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Surgical technique and outcome in cervical and thoracic myelomeningocoele surgery
Volkan Etus1, Hasan Tahsin Sarisoy, Savas Ceylan
1Department of Neurosurgery, Faculty of Medicine, Kocaeli University, 41900, Derince, Kocaeli, Turkey. drvolkanetus@yahoo.com
Insights
Cervical and thoracic myelomeningoceles require specific surgical techniques. Microsurgical untethering of the spinal cord is crucial for preventing neurological deficits and improving outcomes in affected infants.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Spinal Cord Medicine
Background:
- Cervical and thoracic myelomeningoceles present unique challenges compared to lumbosacral forms.
- Infantile spinal cord malformations necessitate specialized surgical approaches.
Purpose of the Study:
- To review the surgical technique and outcomes for infants with cervical or thoracic myelomeningoceles.
- To determine the optimal surgical strategy for managing these rare spinal cord conditions.
Main Methods:
- A retrospective review of six infants undergoing surgery for cervical or thoracic myelomeningocele.
- Surgical techniques included intradural exploration and microsurgical spinal cord untethering.
Main Results:
- Five patients with microsurgical untethering remained neurologically stable post-operatively.
- One patient initially treated with subcutaneous resection experienced progressive neurological decline due to cord tethering.
- Re-operation with microsurgical untethering led to significant neurological improvement in the latter patient.
Conclusions:
- Intradural exploration and microsurgical release of the spinal cord are essential for treating cervical and thoracic myelomeningoceles.
- This technique facilitates postoperative neurological improvement and prevents future deficits.
- Meticulous resection of tethering bands is key to successful surgical outcomes.
Abstract:
Cervical and thoracic myelomeningocoeles differ from common lumbosacral myelomeningocoeles in many respects. We review the surgical technique and outcome achieved for a series of six infants who underwent surgery for cervical or thoracic myelomeningocoele. Five patients, who had intradural exploration and microsurgical untethering of the spinal cord, were neurologically stable on follow-up. The other patient, who had a simple subcutaneous resection of the sac without release of the intradural tethering bands, was re-operated on 16 months later, with progressive neurological symptoms due to cord tethering. Following re-exploration and microsurgical untethering of the spinal cord, the neurological deficits significantly improved. We suggest that the surgical technique in these lesions should include careful intradural exploration and microsurgical release of the spinal cord by meticulous resection of all tethering bands. This enables postoperative neurological improvement and possible prevention of future neurological deficits due to cord tethering.