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Cent Eur Neurosurg 2004; 65(4): 161-167
DOI: 10.1055/s-2004-832347
Original Article

© Georg Thieme Verlag Stuttgart · New York

Surgical Aspects and Outcome of Delayed Tethered Cord Release

Operationstechnik und Ergebnisse bei sekundärem Tethered Cord SyndromH. Haberl1 , G. Tallen1 , T. Michael2 , K. T. Hoffmann3 , G. Benndorf3 , M. Brock1
  • 1Department of Neurosurgery, Charité Medical School, Humboldt University, Berlin, Germany
  • 2Pediatric Department, Charité Medical School, Humboldt University, Berlin, Germany
  • 3Department of Radiology, Charité Medical School, Humboldt University, Berlin, Germany
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Publication History

Publication Date:
18 November 2004 (online)

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Abstract

Out of a total of 550 children followed up at our spina bifida center, we report on 81 patients who were reoperated upon for secondary tethered cord syndrome between 1993 and 2000. In four cases with preceding severe progressive scoliosis, untethering was followed by surgical correction and stabilization of curvatures. In 77 patients, the indication for surgery was based on late progressive neurological deterioration. The current clinical relevance of competing etiologic factors such as symptomatic Chiari malformation, hydromyelia, and shunt dysfunction, requiring different clinical management, had been previously carefully excluded. The children underwent magnetic resonance imaging (MRI) or myelo-computed tomography (m-CT) to identify the morphologic extent of tethering and any associated spinal malformations such as dermoid tumors (19 cases) or diastematomyelia (9 cases). Surgery became faster and safer through bilateral dural incision, undercutting arachnoid adhesions along the tethered area, although this procedure increased the need for dural grafting. Complete release of the conus medullaris and cauda equina was achieved in a total of 75 cases (93 %) including those who had undergone prophylactic surgery. A mean follow-up of 4.8 years in 77 patients operated upon for late progressive neurological deterioration confirmed stabilization of presenting symptoms in 65 cases (84 %) with 20 of them (26 %) even showing significant improvement. In 12 patients (16 %), including all cases of incomplete untethering (n = 4), there was further deterioration.

Zusammenfassung

Durch das sozialpädiatrische Zentrum unserer Kinderklinik werden derzeit etwa 550 Kinder unter der Diagnose eines dysraphischen Syndroms interdisziplinär betreut. Wir berichten in dieser Studie über 77 dieser Patienten, die zwischen 1993 und 2000 wegen eines symptomatischen sekundären Tethered Cord Syndroms operiert wurden. Differenzialdiagnostisch und -therapeutisch relevante andere Ursachen für die vorliegende klinischen Verschlechterung wie z. B. Chiari-Malformation, Hydromyelie oder Shunt-Dysfunktion wurden bezüglich ihrer aktuellen klinischen Relevanz so weit wie möglich ausgeschlossen. Mittels Kernspintomographie (MRT) oder Myelo-CT (m-CT) wurde die Ausdehnung des Tetherings erfasst und das Vorliegen eventueller Begleitpathologien wie z. B. Diastematomylie (9 Fälle) oder Dermoid-Tumor (19 Fälle) untersucht. Operationszeit und -risiko wurden durch eine entlang des Tetherings von mittig dorsal nach beidseits ventrolateral unterhalb der arachnoidalen Adhäsionen geführte Durainzision vermindert, obwohl diese Technik in der Regel die Notwendigkeit der Implantation einer Duraplastik erhöhte. Eine vollständige Myelolyse wurde bei 75 Patienten erreicht (93 %) einschließlich der vier Patienten, die aus prophylaktischer Indikation operiert wurden. Eine durchschnittliche Nachuntersuchungszeit von 4,8 Jahren bestätigte bei 77 Patienten eine Stabilisierung der klinischen Situation in 65 Fällen (84 %). Bei 20 dieser Patienten (26 %) konnte sogar eine signifikante Verbesserung der klinischen Symptomatik beobachtet werden. Bei 12 Patienten (16 %) einschließlich aller Fälle mit inkompletter Neurolyse (4) konnte eine weiter klinische Verschlechterung nicht verhindert werden.

Key words

Tethered cord syndrome - results - surgical technique - endoscopic assistance

Schlüsselwörter

Tethered Cord Syndrom - Operationstechnik - Ergebnisse - endoskopische Unterstützung

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Dr. med. Hannes Haberl

Neurochirurgische Klinik der Humboldt-Universität · Charité · Campus Virchow

Augustenburger Platz 1

13353 Berlin

Germany

Phone: +49/30-45 05-6 00 91

Fax: +49/30-45 05-6 09 03

Email: hannes.haberl@charite.de

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