June 17, 2025

Research

Mar 22, 2025

(2011) Section of the filum terminale: is it worthwhile in Chiari type I malformation?

Even more controversial appears to be the use of SFT in patients with Chiari type I malformation (CIM), which is based on the possible presence of OTCS (occult TCS). This review shows that: (1) there are issues both in favor and against the occurrence of OTCS, (2) there is no significant correlation between CIM and tethered cord, the old "caudal traction theory" being not supported by clinical or experimental evidences. On these grounds, a relationship between CIM and OTCS is hard to be demonstrated, (3) a subgroup of patients with CIM suffering from OTCS may exist and benefit from SFT.

Evidence from pulling down on TF in cadavers that brain doesn’t move

(2024) Chiari Formation or Malformation? Trends in the Pathophysiology and Surgical Treatment of an Ever-Elusive Entity

6.3. Filum Terminale and Chiari I Controversy
The paper references studies that reported improvement in CM1 symptoms following SFT in some patients. However, the authors criticize these studies for methodological issues and lack of long-term data [63].
The authors conclude that no substantial evidence supports a connection between CM1 and OTCS. This was also confirmed by a systematic review by Milano et al., who stressed that there is no scientific support for FT sectioning in patients with CM without evidence of a tethered cord [64].
As part of this controversy, in 2012, the Italian Society of Neurosurgery (Sinch, Società Italiana di Neurochirurgia) released a statement against the sectioning of the filum terminale as a treatment for CMI in cases where there is no clear clinical and radiological evidence of a tethered spinal cord.

Royo 2020 on patients that he’s seen

Kind of all over the place

(2020) The effect of filum terminale sectioning for Chiari 1 malformation treatment: systematic review

In response to increasing judicial demands, the Brazilian Ministry of Health requested an evaluation of filum terminale (FT) sectioning for Chiari malformation (CM) from the Brazilian Neurosurgery Society in 2018. A systematic review was conducted to assess the efficacy and safety of this technique, revealing only two small, low-quality case series from the same group advocating the procedure. The studies lacked standardized outcome measures, included mixed patient populations (CM, scoliosis, syringomyelia), and possibly duplicated data. Given the absence of robust scientific evidence, FT sectioning for CM without signs of tethered cord is not clinically supported and should be considered experimental, warranting validation through controlled clinical trials.