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'.

Abstract:

OBJECTIVES: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 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. CONCLUSION:By using this method, safe untethering can be achieved avoiding root injuries in complicated lipomas such as chaotic or re-tethering cases.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Kim KH,Chong S,Lee JY,Kim SK,Cho BK,Wang KC

doi

10.1016/j.wneu.2018.12.137

subject

Has Abstract

pub_date

2019-01-04 00:00:00

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(18)32960-7

pub_type

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