THECALOSCOPY: A NOVEL METHOD IN SPINE SURGERY

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.

【摘要】
目的：椎管镜检查（thecaloscopy）是一种侵入性更低的脊髓蛛网膜下腔探查术式，借助超薄柔性内窥镜即可开展操作，还可对瘢痕与粘连实施内窥镜下开窗松解术。该术式首次应用于俄罗斯神经外科领域。
方法：自2009年起，我们共为32例符合下述诊断的患者实施手术：17例脊髓粘连性蛛网膜炎（其中8例为局部型，9例为弥漫型）、12例脊髓蛛网膜囊肿（7例为创伤后囊肿，5例为特发性囊肿）以及3例髓外肿瘤患者（术中采用椎管镜视频辅助并完成活检）。所有病例均接受了蛛网膜下腔探查及病灶处理，通过专用器械完成囊肿内窥镜下穿孔或粘连松解操作。本研究队列的平均随访时长为11.4个月。
结果：在接受脊髓蛛网膜炎手术的患者中，87%的患者出现神经功能改善，采用改良Frankel量表（modified Frankel scale）评分平均提升1.4分，采用Ashworth痉挛量表（Ashworth spasticity scale）评分平均提升1.8分。9%的患者出现一过性神经功能恶化，表现为轻度深感觉障碍，经保守治疗后均成功缓解。1例患者（3.1%）因粘连复发接受了三次手术。术中未出现严重并发症，如严重出血或硬脊膜穿孔。术后并发症包括1例脑脊液漏（CSF leakage）及1例术后神经病理性疼痛。患者平均住院时长为7.6天。
结论：基于本研究数据，我们认为椎管镜检查是一种安全有效的术式，可广泛应用于脊髓蛛网膜炎、粘连性蛛网膜炎及脊髓蛛网膜囊肿的治疗。鉴于脊髓粘连性蛛网膜炎属于全身性病变，且脊髓蛛网膜囊肿也可能呈弥漫性生长，椎管镜检查可被视为当前神经外科领域中最为彻底且侵入性最低的外科治疗手段。