SURGICAL VIDEO Minimally Invasive Surgical Approach to Filum Sectioning: Technical Note ∗ ‡ Toshiaki Hayashi, MD, PhD , Tomomi Kimiwada, MD, PhD , ‡ § Reizo Shirane, MD, PhD , Teiji Tominaga, MD, PhD ∗ ‡ Department of Neurosurgery, Sendai City Hospital, Sendai, Japan; Department of Neurosurgery, Miyagi Children’s Hospital, Sendai, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan The content of the paper and video was presented at the 44th annual meeting of the International Society for Pediatric Neurosurgery, Kobe, Japan, October 25, 2016. Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/ opx127 Filum terminale lipoma (FTL) is known to cause various spinal filum terminale was 3 mm in our series. The surgical time for symptoms collectively referred to as tethered cord syndrome children was about 1 h. Adult patients need a deeper surgical (TCS). With the increasing use of magnetic resonance imaging, field, so the operation takes more time. Until now, 46 patients there has been an increase in the identification of FTLs. The (11 mo to 27 yr) have undergone ILA and been followed for more treatment for FTL is surgical untethering by sectioning the than 5 yr. Surgical complication was seen in only one patient who filum terminale, which can prevent symptom progression and developed a subcutaneous fluid collection. All patients remained often results in improvement of symptoms. We recently intro- stable or showed improvement in preoperative symptoms. This duced a new surgical strategy for filum terminale sectioning technique provides the advantage of reduced soft tissue injury named interlaminar approach (ILA). In this surgical video, we and minimal intradural procedures. Thin FTL showing TCS are present a minimally invasive technique of ILA. The surgical candidates for ILA. This article complies with the guideline for approach and postoperative result are outlined. A minimal patient information confidentiality and privacy protection. All 2 cm length of midline skin incision was performed at the L5 the patients in this study provided written, informed consent for vertebral level. After skin incision, dissection was extended to the procedure. expose the ligamentum flavum. The ligamentum flavum was then incised and retracted medially to expose the dural sac. After dural Disclosure incision, the filum terminale was identified and pulled out from The authors have no personal, financial, or institutional interest in any of the the dural sac and then sectioned. The maximum diameter of the drugs, materials, or devices described in this article. OPERATIVE NEUROSURGERY VOLUME 14 | NUMBER 3 | MARCH 2018 | 315 Downloaded from https://academic.oup.com/ons/article-abstract/14/3/315/3863095 by Ed 'DeepDyve' Gillespie user on 16 March 2018
Operative Neurosurgery – Oxford University Press
Published: Mar 1, 2018
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