Tethered cord with tandem lipomyelomeningoceles, split cord malformation and thick filum
A three month old male infant presented with a congenital skin covered soft tissue mass in midline lumbosacral area. There were multiple cutaneous hemangiomatous skin changes over the soft tissue mass. Neurologic examination was intact especially in lower extremities. Thorough urological evaluation confirmed detrusor sphincter dys-synergy with high pressure bladder according to urodynamic study. Spinal MRI confirmed SCM type II associated with low lying conus and lipomatous stalk coming from spinal canal defect to the spinal cord and attached to the cord dorsally [].\nSurgical procedure was done in prone position with an elliptical incision. There were fascial and bony defects at L4 to S1 levels through which lipomatous tissue was invaginating from surface to the dura mater through that defect. Laminotomy above the defect was performed and normal dura mater was exposed and incised. There were two dural defects separated from each other with normal dura mater. The dorsal type lipoma was separated carefully from the neural placode in the spinal canal and then pial edges approximated by 6-0 non-absorbable sutures. Another lipomatous tissue as a distal type lipoma was in continuity with a short right hemicord exiting through a different dural defect in a more caudal and lateral location of the spinal canal. After durotomy and sharp cut of the lipomatous tissue, the cord was released. The left hemicord that was separated from lipomyelomeningoceles and right hemicord had a thick fatty filum terminale that was divided from the attachment to distal dural pouch []. Closure was performed in layers. Postoperative period was uneventful.