Minimally Invasive Surgical Approach to Filum Lipoma.
Minimally Invasive Surgical Approach to Filum Lipoma.
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DOI：
10.2176/nmc.oa.2017-0200
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发表时间：
2018-03-15
影响因子：
1.9
通讯作者：
Tominaga T
中科院分区：
文献类型：
--
作者：
Hayashi T;Kimiwada T;Kohama M;Shirane R;Tominaga T
终丝脂肪瘤（FTL）引起各种脊髓症状，称为脊髓栓系综合征。FTL的治疗是通过切除FTL进行手术松解，这可以防止症状进展，并且通常会导致症状改善。本报告描述了一种微创手术策略，我们已经介绍了超光速切片。自2007年以来，使用这种微创手术策略治疗FTL的儿科患者，我们称之为椎板间入路（ILA）。总之，手术技术包括：最小皮肤切口以暴露下腰椎区域的单侧黄韧带;黄韧带切口以暴露硬脊膜囊，以及硬脊膜切口，然后识别和切片细丝。术后无需卧床休息。在引入ILA之前，我们一直使用标准的单节段椎板切除术/椎板切开术（LL），术后卧床休息超过1周，直到2007年，为ILA提供了充分的对照组。共有49名连续患者接受了ILA治疗。37例采用LL治疗。仅在1例患者中观察到需要手术的手术并发症，该患者在LL患者中发生了脑脊液（CSF）漏。随访期间未观察到再栓系或其他神经系统症状。所有患者均主诉轻微的术后背痛，但ILA患者中没有患者需要术后卧床休息，而LL患者由于背痛需要术后卧床休息。ILA策略的优点是组织损伤最小，术后疼痛、失血和卧床休息最少。
Filum terminale lipoma (FTL) causes various spinal symptoms known as tethered cord syndrome. The treatment for FTL is surgical untethering by sectioning the FTL, which can prevent symptom progression and often results in improvement of symptoms. This report describes a minimally invasive surgical strategy that we have introduced for FTL sectioning. The pediatric patients with FTL since 2007 were treated using this minimally invasive surgical strategy, which we refer to as an interlaminar approach (ILA). In summary, the surgical technique involves: minimal skin incision to expose the unilateral ligamentum flavum in the lower lumbar region; ligamentum flavum incision to expose the dural sac, and dural incision followed by identification and sectioning of the filum. Postoperatively, no bed rest was required. Prior to introducing ILA, we had used standard one level laminectomy/laminotomy (LL) with more than 1 week of postsurgical bed rest until 2007, providing an adequate control group for the benefit of the ILA. A total of 49 consecutive patients were treated using ILA. While 37 patients were treated using LL. Surgical complications that need surgery were seen only in one patient, who developed cerebrospinal fluid (CSF) leak in LL patients. No retethering or additional neurological symptoms were seen during follow-up. All patients complained of minimal postsurgical back pain, but no patients required postoperative bed rest in ILA patients, while LL patients need postsurgical bed rest because of back pain. The ILA strategy provides the advantage of a minimal tissue injury, associated with minimal postoperative pain, blood loss, and bed rest.
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