Helal Ahmed, Pirina Alessandro, Sorenson Thomas J, Palandri Giorgio
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Oper Neurosurg. 2021 Mar 15;20(4):E293. doi: 10.1093/ons/opaa372.
This is a case of a 73 yr-old female presenting with low back pain and bilateral sciatic pain, which progressed to bilateral lower extremity weakness about 1 yr after initial presentation. Imaging of her thoraco-lumbar spine revealed a ventriculus terminalis extending from the level of the eleventh thoracic vertebra (T11) to the first lumbar vertebra (L1). Ventriculus terminalis is an embryological ependymal lined cavity that normally regresses with development. In individuals with persistent ventriculus terminalis, it is usually incidentally noted during spine imaging for other purposes. Surgery is seldom indicated except for patients presenting with progressive neurological deficits. Patient was taken to surgery for fenestration of the ventriculus and decompression of the spinal canal. The patient was positioned prone, and after proper localization the vertebral column was exposed through a midline approach and a central laminectomy was performed from T11-L1. Intraoperative monitoring was used throughout the procedure. This video illustrates the gross appearance of a ventriculus terminalis, dissection of surrounding neural elements, and decompression of the ventriculus using a wide fenestration technique. All relevant patient identifiers have been removed from the video. Nevertheless, patient consent was obtained regarding video recording and redistribution of procedure for educational purposes.
这是一例73岁女性患者，最初表现为腰痛和双侧坐骨神经痛，初始症状出现约1年后进展为双侧下肢无力。其胸腰椎影像学检查显示终室从第十一胸椎（T11）水平延伸至第一腰椎（L1）。终室是一个胚胎期由室管膜衬里的腔隙，通常会随着发育而退化。在存在持续性终室的个体中，通常是在因其他目的进行脊柱成像时偶然发现。除了出现进行性神经功能缺损的患者外，很少需要手术治疗。该患者接受了终室开窗和椎管减压手术。患者取俯卧位，在正确定位后，通过中线入路暴露脊柱，从T11-L1进行了中央椎板切除术。整个手术过程中使用了术中监测。本视频展示了终室的大体外观、周围神经组织的解剖以及使用宽开窗技术对终室进行减压的过程。视频中已去除所有相关患者识别信息。尽管如此，已获得患者关于视频录制及出于教育目的重新分发手术过程的同意。
