Article
Decoding a black box – a case triggered histological investigation of the conus medullaris
Entschlüsselung einer Black Box – eine fallgetriggerte histologische Untersuchung des Conus medullaris
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Authors
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Maximilian Scheer
- Universitätsklinikum Halle, Klinik mit Poliklinik für Neurochirurgie, Halle/Saale, Deutschland
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Bruno Griesler
- Martin-Luther-Universität Halle-Wittenberg, Institut für Anatomie und Zellbiologie, Halle/Saale, Deutschland
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Elisabeth Ottlik
- Martin-Luther-Universität Halle-Wittenberg, Institut für Anatomie und Zellbiologie, Halle/Saale, Deutschland
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Christian Scheller
- Universitätsklinikum Halle, Klinik mit Poliklinik für Neurochirurgie, Halle/Saale, Deutschland
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Christian Strauss
- Universitätsklinikum Halle, Klinik mit Poliklinik für Neurochirurgie, Halle/Saale, Deutschland
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Heike Kielstein
- Martin-Luther-Universität Halle-Wittenberg, Institut für Anatomie und Zellbiologie, Halle/Saale, Deutschland
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Christian Mawrin
- Martin-Luther-Universität Halle-Wittenberg, Institut für Anatomie und Zellbiologie, Halle/Saale, Deutschland; Universität Magdeburg, Institut für Neuropathologie, Magdeburg, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: The background for this investigation was the dramatic course of a 14-year-old girl with a spontaneous hemorrhage in the area of the conus medullaris resulting in a complete cross-sectional syndrome. Despite immediate surgical treatment, there was close to none postoperative improvement. The subsequent histopathological examination of the removed masses revealed a cavernoma. For a better understanding of the link between site and symptoms of conus medullaris lesions a literature research regarding the histological features of this structure was performed. This research did not lead to satisfying results. Although the conus medullaris syndrome is often described, this is, to our knowledge, the first investigation of its histological structure.
Methods: We present the histological examination of the conus medullaris of 18 body donors. The specific slide containing the ending point of the gray matter was noted. The distance between the caudal ending of gray matter in the conus and the macroscopical end of the conus medullaris could be defined as “gray matter to cone termination-distance” (GMCT-distance). Furthermore the greatest (a) and smallest (b) diameters of the conus medullaris were measured.
Results: Gray matter displayed as butterfly figure was found almost along the entire length of the conus medullaris. However, there were great individual variations in the distance from the caudal ending of the gray matter and the macroscopical end of the conus medullaris. Additionally, the correlation of these differences with gender, body height, transverse diameter and area of the cross section at the end of the gray matter was analyzed.
Conclusion: This is the first description of the histological structure of the conus medullaris and can serve as basis for a better understanding of neurological deficits of a conus medullaris syndrome. Findings that the gray matter can be detected far into the conus medullaris with a great individual ending of the gray matter are important for operative care of intramedullary masses in this area and vascular malformations.
