A method of untethering by skipping the area of positive responses on electrical stimulation during surgery of lumbosacral lipomatous malformation: 'hopping on a stepping stone'.

A method of untethering by skipping the area of positive responses on electrical stimulation during surgery of lumbosacral lipomatous malformation: 'hopping on a stepping stone'.

World Neurosurg. 2019 Jan 04;:

Authors: Kim KH, Chong S, Lee JY, Kim SK, Cho BK, Wang KC

Abstract
OBJECTIVES: In complex lumbosacral lipomatous malformation or retethering, 'crotch' dissection, an incision on the dura or lipoma at the site lateral to the lipoma-cord fusion line saving underlying roots, is often not easy. Attempts of this dissection in complex and obscured conditions may cause damage to the spinal cord or nerve roots. A method for caudal extension of untethering while positive areas on electrical stimulation were encountered during crotch dissection of lumbosacral lipomatous malformation is described.
METHODS: After thinning out the negative-response area just caudal to the positive-response area, a small perforation is made at the negative-response area skipping the positive-response area with probing the dissection direction through the subarachnoid space by an inside out fashion. Subsequently, the procedure is continued caudally from the perforation site.
RESULTS: Safe caudal extension of untethering is possible using this method. Illustrative operative photographs are shown.
CONCLUSION: By using this method, safe untethering can be achieved avoiding root injuries in complicated lipomas such as chaotic or re-tethering cases.

PMID: 30615990 [PubMed - as supplied by publisher]

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