Intrathecal endoscopy to enhance the diagnosis of tethered cord syndrome

Woods, Kamal R.M.; Colohan, Austin R. T.; Yamada, Shokei; Yamada, Shoko M.; Won, Daniel J.

doi:10.3171/2010.4.spine09591

Cited by 16 publications

(11 citation statements)

References 16 publications

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“…Other studies have shown that endoscopic visualization of the intrathecal contents and the filum terminale is possible in cadaver specimens (8,9) and in clinical patients (10,11). These studies utilize small endoscopic cameras that do not contain a working channel.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive endoscopic spinal cord untethering: case report

Telfeian¹,

Punsoni²,

Hofstetter

2017

J. Spine Surg.

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Tethered cord syndrome is a constellation of symptoms and signs that include back and leg pain, bowel and bladder dysfunction, scoliosis and lower extremity weakness and deformity. Tethering may be due to a tight filum terminale or a form of spinal dysraphism. The authors present a case of a 40-year-old man who presented with symptoms of back pain, bilateral lower extremity radicular pain, and bowel and bladder dysfunction. Magnetic resonance imaging showed a sacral lipomyelomeningocele, with fat tracking superiorly to the conus, which was tethered at the L4-L5 level. A minimally-invasive surgical approach with endoscopic visualization and identification of the nerve roots and filum terminale was performed.The patient's postoperative clinical course was uneventful. This case highlights two important issues.First, minimally invasive spine techniques should be considered in the surgical treatment of tethered cord especially given the theoretical advantages of minimizing pain, spinal fluid leakage, and subsequent scarring.And second, endoscopic techniques are advancing. In the case presented here, endoscopic visualization and operative techniques made identification and transection of the filum terminale possible through a tiny dural opening. The small dural opening could theoretically pose the advantage of decreasing the risk of spinal fluid leakage. Clinicians should be aware that endoscopic visualization and techniques can serve as minimallyinvasive adjuncts to enhance the traditional approach to many surgical pathologies.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive endoscopic spinal cord untethering: case report

Telfeian¹,

Punsoni²,

Hofstetter

2017

J. Spine Surg.

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“…In previous studies, in contrast to our technique, flexible systems could not go beyond the visualization of the lumbar intradural space. 26 Furthermore, laminectomy or sacral hiatus were the only way to reach the dura mater. There was also no verification of filum terminale specimens with histopathologic examination in previous autopsy series that proved the efficacy of minimally invasive surgery in reaching the filum terminale.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis and/or treatment of tethered cord syndrome, arachnoiditis, and spinal subdural hematoma can be established. [23][24][25][26] A novel endoscopic technique for the visualization and surgical manipulation of the filum terminale with no assistance from a loupe or microscope was described and supported with Key words -Filum terminale -Interlaminar -Minimal invasive spine surgery -Spinal endoscopy -Tethered cord syndrome -Untethering histopathologic examination. The utility, safety, and feasibility of this method were investigated in fresh postmortem adult human cadavers.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Fully Endoscopic İnterlaminar Approach to the Filum Terminale: A Cadaveric Study

Yörükoğlu¹,

Tahta

Akçakaya

et al. 2016

World Neurosurgery

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“…Karakhan et al 14 described different approaches, including a dorsal paramedian approach to the intradural space via interlaminar fenestration or hemilaminectomy. Woods et al 30 used the same type of endoscope as we did in the study presented here, and performed endoscopy to diagnose tethered cord syndrome prior to wide exposure of the dura.…”

Section: Discussionmentioning

confidence: 99%

Arachnoscopy: a special application of spinal intradural endoscopy

Mauer¹,

Gottschalk²,

Kunz³

et al. 2011

FOC

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Object The microsurgical removal of obstructions to CSF flow is the treatment of choice in the surgical management of intradural arachnoid cysts. Cardiac-gated phase-contrast MR imaging is an effective tool for the primary diagnosis and localization of arachnoid cysts. Microsurgery, however, does not lend itself to assessments of further adhesions beyond the borders of the exposed area. The use of a thin endoscope allows surgeons to assess intraoperatively whether the exposure is wide enough. Methods Between 2006 and 2010, a single neurosurgeon performed 31 consecutive microsurgical procedures with endoscopic assistance in 28 patients with spinal arachnoid adhesions. A MurphyScope endoscope was used for this purpose. The CSF flow was studied before and after surgery in all patients by using phase-contrast MR imaging in the region of the craniocervical junction, the cervical spine, the thoracic spine, and the lumbar spine. Results In all 31 procedures, CSF flow obstructions were detected at the level identified by phase-contrast MR imaging. In 29 procedures, image quality was sufficient for an inspection of the adjacent subarachnoid space. In 6 cases, the surgeon detected further adhesions that obstructed CSF flow in the adjacent subarachnoid space that were not visualized with the microscope. In all cases, these adhesions were identified and removed during microsurgery. Conclusions Arachnoscopy is a helpful adjunct to microsurgery and can be performed safely and easily. It allows the surgeon to detect further adhesions in the subarachnoid space that would remain undetected by microscopy alone.

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Intrathecal endoscopy to enhance the diagnosis of tethered cord syndrome

Cited by 16 publications

References 16 publications

Minimally invasive endoscopic spinal cord untethering: case report

Minimally invasive endoscopic spinal cord untethering: case report

Percutaneous Fully Endoscopic İnterlaminar Approach to the Filum Terminale: A Cadaveric Study

Arachnoscopy: a special application of spinal intradural endoscopy

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