Il «Tethered Cord» è una malformazione congenita polimorfa the insorge a partire dalla 6° settimana di vita embrionale. II quadro anatomo-radiologico è caratterizzato da un cono midollare ancorato in posizione anomala, per lo più estremamente bassa, da alcune forme di anomalie intradurali, e si inquadra frequentemente nell'ambito della sequenza malformativa di uno stato disrafico.
Il miglioramento prodotto dalla TC e dalla mielo-TC nella neurodiagnostica dei disrafismi spinali è stato ulteriormente incrementato dall'avvento della risonanza magnetica. Anche se quest'ultima consente frequentemente un inquadramento completo, in alcuni casi l'integrazione con mielo-TC permette una valutazione più precisa dell'estensione e dei rapporti delle varie componenti la malformazione.
Tuttavia alcuni aspetti della malformazione possono restare poco chiari, ancora insoluto appare il problema del riconoscimento del cono midollare dal filum terminale ispessito in alcune forme di «Tethered Cord». In questi casi tale difficoltà si riscontra anche in sede operatoria, pur utilizzando tecniche microchirurgiche. Proponiamo pertanto di definire l'unità anatomica Cono Midollare - Filum Terminale ispessito morfologicamente indistinti: «Struttura neurofibrosa».
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