AI Article Synopsis
- * The proposed technique involves carefully creating a small opening in a negative-response area while avoiding positive-response areas identified through electrical stimulation to guide the dissection.
- * Results indicate that this approach allows for safe caudal extension of untethering, effectively minimizing the risk of injuries to spinal nerves during surgery.
Article 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.
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| http://dx.doi.org/10.1016/j.wneu.2018.12.137 | DOI Listing |
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