Causes of Foot Drop: Rare and Underappreciated Differential Diagnoses. J Spinal Cord Med. 2007 Jan;30(1):62–6.
Kural C, Guresci S, Simsek GG, Arslan E, Tehli O, Solmaz I, et al. Histological structure of filum terminale in human fetuses: Laboratory investigation. J Neurosurg Pediatr. 2014 Apr;13(4):362–7.
Saker E, Henry BM, Tomaszewski KA, Loukas M, Iwanaga J, Oskouian RJ, et al. The filum terminale internum and externum: A comprehensive review. J Clin Neurosci. 2017 Jun;40:6–13.
Borges LF. Spinal intramedullary ependymoma: surgical approaches and outcome. J Neurosurg Sci. 2018;62(1):12.
Kim JS, Jung B. Myxopapillary Ependymoma of Filum Terminale Mimicking Nerve Sheath Tumor. :4.
Shih P, Halpin RJ, Ganju A, Liu JC, Koski TR. Management of recurrent adult tethered cord syndrome. Neurosurg Focus. 2010 Jul;29(1):E5.
Kim DJ, Han MH, Lee S. Extramedullary tanycytic ependymoma of the lumbar spinal cord. Yeungnam Univ J Med. 2020 Apr 30;37(2):128–32.
Kanda S, Akiyama T, Chikuda H, Yamaguchi T, Saita K. An Unusual Presentation of Adult Tethered Cord Syndrome Associated with Severe Chest and Upper Back Pain. Case Rep Orthop. 2015;2015:1–5.
Klekamp J. Tethered cord syndrome in adults: Clinical article. J Neurosurg Spine. 2011 Sep;15(3):258–70.
Elmesallamy W, AbdAlwanis A, Mohamed S. Tethered cord syndrome: surgical outcome of 43 cases and review of literatures. Egypt J Neurosurg. 2019 Dec;34(1):4.
Sofuoglu OE, Abdallah A, Emel E, Ofluoglu AE, Gunes M, Guler B. Management of tethered cord syndrome in adults: experience of 23 cases. Turk Neurosurg [Internet]. 2015 [cited 2021 Sep 30]; Available from: http://www.turkishneurosurgery.org.tr/summary_en_doi.php3?doi=10.5137/1019-5149.JTN.15892-15.1
Düz B, Gocmen S, Ibrahim Secer H, Basal S, Gönül E. Tethered Cord Syndrome in Adulthood. J Spinal Cord Med. 2008 Jan;31(3):272–8.
Sharif Bidabadi S, Tan T, Murray I, Lee G. Tracking Foot Drop Recovery Following Lumbar-Spine Surgery, Applying Multiclass Gait Classification Using Machine Learning Techniques. Sensors. 2019 Jun 4;19(11):2542.
Celano E, Salehani A, Malcolm JG, Reinertsen E, Hadjipanayis CG. Spinal cord ependymoma: a review of the literature and case series of ten patients. J Neurooncol. 2016 Jul;128(3):377–86.
Toyoda H, Yamada K, Terai H, Hoshino M, Suzuki A, Takahashi S, et al. Classification and prognostic factors of residual symptoms after minimally invasive lumbar decompression surgery using a cluster analysis: a 5-year follow-up cohort study. Eur Spine J. 2021 Apr;30(4):918–27.

[1] Huynh T, Lu C, Drazin D, Lekovic G. Myxopapillary ependymoma with anaplastic features: A case report with review of the literature. Surg Neurol Int. 2018;9(1):191.

[2] World Health Organization. WHO classification of tumours of the central nervous system. Revised 4th edition. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, editors. Lyon: International Agency for Research on Cancer; 2016. 408 p. (World Health Organization classification of tumours).

[3] Sudhan M, Satyarthee G, Joseph L, Sharma M, Kakkar A, Sharma B. Management and outcome analysis of conus and filum ependymoma: A tertiary center study. Asian J Neurosurg. 2019;14(3):821.

[4] Westhout FD, Pare LS, Linskey ME. Central Causes of Foot Drop: Rare and Underappreciated Differential Diagnoses. J Spinal Cord Med. 2007 Jan;30(1):62–6.

[5] Kural C, Guresci S, Simsek GG, Arslan E, Tehli O, Solmaz I, et al. Histological structure of filum terminale in human fetuses: Laboratory investigation. J Neurosurg Pediatr. 2014 Apr;13(4):362–7.

[6] Saker E, Henry BM, Tomaszewski KA, Loukas M, Iwanaga J, Oskouian RJ, et al. The filum terminale internum and externum: A comprehensive review. J Clin Neurosci. 2017 Jun;40:6–13.

[7] Borges LF. Spinal intramedullary ependymoma: surgical approaches and outcome. J Neurosurg Sci. 2018;62(1):12.

[8] Kim JS, Jung B. Myxopapillary Ependymoma of Filum Terminale Mimicking Nerve Sheath Tumor. :4.

[9] Shih P, Halpin RJ, Ganju A, Liu JC, Koski TR. Management of recurrent adult tethered cord syndrome. Neurosurg Focus. 2010 Jul;29(1):E5.

[10] Kim DJ, Han MH, Lee S. Extramedullary tanycytic ependymoma of the lumbar spinal cord. Yeungnam Univ J Med. 2020 Apr 30;37(2):128–32.

[11] Kanda S, Akiyama T, Chikuda H, Yamaguchi T, Saita K. An Unusual Presentation of Adult Tethered Cord Syndrome Associated with Severe Chest and Upper Back Pain. Case Rep Orthop. 2015;2015:1–5.

[12] Klekamp J. Tethered cord syndrome in adults: Clinical article. J Neurosurg Spine. 2011 Sep;15(3):258–70.

[13] Elmesallamy W, AbdAlwanis A, Mohamed S. Tethered cord syndrome: surgical outcome of 43 cases and review of literatures. Egypt J Neurosurg. 2019 Dec;34(1):4.

[14] Sofuoglu OE, Abdallah A, Emel E, Ofluoglu AE, Gunes M, Guler B. Management of tethered cord syndrome in adults: experience of 23 cases. Turk Neurosurg [Internet]. 2015 [cited 2021 Sep 30]; Available from: http://www.turkishneurosurgery.org.tr/summary_en_doi.php3?doi=10.5137/1019-5149.JTN.15892-15.1

[15] Düz B, Gocmen S, Ibrahim Secer H, Basal S, Gönül E. Tethered Cord Syndrome in Adulthood. J Spinal Cord Med. 2008 Jan;31(3):272–8.

[16] Sharif Bidabadi S, Tan T, Murray I, Lee G. Tracking Foot Drop Recovery Following Lumbar-Spine Surgery, Applying Multiclass Gait Classification Using Machine Learning Techniques. Sensors. 2019 Jun 4;19(11):2542.

[17] Celano E, Salehani A, Malcolm JG, Reinertsen E, Hadjipanayis CG. Spinal cord ependymoma: a review of the literature and case series of ten patients. J Neurooncol. 2016 Jul;128(3):377–86.

[18] Toyoda H, Yamada K, Terai H, Hoshino M, Suzuki A, Takahashi S, et al. Classification and prognostic factors of residual symptoms after minimally invasive lumbar decompression surgery using a cluster analysis: a 5-year follow-up cohort study. Eur Spine J. 2021 Apr;30(4):918–27.

Drop foot and adult onset tethered cord syndrome caused by filum terminal ependymoma: A case report

Abstract

References

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