Endoscopic untethering of tight filum terminale: an operative technique

Abstract

AIM: To demonstrate the various technical advantages of minimally invasive endoscopic untethering of tight filum terminale for the treatment of tethered cord syndrome (TCS). MATERIAL and METHODS: In five pediatric cases of TCS, we performed untethering by using the endoscopic technique. The age of the patients were 6, 7, 8, 9, and 12 years old. We used a nasal speculum of the transsphenoidal approach during the endoscopic surgical procedure. RESULTS: All the procedures were performed uneventfully, except for one case with a split cord malformation that showed neurologic deterioration caused by excision of the diastematomyelic fibrous septum at the thoracic level (unrelated to the endoscopic procedure at the L5-S1 level). This patient was referred to a rehabilitation clinic 5 days after surgery and showed significant improvement by the third postoperative month. The other four patients were discharged 1 day after the operation. CONCLUSION: Endoscopic release of filum terminale is a safe technique especially if it is performed with neuromonitoring. This technique may shorten the length of hospital stay and reduce perioperative blood loss. However, futher studies with a larger number of patients and long-term follow-up are needed.

Endoscopic spinal cord untethering using a 1 cm skin incision technique in pediatrics: A technical case report

“…An oblique-viewing endoscope is also useful for checking for bleeding or adhesions at the end of the cranially retracted lum terminale. Okay O et al reported that endoscopic release of the lum terminale may provide bene ts such as shorter hospital stay and less blood loss [12].…”

“…The classical surgical treatment of lar lipoma is one-level laminectomy or laminectomy and microsurgical sectioning of the lum terminale [8,9]. To keep surgical invasiveness and complications to a minimum, minimally invasive techniques such as the interlaminar approach or endoscopic-assisted techniques have been increasingly used in recent years [5,9,10,11,12]. We present our surgical technique for a minimally invasive full-endoscopic untethering that can be performed through a 1 cm skin incision, the smallest skin incision that has been reported to date.…”

Endoscopic spinal cord untethering using a 1 cm skin incision technique in pediatrics: a technical case report

“…An oblique-viewing endoscope is also useful for checking for bleeding or adhesions at the end of the cranially retracted filum terminale. Okay O et al reported that endoscopic release of the filum terminale may provide benefits such as shorter hospital stay and less blood loss [ 12 ].…”

“…The classical surgical treatment of filar lipoma is one-level laminectomy or laminectomy and microsurgical sectioning of the filum terminale [ 8 , 9 ]. To keep surgical invasiveness and complications to a minimum, minimally invasive techniques such as the interlaminar approach or endoscopic-assisted techniques have been increasingly used in recent years [ 5 , 9 – 12 ]. We present our surgical technique for a minimally invasive full-endoscopic untethering that can be performed through a 1 cm skin incision, the smallest skin incision that has been reported to date.…”

Comparison of the Inter-laminar Approach and Laminotomy Open Approach for Filum Terminale Lipoma: A Retrospective Analysis

“…They found that the skin incision was 4-5 cm smaller than that used in conventional techniques, leading to paraspinal muscle dissection and less scar tissue. Okay et al [19] reported a minimally invasive procedure using an endoscopic approach wherein a 2-cm skin incision was used. Greuter et al…”