A Method of Untethering by Skipping the Area of Positive Responses on Electrical Stimulation During Surgery of Lumbosacral Lipomatous Malformation: "Hopping on a Stepping Stone".
World Neurosurg
; 124: 48-51, 2019 Apr.
Article
in En
| MEDLINE
| ID: mdl-30615990
ABSTRACT
OBJECTIVE:
In complex lumbosacral lipomatous malformation or retethering, "crotch" dissection, an incision on the dura or lipoma at the site lateral to the lipoma-cord fusion line saving underlying roots, is often not easy. Attempts of this dissection in complex and obscured conditions may cause damage to the spinal cord or nerve roots. A method for caudal extension of untethering while positive areas on electrical stimulation were encountered during the crotch dissection of lumbosacral lipomatous malformation is described.METHODS:
After thinning out the negative-response area just caudal to the positive-response area, a small perforation is made at the negative-response area skipping the positive-response area with probing the dissection direction through the subarachnoid space by an inside-out fashion. Subsequently, the procedure is continued caudally from the perforation site.RESULTS:
Safe caudal extension of untethering is possible using this method. Illustrative operative photographs are shown.CONCLUSIONS:
By using this method, safe untethering can be achieved avoiding root injuries in complicated lipomas such as chaotic or retethering cases.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Language:
En
Journal:
World Neurosurg
Journal subject:
NEUROCIRURGIA
Year:
2019
Document type:
Article