Percutaneous Approach for Thecaloscopy of the Lumbar Subarachnoidal Space

Abstract

Introduction: Endoscopy of the lumbar subarachnoidal space is named thecaloscopy, which has been used for diagnostic and therapeutic purposes. However, the insertion of the endoscope required microsurgical assistance from the skin into thecal sac in the lumbar region. The current study was applied to explore the possibility of a percutaneous approach for lumbar thecaloscopy insertion, transferring from the previous microsurgical procedure.

Method: A 2.8-mm fiberoptic endoscope (Storz and Co., Tuttlingen, Germany) was used in the study. In two fresh human cadavers, a thecaloscope was first inserted through a transsacral approach and the tip was advanced inside the thecal sac to the lumbar region for observation. A percutaneous endoscopic approach was performed with the Seldinger technique under fluoroscopic control into the lumbar subarachnoid space. After completing the endoscopic procedure, the lumbar subarachnoid space was exposed microsurgically for morphological investigation of rootlets and surrounding structures.

Results: By the observation through a live video in the thecal sac, the percutaneous insertion of a 2.8-mm endoscope into the lumbar subarachnoidal space is feasible without any neural structural damage seen.

Conclusion: The percutaneous approach for flexible endoscopes into the lumbar subarachnoidal space is a practical option for the future of thecaloscopy.

Key words

Percutaneous endoscopic approach - thecaloscopy - minimal endoscopic lumbar procedures

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Correspondence