ABSTRACT
Objetive:
Thecaloscopy is a less invasive method of exploration of the spinal subarachnoid space, using an ultra-thin, flexible endoscope and endoscopic fenestration of scars and adhesions. Thecalopscopy was used in Russian neurosurgery for the first time.
Methods:
Since 2009, we have operated on 32 patients with the following diagnoses: 17 - spinal adhesive arachnoiditis (8 - local forms, 9 - diffuse forms), 12 - spinal arachnoid cysts (7 - post-traumatic cysts, 5 - idiopathic cysts), and 3 - extramedullary tumors (thecaloscopic videoassistance and biopsy). In all cases, we performed exploration of subarachnoid space and pathologic lesion with endoscopic perforation of the cyst or dissection of adhesions using special instrumentation. The mean follow-up time in our group was 11.4 months.
Results:
Neurological improvement (mean 1.4 by the modified Frankel scale, 1.8 by the Ashworth spasticity scale) was seen in 87% of patients operated for spinal arachnopathies. Temporary neurological deterioration (mild disturbances of deep sensitivity) was seen in 9% of patients and managed successfully with conservative treatment. One patient (3.1%) was operated three times due to relapse of adhesions. There were no serious intraoperative complications (e.g. severe bleeding or dura perforation). Postoperative complications included one CSF leakage and one case of postoperative neuralgic pain. The mean hospitalization time was 7.6 days.
Conclusion:
According to our data, we conclude that thecaloscopy is efficient and safe method, and should be widely used for spinal arachnopathies, adhesive arachnoiditis and arachnoid cysts. Taking into account that adhesive spinal arachnoiditis is a systemic process, and that spinal arachnoid cysts may also be extended, thecaloscopy may be regarded as the most radical and less-invasive form of surgical treatment that currently exists in neurosurgery.
Keywords:
Spinal cord; Arachnoiditis; Arachnoid cysts; Subarachnoid space; Endoscopy; Neuroendoscopy; Syringomyelia
* Modified Frankel Scale: A (complete injury) - no motor or sensory function clinically detected below the level of the injury; B (preserved sensation only) - sensory function partially preserved below the level of the injury; no voluntary movements. C - (minimum motor function) - motor functions are preserved with significant strength reduction down to 2; D (preserved motor function) - motor functions preserved below the level of injury with the strength of more than 3; patient can walk with or without aid; E (normal motor) - normal motor or sensory function. ** Modified Ashworth Scale: 0 - no increase in tone 1 - slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part is moved in flexion or extension. 1+ - slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the less than half of the range of movement; 2 - more marked increase in muscle tone through most of the range of movement, but affected part easily moved; 3 - considerable increase in muscle tone passive, movement difficult; 4 - affected part rigid in flexion or extension (flexion or extension contracture).
