tcs and a hydromyelia

my little girl who is 32 month has a tethered cord at the L3 level.  we also just found out that she has a hydromyelia that runs the leingh of her mid and lower thoraxic spine down to her conus.  isn't that a large portion of her spine to holding extraf luides.  my mane question is if this is  due to her spinal lipoma which caused her tethereing when it is surically corrected will the hydromyelia resolve itself or will sh possibly require a shunt?  also if she had a cheri malformation whouldnt it had showed up on her MRI of her cervical spine?  last  question she has 2 hemivertsbre at L@ and L# does this increase the likelly hood of her becoming retethered on a notch that may be hidden inside when she had her mri of lumbar spine they only did one view as a result where unable to identify the hemivertabre or any knotches they may have is this off ony concern?

[CCF Neuro[P] MD, RPS]

Dear Katelynn:

Sorry to hear about your daughter.  The condition of a tethered cord is associated with disorders of secondary neurulation, or also called occult dysraphism.  The finding of a lipoma is one of the defects of the spinal column not developing correctly.  Having the enlarged central canal is a part of the malformation, it is also called meningocele.  Thus, the lipoma did not cause the central canal (which is there is all spinal cords but usually not present to any significant degree), but the malformation of spinal column differentiation lead to both the lipoma, meningocele, and tethered cord, and likely the hemivertebrae.  I can't tell you for sure concerning the last question.  The tethered cord release will likely be okay but the reasons for the tethered cord in the first place will remain.  The clinical benefit will depend on the degree of all of these and the surgery.  The surgeon doing the operation will know these best.  I hope the surgery goes well.

Sincerely,

CCF Neuro MD

[joanna hanna]

i am sorry the hemi vertabre are at L2 and L3 forgot to let go of caps sorry;)

[joanna hanna]

just one more ? i did chech her mri and they reported there was no sighn of a menigocele do you know wwhat else might cause that can that be a defect all of its own or is ther usually more going on?

[CCF Neuro[P] MD, RPS]

Dear Katelynn:

The hydromyelia is likely caused by the process of disordered secondarily neurulation that caused the other abnormalities.

CCF Neuro MD

[joanna hanna]

thanks for the second reply:)