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Strong MJ, North RY, Yee TJ, Oppenlander ME. Commentary: Decompression of a Dorsal Arachnoid Web of the Spine: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E144-E145. [PMID: 33294934 DOI: 10.1093/ons/opaa359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael J Strong
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Robert Y North
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Timothy J Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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YAMAMOTO A, FUJIMOTO M, AOKI K, SUZUKI Y, MIZUNO M, SUZUKI H. A Dorsal Arachnoid Web of the Cervical Spine: A Case Report. NMC Case Rep J 2021; 8:281-286. [PMID: 35079476 PMCID: PMC8769406 DOI: 10.2176/nmccrj.cr.2020-0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/13/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Atsushi YAMAMOTO
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masashi FUJIMOTO
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kazuaki AOKI
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yume SUZUKI
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masaki MIZUNO
- Department of Neurosurgery, Suzuka Kaisei Hospital, Suzuka, Mie, Japan
- Department of Minimum-Invasive Neurospinal Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hidenori SUZUKI
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Yang H, Li P, Jia N, Wang J, Jin X. [Comparison of different transforaminal endoscope approaches in treatment of serious lumbar disc herniation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:300-307. [PMID: 32174073 DOI: 10.7507/1002-1892.201811005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the difference between four transforaminal endoscopic approaches in the treatment of serious lumbar disc herniation. Methods Between October 2010 and February 2015, a total of 122 patients with serious lumbar disc herniation were enrolled and treated with discectomy under transforaminal endoscope. The patients were divided into 4 groups according to the different approaches. The transforaminal endoscopic spine system (TESSYS) technology was used in group A (31 cases), Yeung endoscopic spine system (YESS) technology was used in group B (30 cases), improved transforaminal endoscopic access (ITEA) technology was used in group C (31 cases), and interlaminar dorsal access (IDA) technology was used in group D (30 cases). There was no significant difference in gender, age, disease duration, lesion segment, and preoperative visual analogue scale (VAS) score of low back pain, VAS score of bilateral lower extremities pain, Oswestry disability index (ODI), intervertebral height, lumbar curvature index (LCI), and disc degeneration grading between groups ( P>0.05). The removal volume of nucleus pulposus was compared; after operation, VAS score, ODI score, LCI, intervertebral height, and disc degeneration grading were used to evaluate the effectiveness. Results The removal volumes of nucleus pulposus in groups A, B, C, and D were (3.6±0.9), (3.5±0.7), (4.6±1.0), (3.1±1.1) cm 3, respectively. There were significant differences between groups ( P<0.05). All incisions healed by first intention, and no early postoperative complications was found. All cases were followed up 12-35 months, with an average of 24 months. During follow-up, there was no recurrence of nucleus pulposus herniation, infection of intervertebral space, cerebrospinal fluid leakage, epidural hematoma, or other complications. At last follow-up, the VAS scores of low back pain and bilateral lower extremities pain, and ODI scores in each group significantly improved when compared with those before operation ( P<0.05); there was no significant difference in the scores and improvements between groups after operation ( P>0.05). At last follow-up, the disc degeneration grading in group B significantly improved when compared with that before operation ( P<0.05); there was no significant difference between groups ( P>0.05). At last follow-up, there was no significant difference in LCI of each group when compared with that before operation ( P>0.05); and there was no significant difference in LCI and loss value between groups ( P>0.05). There was no significant difference in the intervertebral height of the 4 groups at immediate after operation and last follow-up when compared with preoperative value ( P>0.05), and there was no significant difference between groups at immediate after operation and last follow-up ( P>0.05). Conclusion Application of transforaminal endoscope in the treatment of serious lumbar disc herniation has great clinical outcomes. The ITEA technology can obtain a wider field of view and be more convenient to find and remove the degenerative nucleus pulposus. However, the appropriate approach should be selected according to the symptoms and characteristics of lumbar disc herniation.
