open access

Vol 77, No 4 (2018)
ORIGINAL ARTICLES
Published online: 2018-04-19
Submitted: 2018-03-07
Accepted: 2018-04-10
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Morphometric parameters and histological study of the filum terminale of adult human cadavers and magnetic resonance images

A. Y. Nasr, A. M. Hussein, S. A. Zaghloul
DOI: 10.5603/FM.a2018.0041
·
Pubmed: 29802712
·
Folia Morphol 2018;77(4):609-619.

open access

Vol 77, No 4 (2018)
ORIGINAL ARTICLES
Published online: 2018-04-19
Submitted: 2018-03-07
Accepted: 2018-04-10

Abstract

Background: Morphology and histology of filum terminale (FT) has a role in the pathophysiology of tethered cord syndrome (TCS). This research was implemented to investigate the morphometric parameters and histological structure of normal FT in adult human cadavers and magnetic resonance imaging (MRI) scans to correlate them with the pathophysiology of TCS.

Materials and methods: Twenty five adult human cadavers (15 males, 10 females) and 100 MRI echo scans of lumbosacral region (50 males and 50 females), were used in this study. MRI patients were divided into 21–40 and 41–60 age groups. The cadavers were dissected at the prone position to explore their fila. The length of FT, filum terminale internum (FTI), filum terminale externum (FTE), vertebral level of beginning, dural piercing and termination of FT, and the initial, midpoint, and mid-FTE diameters were determined. Four segments were excised from lower conus, upper, middle, and lower thirds of FT. The specimens were processed for light microscopic examination. Statistical analysis was done for these parameters.

Results: MRI morphometrical parameters of FT, except FTI length, revealed no age effect or sex differences, where length of FTI, FTE, initial diameter, level of conus medullaris termination (CMT) and dural sac termination (DST) were 174.1 ± 16.8, 75.8 ± 9.5, 1.6 ± 0.21, L1-2 and S2U in males and 166.9 ± 18.9, 74.1 ± 9.3, 1.53 ± 0.25, L1-2 and S2M vertebrae in females, respectively. However, non-significant sex difference was observed in morphometric parameters of cadaveric FT, where length of FTI and FTE, initial diameter, CMT and DST levels were 164.2 ± 11.6, 76.7 ± 8.1, 1.7 ± 0.14, L1L and S2U vertebrae in males and 159.2 ± 10.1, 71.02 ± 7.3, 1.6 ± 0.29, L1L and S2U in females, respectively. Moreover, CMT below L2 vertebra was seen in 5% of MRI scans and 8% of cadavers. Also, the initial diameter of FT > 2 mm was recorded in 7% of MRI and 8% of cadaveric cases. Histologically, the structure of FT showed gradual reduction in nervous, glial, and vascular tissues with converse increase in collagen content in FTE compared with those of FTI.

Conclusions: Knowledge of the morphometric parameters and the histological structure of FT are necessary for clinicians who dealing with diagnosis or treatment of tethered cord syndrome.

Abstract

Background: Morphology and histology of filum terminale (FT) has a role in the pathophysiology of tethered cord syndrome (TCS). This research was implemented to investigate the morphometric parameters and histological structure of normal FT in adult human cadavers and magnetic resonance imaging (MRI) scans to correlate them with the pathophysiology of TCS.

Materials and methods: Twenty five adult human cadavers (15 males, 10 females) and 100 MRI echo scans of lumbosacral region (50 males and 50 females), were used in this study. MRI patients were divided into 21–40 and 41–60 age groups. The cadavers were dissected at the prone position to explore their fila. The length of FT, filum terminale internum (FTI), filum terminale externum (FTE), vertebral level of beginning, dural piercing and termination of FT, and the initial, midpoint, and mid-FTE diameters were determined. Four segments were excised from lower conus, upper, middle, and lower thirds of FT. The specimens were processed for light microscopic examination. Statistical analysis was done for these parameters.

Results: MRI morphometrical parameters of FT, except FTI length, revealed no age effect or sex differences, where length of FTI, FTE, initial diameter, level of conus medullaris termination (CMT) and dural sac termination (DST) were 174.1 ± 16.8, 75.8 ± 9.5, 1.6 ± 0.21, L1-2 and S2U in males and 166.9 ± 18.9, 74.1 ± 9.3, 1.53 ± 0.25, L1-2 and S2M vertebrae in females, respectively. However, non-significant sex difference was observed in morphometric parameters of cadaveric FT, where length of FTI and FTE, initial diameter, CMT and DST levels were 164.2 ± 11.6, 76.7 ± 8.1, 1.7 ± 0.14, L1L and S2U vertebrae in males and 159.2 ± 10.1, 71.02 ± 7.3, 1.6 ± 0.29, L1L and S2U in females, respectively. Moreover, CMT below L2 vertebra was seen in 5% of MRI scans and 8% of cadavers. Also, the initial diameter of FT > 2 mm was recorded in 7% of MRI and 8% of cadaveric cases. Histologically, the structure of FT showed gradual reduction in nervous, glial, and vascular tissues with converse increase in collagen content in FTE compared with those of FTI.

Conclusions: Knowledge of the morphometric parameters and the histological structure of FT are necessary for clinicians who dealing with diagnosis or treatment of tethered cord syndrome.

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Keywords

filum terminale, morphometry, measurements, histology, magnetic resonance imaging, adult, cadavers

About this article
Title

Morphometric parameters and histological study of the filum terminale of adult human cadavers and magnetic resonance images

Journal

Folia Morphologica

Issue

Vol 77, No 4 (2018)

Pages

609-619

Published online

2018-04-19

DOI

10.5603/FM.a2018.0041

Pubmed

29802712

Bibliographic record

Folia Morphol 2018;77(4):609-619.

