Kim Kyung Hyun, Chong Sangjoon, Lee Ji Yeoun, Kim Keewon, Kim Seung-Ki, Wang Kyu-Chang
Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Neurosurgery, Asan Medical Center, Seoul, Republic of Korea.
Childs Nerv Syst. 2019 Mar;35(3):529-533. doi: 10.1007/s00381-019-04049-8. Epub 2019 Jan 8.
It is well known that the preoperative enlarged sac in occult spinal dysraphism, in which the spinal cord is attached to its dome, can be associated with neurological deficits by aggravation of spinal cord traction. We experienced a similar phenomenon during the early stage of untethering surgery for "lipomyelomeningocele in a strict sense (LMMC)."
We report a case of a 3-month-old girl with LMMC, which showed decreased motor evoked potentials (MEPs) in the lower extremities during the early stage of untethering surgery. The sac was released from the original nest by incision with separation of the overlying skin and dissection from the muscle fascia. The sac became rounder, and the spinal cord attached to the dome of the sac was further stretched. After aspiration of cerebrospinal fluid from the sac, the MEPs recovered. Postoperatively, the patient had no neurological deficits.
Although this phenomenon rarely occurs, release of the herniated sac of LMMC from the original nest during the early stage of untethering surgery may result in neurological changes. Application of intraoperative neurophysiological monitoring helps to detect electrophysiological deterioration and can prevent neurological deficits.
众所周知，隐匿性脊柱裂中术前增大的囊肿（脊髓附着于其顶部）可因脊髓牵张加重而伴有神经功能缺损。我们在“严格意义上的脂肪脊髓脊膜膨出（LMMC）”的松解手术早期也遇到了类似现象。
我们报告一例3个月大患有LMMC的女孩，在松解手术早期其下肢运动诱发电位（MEP）降低。通过切开分离覆盖的皮肤并从肌肉筋膜进行解剖，囊肿从原来的窝中松解出来。囊肿变得更圆，附着于囊肿顶部的脊髓被进一步拉伸。从囊肿中抽出脑脊液后，MEP恢复。术后，患者无神经功能缺损。
虽然这种现象很少发生，但在松解手术早期将LMMC的突出囊肿从原来的窝中松解出来可能会导致神经功能改变。术中应用神经生理监测有助于检测电生理恶化情况，并可预防神经功能缺损。