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Affiliation(s)
- Hu Yang
- Department of Orthopaedics, Harrison International Peace Hospital, Hebei Medical University, Hengshui Hebei, 053000, P.R.China
| | - Pengfei Li
- Department of Orthopaedics, Harrison International Peace Hospital, Hebei Medical University, Hengshui Hebei, 053000, P.R.China
| | - Nan Jia
- Department of Orthopaedics, Harrison International Peace Hospital, Hebei Medical University, Hengshui Hebei, 053000, P.R.China
| | - Jinxing Wang
- Department of Orthopaedics, Harrison International Peace Hospital, Hebei Medical University, Hengshui Hebei, 053000, P.R.China
| | - Xianhui Jin
- Department of Orthopaedics, Harrison International Peace Hospital, Hebei Medical University, Hengshui Hebei, 053000, P.R.China
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Abstract
Cervical vertebral compressive myelopathy (CVCM) represents the most significant disease of the spinal cord in horses for which surgical treatment is described. Current surgical methods used include ventral interbody fusion with kerf cut cylinders and dorsal laminectomy. Polyaxial pedicle screw and rod constructs and ventral locking compression plating have been introduced in the treatment of equine CVCM and present promising alternative approaches to achieve ventral interbody fusion. Advancements in diagnostic imaging and endoscopy of the cervical vertebral canal may improve reliable preoperative identification of the exact locations of spinal cord compression in horses with CVCM to improve postoperative outcomes.
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Affiliation(s)
- Lynn Pezzanite
- Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, 300 W Drake Road, Fort Collins, CO 80523, USA
| | - Jeremiah Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, 300 W Drake Road, Fort Collins, CO 80523, USA.
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Nisson PL, Hussain I, Härtl R, Kim S, Baaj AA. Arachnoid web of the spine: a systematic literature review. J Neurosurg Spine 2019; 31:175-184. [PMID: 31003220 DOI: 10.3171/2019.1.spine181371] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/31/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE An arachnoid web of the spine (AWS) is a rare and oftentimes challenging lesion to diagnose, given its subtle radiographic findings. However, when left untreated, this lesion can have devastating effects on a patient's neurological function. To date, only limited case reports and series have been published on this topic. In this study, the authors sought to better describe this lesion, performing a systematic literature review and including 2 cases from their institution's experience. METHODS A systematic literature search was performed in September 2018 that queried Ovid MEDLINE (1946-2018), PubMed (1946-2018), Wiley Cochrane Library: Central Register of Controlled Trials (1898-2018), and Thompson Reuters Web of Science: Citation Index (1900-2018), per PRISMA guidelines. Inclusion criteria specified all studies and case reports of patients with an AWS in which any relevant surgery types were considered and applied. Studies on arachnoid cysts and nonhuman populations, and those that did not report patient treatments or outcomes were excluded from the focus review. RESULTS A total of 19 records and 2 patients treated by the senior authors were included in the systematic review, providing a total of 43 patients with AWS. The mean age was 52 years (range 28-77 years), and the majority of patients were male (72%, 31/43). A syrinx was present in 67% (29/43) of the cases. All AWSs were located in the thoracic spine, and all but 2 (95%) were located dorsally (1 ventrally and 1 circumferentially). Weakness was the most frequently reported symptom (67%, 29/43), followed by numbness and/or sensory loss (65%, 28/43). Symptoms predominated in the lower extremities (81%, 35/43). It was found that nearly half (47%, 20/43) of patients had been experiencing symptoms for 1 year or longer before surgical intervention was performed, and 35% (15/43) of reports stated that symptoms were progressive in nature. The most commonly used surgical technique was a laminectomy with intradural excision of the arachnoid web (86%, 36/42). Following surgery, 91% (39/43) of patients had reported improvement in their neurological symptoms. The mean follow-up was 9.2 months (range 0-51 months). CONCLUSIONS AWS of the spine can be a debilitating disease of the spine with no more than an indentation of the spinal cord found on advanced imaging studies. The authors found this lesion to be reported in twice as many males than females, to be associated with a syrinx more than two-thirds of the time, and to only have been reported in the thoracic spine; over 90% of patients experienced improvement in their neurological function following surgery.