Keywords

filum terminale
morphometry
measurements
histology
magnetic resonance imaging
adult
cadavers

Authors

A. Y. Nasr
A. M. Hussein
S. A. Zaghloul

References (26)
  1. Aggarwal A, Kaur H, Batra YK, et al. Anatomic consideration of caudal epidural space: a cadaver study. Clin Anat. 2009; 22(6): 730–737.
  2. Bancroft JD, Gamble M. Theory and practice of histological techniques. 5th ed. Edinburgh. New York, London, Philadelphia Churchill Livingstone. 2002. 125–138, 172-175, 184-193, 593-620.
  3. Barun KS, Rubi D, Sumit K, et al. magnetic resonance imaging study of the variations of position of conus medullaris and thecal sac in the adult population in Sikkim. Indian J Clin Anat Physiology. 2017; 4(1): 8–10.
  4. Cummings T, George T. The Immunohistochemical Profile of the Normal Conus medullaris and Filum terminale. Neuroembryology. 2003; 2(2): 43–49.
  5. Demiryürek D, Aydingöz U, Akşit MD, et al. MR imaging determination of the normal level of conus medullaris. Clin Imaging. 2002; 26(6): 375–377.
  6. De Vloo P, Monea AG, Sciot R, et al. The filum terminale: a cadaver study of anatomy, histology, and elastic properties. World Neurosurg. 2016; 90: 565–573.e1.
  7. Eric TM, Michael SJ, Garth W, et al. Clinical significance of imaging and histological characteristics of filum terminale in tethered cord syndrome. J Neurosurg Pediatr. 2014; 13(3): 255–259.
  8. Filippidis AS, Kalani MY, Theodore N, et al. Spinal cord traction, vascular compromise, hypoxia, and metabolic derangements in the pathophysiology of tethered cord syndrome. Neurosurg Focus. 2010; 29(1): E9.
  9. Fontes RBV, Saad F, Soares MS, et al. Ultrastructural study of the filum terminale and its elastic fibers. Neurosurgery. 2006; 58(5): 978–984; discussion 978.
  10. Karabulut O, Akay H, Karabulut Z, et al. Conus medullaris position in an adult population: analysis of magnetic resonance imaging. Int J Morphol. 2016; 34(4): 1352–1356.
  11. Li J, Zhang J, Guan X, et al. Scanning electron microscopy (SEM) study on filum terminale with human fetus. Int J Clin Exp Med. 2016; 9(2): 3118–3124.
  12. Liu FY, Li JF, Guan X, et al. SEM study on filum terminale with tethered cord syndrome. Childs Nerv Syst. 2011; 27(12): 2141–2144.
  13. Moore KL, Persaud TVN, Mark G. Torchia. The developing of human, clinically oriented embryology. 10th ed. Saunders. 2015.
  14. Moussallem CD, El Masri H, El-Yahchouchi C, et al. Relationship of the lumbar lordosis angle to the level of termination of the conus medullaris and thecal sac. Anat Res Int. 2014; 2014: 351769.
  15. Nasr AY, Nasr AY. Clinical relevance of conus medullaris and dural sac termination level with special reference to sacral hiatus apex: anatomical and MRI radiologic study. Anat Sci Int. 2017; 92(4): 456–467.
  16. Pinto FC, Fontes RB, Leonhardt Md, et al. Anatomic study of the filum terminale and its correlations with the tethered cord syndrome. Neurosurgery. 2002; 51(3): 725–729; discussion 729.
  17. Selçuki M, Vatansever S, Inan S, et al. Is a filum terminale with a normal appearance really normal? Childs Nerv Syst. 2003; 19(1): 3–10.
  18. Selden NR, Nixon RR, Skoog SR, et al. Minimal tethered cord syndrome associated with thickening of the terminal filum. J Neurosurg. 2006; 105(3 Suppl): 214–218.
  19. Soleiman J, Demaerel P, Rocher S, et al. Magnetic resonance imaging study of the level of termination of the conus medullaris and the thecal sac: influence of age and gender. Spine (Phila Pa 1976). 2005; 30(16): 1875–1880.
  20. Soonwook Kwon , Kim T, Kim H, et al. The tip level of the conus medullaris by magnetic resonance imaging and cadaver studies in korean adults. Korean J Physical Anthropol. 2016; 29(2): 47–51.
  21. Standring S. Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice41st ednEdinburgh, London, New York, PhiladelphiaSydneyToronto: Churchill Livingstone Elsevier. 2016.
  22. Stroman PW, Wheeler-Kingshott C, Bacon M, et al. The current state-of-the-art of spinal cord imaging: methods. Neuroimage. 2014; 84: 1070–1081.
  23. Tehli O, Hodaj I, Kural C, et al. A comparative study of histopathological analysis of filum terminale in patients with tethered cord syndrome and in normal human fetuses. Pediatr Neurosurg. 2011; 47(6): 412–416.
  24. Tubbs RS, Murphy RL, Kelly DR, et al. The filum terminale externum. J Neurosurg Spine. 2005; 3(2): 149–152.
  25. Yamada S, Won DJ, Yamada SM, et al. Adult tethered cord syndrome: relative to spinal cord length and filum thickness. Neurol Res. 2004; 26(7): 732–734.
  26. Yamada S, Won DJ, Pezeshkpour G, et al. Pathophysiology of tethered cord syndrome and similar complex disorders. Neurosurg Focus. 2007; 23(2): E6.

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