[vini]

hi all

any body heard of this opp please chime in, could this help any one we know ,could tension on the filum terminale cause cysts ?
kind regards Vini

link to full article http://www.institutneurologicbcn.com...old-chiari.htm


Figure 2.- Simplified sagittal section of the skull and the brain, normal on the left, on the right, with the cerebellum protruding downward through the foramen occipitalis as does when there is an Arnold Chiari malformation.

Does the section of the filum terminale make the brain move back to its original place?
If the human brain had the plasticity and memory of a spring or if it was made of rubber, the cerebellar tonsils and the cerebellum would move back to their original position. However, tha brain has formed under a strong traction power. When it is freed from this strain, its recovering depends on its degree of plasticity, which in time depends on the age of the patient, the genes, the time and intensity of the strain.

Then, what is the use of cutting the ligament?
The first thing achieved with the section of the filum terminale is the elimination of the main strain that makes the disease progress. Thus, the progression of the disease is stopped when the cause is supressed. The symptoms of the Chairi I disease are due to the stress suffered by the brain tissue as it is moved downward and it protrudes into the foramen occipitalis. When the filum terminale is cut, in spite of the fact that the magnetic resonance imaging does not show any apparent change in the position of the protruding part of the brain, the strain of the spinal cord has disappeared and the opression inside the foramen occipitalis has decreased. Congestion and the lack of blood in the affected area improve and, therefore, the symptoms these caused also improve.

What exactly is the surgical section of the filum terminale?
The surgical section of the filum terminale is carried out by making a small incision on the sacrum, at the end of the backbone, so there is no alteration of the spine mechanics, visualizing the filum terminale and cutting it by means of microsurgery techniques, all of which is done in hardly half an hour and the patient is in hospital less than a day.

What are the consecuences of cutting this ligament?
The filum terminale is the result of the empty cover of the spine cord at the lower back or lumbosacral region. The covering that separates the spinal cord from the spine at the sacrum and lower back, dura mater, arachnoid mater and pia mater, do not contain spine cord anymore and fold as a fibrous cord which forms the filum terminale; this portion of the spinal cord can be compared to a sock we are wearing and we pull taking it half way off our foot: the half that does not contain our foot could be cut with no risk to our foot. In much the same way, the filum terminale can be cut at any point with no harm.

Does the spinal cord suffer because of the tethering?
Research and tests with animals have proven that a mild tethering of the spinal cord makes neurons stop functioning due to insufficient blood flow. In humans, intense tethering decreases blood flow inside the spinal cord, because there are important arteries there for the spinal cord and because spinal cord arteries are centripetal, they go from the outside to the inside, especially at the cervical region, since there is the limit to the downward movement. The lack of blood flow causes the necrosis or death of part of the spinal cord tissue, and then it attracts interstitial fluid from within the spine and forms a cyst in the centre of the spinal cord called syringomyelic cavity, syrinx or Syringomyelia, a disease described 500 years ago, of unknown cause up to present.

Does tethering of the spinal cord have any effects on the brain?
The strain of the filum terminale, besides forcing the spine to bend, in order to prevent the strain of the spinal cord, it also pulls downward the lower part of the brain, the socalled cerebellar tonsils, into the foramen occipitalis which connects the skull to the spine, causing the Arnold Chiari malformation, a disease described 100 years ago and was of unknown cause up to present.

The surgical section of the filum for Arnold Chiari malformation makes the downward strain disappear for the cerebellar tonsils, it stops them from suffering because they do not opress themselves into the foramen occipitalis anymore. The operation improves many of the symptoms of the disease and the cerebellar tonsils do not move upwards because they are deformed and because of their little elasticity.
The tethering of the filum terminale, aside from causing a downward movement of the cerebellum and the death of the central part of the spinal cord, generates a flexion-producing stimulus on the spine that seeks preventing the strain of the spinal cord and causes a spinal deformity called scoliosis.
The section of the filum terminale supresses the flexion-producing stimulus and stops scoliosis.

Does this mean that syringomyelia can also be treated with the same surgical technique as scoliosis and Chiari I malformation?
In a similar way to scolisis and Chiari I malformation, in the case of syringomyelia the section of the filum terminale stops the disease. The cyst resulting from the necrosis remains the same, but it may disappear when the space surrounding the spinal cord opens spontaneously or does so towards its centre where there is the ependymal canal, which connects the centre of the spinal cord to the brain cavities. This does not mean that the disease is cured, it only means that the cyst has emptied; the disease persists since it is about spine cord strain. The symptoms of the disease are caused by the cell death and the tumor-like effect of the cyst. The section of the filum has three beneficial effects: it stops the death of cells caused by spine cord strain, it helps recover the non functioning but alive neurons, and it diminishes the tumor-like effect of the cyst because it relaxes the spinal cord.

Has this treatment been applied to patients?
40 patients of the three diseases, that is, scoliosis, Arnold Chiari malformation and syringomyelia, have been operated; some had all three conditions, and in some cases, the improvement has been dramatic.

Can you give an examplel?
A forty-eight year old woman had a very pronounced scoliosis; she had had back pains since the age of fourteen, whatever position she was in, even lying in bed, when getting up, when rolling constantly, she did not have a pause for thirty-four years. She was operated seven months ago and has not had the slightest vertebral pain since (case 14 of publication 4).
One case of syringomyelia: a young man of twenty-five, he had no sense for temperature on the left side of his body and had a big cyst in the centre of the spinal cord (case 2 of publications 3 and 4). Six hours after the operation, the specialist verified the total recovery of the patient’s sense of touch, the improvement lasting to present, eleven years later. This patient now works in a warehouse in Galicia, while other specialists, at the sight of his serious injuries predicted total disability in two years after diagnosing syringomyelia.