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Affiliation(s)
- Peyton L Nisson
- 1University of Arizona, College of Medicine, Tucson, Arizona; and
- 2Department of Neurosurgery, Weill Cornell Brain and Spine Center, New York, New York
| | - Ibrahim Hussain
- 2Department of Neurosurgery, Weill Cornell Brain and Spine Center, New York, New York
| | - Roger Härtl
- 2Department of Neurosurgery, Weill Cornell Brain and Spine Center, New York, New York
| | - Samuel Kim
- 2Department of Neurosurgery, Weill Cornell Brain and Spine Center, New York, New York
| | - Ali A Baaj
- 2Department of Neurosurgery, Weill Cornell Brain and Spine Center, New York, New York
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Shrauner B, Blikslager A, Davis J, Campbell N, Law M, Lustgarten M, Prange T. Feasibility and safety of lumbosacral epiduroscopy in the standing horse. Equine Vet J 2016; 49:322-328. [DOI: 10.1111/evj.12591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/09/2016] [Indexed: 12/13/2022]
Affiliation(s)
- B. Shrauner
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - A. Blikslager
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - J. Davis
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - N. Campbell
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - M. Law
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - M. Lustgarten
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - T. Prange
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
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Hakky MM, Justaniah AI, David C, French RJ, Martin D, Kwok N, Erbay SH. The Neuroimaging Spectrum of Septum Posticum Derangement and Associated Thoracic Myelopathy. J Neuroimaging 2015; 25:818-23. [DOI: 10.1111/jon.12243] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 12/29/2022] Open
Affiliation(s)
- Michael M. Hakky
- Department of Radiology; Lahey Clinic Medical Center; Burlington Massachusetts
| | | | - Carlos David
- Department of Neurosurgery; Lahey Clinic Medical Center; Burlington Massachusetts
| | - Robert J. French
- Department of Radiology; Lahey Clinic Medical Center; Burlington Massachusetts
| | - Dann Martin
- Department of Radiology; Lahey Clinic Medical Center; Burlington Massachusetts
| | - Nathan Kwok
- Tufts University School of Medicine; Boston Massachusetts
| | - Sami H. Erbay
- Department of Radiology; Lahey Clinic Medical Center; Burlington Massachusetts
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Chern JJ, Gordon AS, Naftel RP, Tubbs RS, Oakes WJ, Wellons JC. Intradural spinal endoscopy in children. J Neurosurg Pediatr 2011; 8:107-11. [PMID: 21721897 DOI: 10.3171/2011.4.peds10533] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracranial endoscopy in the treatment of hydrocephalus, arachnoid cysts, or brain tumors has gained wide acceptance, but the use of endoscopy for intradural navigation in the pediatric spine has received much less attention. The aim of the authors' present study was to analyze their experience in using spinal endoscopy to treat various pathologies of the spinal canal. The authors performed a retrospective review of intradural spinal endoscopic cases at their institution. They describe 4 representative cases, including an arachnoid cyst, intrinsic spinal cord tumor, holocord syrinx, and split cord malformation. Intradural spinal endoscopy was useful in treating the aforementioned lesions. It resulted in a more limited laminectomy and myelotomy, and it assisted in identifying a residual spinal cord tumor. It was also useful in the fenestration of a multilevel arachnoid cyst and in confirming communication of fluid spaces in the setting of a complex holocord syrinx. Endoscopy aided in the visualization of the spinal cord to ensure the absence of tethering in the case of a long-length Type II split spinal cord malformation. Conclusions Based on their experience, the authors found intradural endoscopy to be a useful surgical adjunct and one that helped to decrease morbidity through reduced laminectomy and myelotomy. With advances in technology, the authors believe that intradural endoscopy will begin to be used by more neurosurgeons for treating diseases of this anatomical region.
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Affiliation(s)
- Joshua J Chern
- Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA
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Endoscope-assisted surgery of spinal intradural adhesions in the presence of cerebrospinal fluid flow obstruction. Spine (Phila Pa 1976) 2011; 36:E773-9. [PMID: 21289584 DOI: 10.1097/brs.0b013e3181fb8698] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To investigate whether the adjunctive use of endoscopy of the subarachnoid space (arachnoscopy) can improve the success of microsurgery for spinal arachnoid adhesions. SUMMARY OF BACKGROUND DATA Intradural adhesions that obstruct pulsatile cerebrospinal fluid (CSF) flow are a typical spinal cause of syringomyelia. Phase-contrast magnetic resonance imaging (MRI) allows CSF flow obstructions to be reliably localized. The treatment of choice is the microsurgical removal of CSF flow obstructions caused by adhesions. Microsurgery, however, does not lend itself to assessments of further adhesions beyond the borders of the exposed area. In this study, we therefore investigated whether endoscopic assistance allows adhesions in the vicinity of the exposed area to be detected. METHODS From 2006 to 2009, a single neurosurgeon performed 27 consecutive microsurgical procedures with endoscopic assistance in 25 patients with spinal arachnoid adhesions. A MurphyScope endoscope was used for this purpose. CSF flow was studied before and after surgery in all patients using phase-contrast MRI in the region of the craniocervical junction, the cervical spine, the thoracic spine, and the lumbar spine. RESULTS In all 27 procedures, CSF flow obstructions were detected at the level identified by phase-contrast MRI. In 25 procedures, image quality was sufficient for an inspection of the adjacent subarachnoid space. In six cases, the surgeon detected further adhesions that obstructed CSF flow in the adjacent subarachnoid space not visualized with the microscope. In all cases, these adhesions were identified and removed during microsurgery.Postoperative MRI scans demonstrated free CSF flow in all patients and a decrease in syrinx size in six patients. CONCLUSION Arachnoscopy is a helpful adjunct to microsurgery and can be performed safely and easily. It allows the surgeon to detect further adhesions in the subarachnoid space, which would remain undetected by microscopy alone.
