Thecaloscopy – newest less invasive method of diagnosis and surgical treatment in spine surgery

Abstract

Thecaloscopy is less invasive exploration of spinal subarachnoidspace with ultra-thin flexible endoscope and endoscopic fenestratioof scars and adhesions. Thecaloscopy was used inRussian neurosurgery at the first time. Since 2009 we operated32 patients with following diagnosis: 17 spinal adhesive arachnoiditis(8 local forms, 9 diffuse forms), 12 spinal arachnoidcysts (7 posstraumatic cysts, 5 idiopathic cysts), 3 extramedullary tumors (thecaloscopic videoassistance and biopsy).In all cases we realized exploration of subarachnoid spaceand pathologic lesion with endoscopic perforation of cyst or dissectionof adhesions using special instrumentation. Mean follow-up in our group was 11.4 months. Neurological improvement(mean 1.4 by modified Frankel scale, 1.8 by Ashworthspasticity scale) was seen in 87% of patients operated for spinalarachnopathies. Temporary neurological deterioration (milddisturbances of deep sensitivity) was seen in 9% of patients andmanaged successfully with conservative treatment. 1 patient(3.1%) was operated 3 times because of relapse of adhesions.There were no serious intraoperative complications (e.g., seriousbleeding, dura perforation etc). Postoperative complicationsincluded 1 CSF leakage and 1 postoperative neuralgic pain.Mean term of hospitalization was 7.6 days. According to ourdata, we suppose that thecaloscopy is efficient and safe method,and should be widely used for spinal arachnopaties, adhesivearachnoiditis and arachnoid cysts. Taking into account thatadhesive spinal arachnoiditis is systemic process and spinalarachnoid cysts can be extended as well, thecaloscopy may beregarded as the most radical and less-invasive way of surgicaltreatment existing currently in neurosurgery

Keywords

• thecaloscopy
• epidurosopy
• spinal arachnoiditis
• arachnoid cysts
• subarachnoid space
• flexible endoscopy
• neuroendoscopy
• syringomyelia