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Minimally Invasive Keyhole Interlaminar Detethering for Symptomatic Fatty Filum Terminale in Pediatric Patients: An

Bin Yuan1, Yi Zhong1, Ruxuan Zhou1

  • 1Department of Neurosurgery, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.

World Neurosurgery
|May 9, 2026
PubMed
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A keyhole interlaminar approach for fatty filum terminale (FFT) in children is safe and effective. This minimally invasive technique reduces surgical trauma and improves neurological outcomes for tethered cord syndrome (TCS).

Area of Science:

  • Neurosurgery
  • Pediatric Surgery
  • Minimally Invasive Surgery

Background:

  • Fatty filum terminale (FFT) is a frequent cause of pediatric tethered cord syndrome (TCS).
  • Conventional surgical detethering often involves laminectomy, increasing surgical trauma and potential complications.
  • There is a need for less invasive surgical options for FFT.

Purpose of the Study:

  • To evaluate the safety and efficacy of a minimally invasive keyhole interlaminar approach for detethering FFT in pediatric patients.
  • To compare the outcomes of this novel approach with traditional methods.

Main Methods:

  • Retrospective analysis of 17 pediatric patients with symptomatic FFT undergoing keyhole interlaminar detethering (January 2020 - February 2021).
  • A small midline incision (1-2 cm) at L3-L4 allowed a working channel without bone removal.
Keywords:
Fatty filum terminaleKeyhole surgeryMinimally invasive techniquePediatric neurosurgeryTethered cord syndrome

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  • Microsurgical detethering was performed under neurophysiological monitoring, with pre- and post-operative MRI and Spina Bifida Neurological Scale (SBNS) assessment.

    • Main Results:

    • All 17 patients had successful surgeries without intraoperative complications or conversion to open procedures.
    • Postoperative MRI confirmed complete filum transection; mean follow-up was 33 months.
    • 14 patients (82%) achieved complete recovery, and 3 (18%) had mild residual deficits, with no late complications.

    Conclusions:

    • The keyhole interlaminar approach is a safe and effective minimally invasive technique for FFT detethering in children.
    • This method results in reduced surgical trauma, quicker recovery, and significant neurological improvement.
    • It presents a promising alternative to conventional open surgical detethering for pediatric TCS.