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Mauer UM, Gottschalk A, Kunz U, Schulz C. Arachnoscopy: a special application of spinal intradural endoscopy. Neurosurg Focus 2011; 30:E7. [DOI: 10.3171/2011.1.focus10291] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The microsurgical removal of obstructions to CSF flow is the treatment of choice in the surgical management of intradural arachnoid cysts. Cardiac-gated phase-contrast MR imaging is an effective tool for the primary diagnosis and localization of arachnoid cysts. Microsurgery, however, does not lend itself to assessments of further adhesions beyond the borders of the exposed area. The use of a thin endoscope allows surgeons to assess intraoperatively whether the exposure is wide enough.
Methods
Between 2006 and 2010, a single neurosurgeon performed 31 consecutive microsurgical procedures with endoscopic assistance in 28 patients with spinal arachnoid adhesions. A MurphyScope endoscope was used for this purpose. The CSF flow was studied before and after surgery in all patients by using phase-contrast MR imaging in the region of the craniocervical junction, the cervical spine, the thoracic spine, and the lumbar spine.
Results
In all 31 procedures, CSF flow obstructions were detected at the level identified by phase-contrast MR imaging. In 29 procedures, image quality was sufficient for an inspection of the adjacent subarachnoid space. In 6 cases, the surgeon detected further adhesions that obstructed CSF flow in the adjacent subarachnoid space that were not visualized with the microscope. In all cases, these adhesions were identified and removed during microsurgery.
Conclusions
Arachnoscopy is a helpful adjunct to microsurgery and can be performed safely and easily. It allows the surgeon to detect further adhesions in the subarachnoid space that would remain undetected by microscopy alone.
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Prange T, Derksen FJ, Stick JA, Garcia-Pereira FL, Carr EA. Cervical vertebral canal endoscopy in the horse: intra- and post operative observations. Equine Vet J 2011; 43:404-11. [PMID: 21496080 DOI: 10.1111/j.2042-3306.2010.00310.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
REASONS FOR PERFORMING STUDY Despite modern medical diagnostic imaging, it is not possible to identify reliably the exact location of spinal cord compression in horses with cervical vertebral stenotic myelopathy (CVSM). Vertebral canal endoscopy has been successfully used in man and a technique for cervical vertebral canal endoscopy (CVCE) has been described in equine cadavers. OBJECTIVE To determine the feasibility and safety of CVCE in healthy mature horses. METHODS Six healthy mature horses were anaesthetised. A flexible videoendoscope was subsequently introduced via the atlanto-occipital space into the epidural space (epiduroscopy, Horses 1-3) or the subarachnoid space (myeloscopy, Horses 4-6) and advanced to the 8th cervical nerve. Neurological examinations were performed after surgery and lumbosacral cerebrospinal fluid (CSF) analysed in horses that had undergone myeloscopy. RESULTS All procedures were completed successfully and all horses recovered from anaesthesia. Anatomical structures in the epidural space (including the dura mater, nerve roots, fat and blood vessels) and subarachnoid space (including the spinal cord, blood vessels, arachnoid trabeculations, nerve roots and the external branch of the accessory nerve) were identified. During epiduroscopy, a significant increase in mean arterial pressure was recognised, when repeated injections of electrolyte solution into the epidural space were performed. In one horse of the myeloscopy group, subarachnoid haemorrhage and air occurred, resulting in transient post operative ataxia and muscle fasciculations. No complications during or after myeloscopy were observed in the other horses. CSF analysis indicated mild inflammation on Day 7 with values approaching normal 21 days after surgery. CONCLUSIONS Endoscopic examination of the epidural and subarachnoid space from the atlanto-occipital space to the 8th cervical nerve is possible and can be safely performed in healthy horses. POTENTIAL RELEVANCE Cervical vertebral canal endoscopy might allow accurate identification of the compression site in horses with CVSM and aid diagnosis of other lesions within the cervical vertebral canal.
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Affiliation(s)
- T Prange
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, MI, USA.
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PRANGE T, DERKSEN FJ, STICK JA, GARCIA-PEREIRA FL. Endoscopic anatomy of the cervical vertebral canal in the horse: A cadaver study. Equine Vet J 2010; 43:317-23. [DOI: 10.1111/j.2042-3306.2010.00170.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shimoji K, Ogura M, Gamou S, Yunokawa S, Sakamoto H, Fukuda S, Morita S. A new approach for observing cerebral cisterns and ventricles via a percutaneous lumbosacral route by using fine, flexible fiberscopes. J Neurosurg 2009; 110:376-81. [DOI: 10.3171/2007.12.17287] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
To establish a new method for the diagnosis of central nervous system diseases, the authors visualized the cerebral cisterns and ventricles via a percutaneous lumbosacral route by using newly developed fine, flexible fiberscopes.
Methods
Fine, flexible fiberscopes, 0.9 and 1.4 mm in diameter, were introduced up to the cerebral cisterns and ventricles through a percutaneous lumbosacral route in awake patients with chronic headache and/or neck pain or those undergoing spinal surgery and in whom MR imaging did not disclose any particular abnormalities in the brain. A lumbosacral subarachnoid puncture was made with a modified method of a continuous epidural block.
Results
In 25 of 31 patients tested, the cerebellomedullary and/or pontine/interpeduncular cisterns were easily and safely reached, and the brainstem structures were visualized. Advancement of the fiberscope beyond the spinal level was abandoned in 6 patients with adhesive spinal arachnoiditis, because the fiberscopes encountered resistance seemingly caused by arachnoid adhesions. Further advancement of the fiberscopes up to the fourth and third ventricles was successfully achieved in 2 patients. A number of arachnoid filaments were found in the cerebellomedullary cistern in 4 patients: 2 with chronic spinal arachnoiditis, 1 with a spinal arachnoid cyst, and 1 with posttraumatic pain syndrome. None of the patients reported pain or any major complication except a postspinal headache and light fever, which were encountered in 4 and 1 patient, respectively.
Conclusions
The approach to the supraspinal structures via the lumbosacral route by using a fine, flexible fiberscope may provide a new, minimally invasive, and safe way to observe the cerebral cisterns and/or brainstem regions.
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Affiliation(s)
- Koki Shimoji
- 1Department of Human Sciences, Ube Frontier University Graduate School, Ube, Yamaguchi
- 2Pain Control Institute, Shinjuku, Tokyo
- 3Department of Anesthesiology, Niigata University Graduate School of Medicine, Niigata; and
| | - Mai Ogura
- 4Department of Anesthesiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Sanae Gamou
- 4Department of Anesthesiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Seki Yunokawa
- 4Department of Anesthesiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Hidetoshi Sakamoto
- 4Department of Anesthesiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Satoru Fukuda
- 4Department of Anesthesiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Shigeho Morita
- 4Department of Anesthesiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
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Baron EM, Levene HB, Heller JE, Jallo JI, Loftus CM, Dominique DA. Neuroendoscopy for spinal disorders: a brief review. Neurosurg Focus 2005; 19:E5. [PMID: 16398482 DOI: 10.3171/foc.2005.19.6.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neuroendoscopy has grown rapidly in the last 20 years as a therapeutic modality for treating a variety of spinal disorders. Spinal endoscopy has been widely used to treat patients with cervical, thoracic, and lumbosacral disorders safely and effectively. Although it is most commonly used with minimally invasive lumbar spine surgery, endoscopy has gained widespread acceptance for the treatment of thoracic disc herniations and for anterior release and rod implantation in the correction of thoracic spinal deformity. The authors review the use of endoscopy in spine surgery and in the treatment of spinal disorders as well as in the treatment of intrathoracic nonspinal lesions. Endoscopy has some significant advantages over open or other minimally invasive techniques in that it can allow for better visualization of the lesion, smaller incision sizes with reduced morbidity and mortality, reduced hospital stays, and ultimately lower cost. In addition, spinal endoscopy allows observers and operating room staff to be more involved in each case and fosters education. Spinal endoscopy, like any novel modality, carries with it additional risks and the surgeon must always be prepared to convert to an open procedure. The learning curve for spinal endoscopy is steep and the procedure should not be attempted alone by a novice surgeon. Nevertheless, with training and experience, the spine surgeon can achieve better outcomes, reduced morbidity, and better cosmesis with spinal endoscopy, and the operating times are comparable to open procedures. As technology evolves and more experience is obtained, neuroendoscopy will likely achieve further roles as a mainstay in spine surgery.
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Affiliation(s)
- Eli M Baron
- Department of Neurosurgery, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA
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Shah RV, Heavner JE. Recognition of the Subarachnoid and Subdural Compartments During Epiduroscopy: Two Cases. Pain Pract 2003; 3:321-5. [PMID: 17166128 DOI: 10.1111/j.1530-7085.2003.03036.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rinoo V Shah
- Department of Anesthesiology, Pain Division, Texas Tech University of Health Sciences Center, USA.
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Tobita T, Okamoto M, Tomita M, Yamakura T, Fujihara H, Baba H, Uchiyama S, Hamann W, Shimoji K. Diagnosis of spinal disease with ultrafine flexible fiberscopes in patients with chronic pain. Spine (Phila Pa 1976) 2003; 28:2006-12. [PMID: 12973149 DOI: 10.1097/01.brs.0000083595.10862.98] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Spinal epidural and subarachnoid spaces were observed with the newly developed fine flexible fiberscopes in 55 patients with chronic pain. OBJECTIVES To evaluate the fiberscopes as diagnostic tools for spinal canal disease. SUMMARY OF BACKGROUND DATA Fine flexible fiberscopes make it possible to visualize the entire length of the spinal subarachnoid space without major complications, and they may be of value for the diagnosis of certain spinal canal diseases. METHODS The epidural and subarachnoid spaces were accessed by fine flexible fiberscopes (Purely Fine [PF] types) in the initial 45 patients and by those equipped with a tip-steering function and a working channel (Medical Science [MS] types) in the later 10 patients, respectively. The procedures were based on those of continuous epidural or subarachnoid block. RESULTS Normal and abnormal subarachnoid spaces were clearly observed. When the MS types were used, the intended sites of the spinal structures could be more easily approached. In 12 patients, new diagnoses were made (chronic arachnoiditis 9, subarachnoid cyst 2, old subdural hematoma 1) that could not be found by magnetic resonance imaging or computed tomography. Additionally, chronic arachnoiditis was found in 2 patients with spinal trauma. Pathologic changes were confirmed by fiberscopic examination in 16 patients (arachnoiditis 11, spinal trauma 2, arteriovenous malformation 2, subarachnoid cyst 1). No pathologic changes could be detected in 27 patients with spinal canal stenosis, disc herniation, reflex sympathetic dystrophy, or posttraumatic pain syndrome. There were no significant differences in incidence of new diagnoses between the PF and MS types of fiberscopes. There were no major complications. There were 2 cases of light fever in the initial 10 patients and 7 cases of headache in the initial 14 patients. Only 4 cases of headache were observed in the subsequent 41 patients, in whom 20 mL of saline was injected into the epidural space. CONCLUSION These fine flexible fiberscopes may provide new diagnostic and interventional tools for spinal canal diseases, provided skilled techniques are applied.
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Affiliation(s)
- Toshiyuki Tobita
- Department of Anesthesiology, Niigata University Graduate School of Medicine, Asahi-machi, Niigata 951-8510, Japan
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Hayatsu K, Tomita M, Fujihara H, Baba H, Yamakura T, Taga K, Shimoji K. The placement of the epidural catheter at the predicted site by electrical stimulation test. Anesth Analg 2001; 93:1035-9. [PMID: 11574379 DOI: 10.1097/00000539-200110000-00048] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED More accurate segmental and sagittal positioning of the epidural catheter tip is required for the success of continuous epidural analgesia, spinal cord monitoring, and percutaneous epidural spinal cord stimulation. We examined the usefulness of an electrical stimulation test for verifying the proper placement of the epidural catheter tip at the predicted site in the posterior epidural space by using a locally developed epidural catheter with electrodes at its tip. The test included the observation of segmental bilateral muscle twitches and the patient's report of feeling in the region stimulated by moving the epidural catheter electrode back and forth and changing the direction of the bevel of the Tuohy needle. The success rate of midline placement at the required spinal segment was significantly more frequent (99%; P < 0.001) in the group (n = 289) receiving the electrical stimulation test compared with the group (n = 277) not receiving the test (success rate 57%). The results indicate the usefulness of this method. We concluded that the electrical stimulation test is effective for verifying the proper placement of the catheter electrode tip. IMPLICATIONS Ideally the epidural catheter tip should be positioned in the posterior epidural space near the midline. We concluded that the electrical stimulation test is effective for verifying the proper placement of the catheter electrode tip.
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Affiliation(s)
- K Hayatsu
- Department of Anesthesiology, School of Medicine, Niigata University, Niigata, Japan
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