Mehrotra Anant, Kumar Ashutosh, Raiyani Vandan, Singh Ranapratap, Verma Pawan Kumar, Das Kuntal Kanti, Jaiswal Awadhesh Kumar, Kumar Raj
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Neurosci Rural Pract. 2023 Jan-Mar;14(1):177-181. doi: 10.25259/JNRP-2022-5-32. Epub 2022 Dec 22.
Prevailing techniques of dural closure in endoscopic spine surgery (ESS) for intradural extramedullary (IDEM) tumor excision increase the steep learning curve and operative time. We aimed to assess the efficacy of augmented duroplasty with artificial dura and share our initial experience of ESS for IDEM excision.
We retrospectively analyzed 18 ( = 18) consecutive patients of IDEM tumors operated by ESS using Destandau's endoscopic system. The pre-operative, post-operative, and at the latest follow-up clinical status were recorded in terms of Nurick's grades and the Oswestry Disability Index. Immediate post-operative complications and intraoperative findings were noted from hospital information system and patient records.
The mean (± SD) age of patients was 40.3 ± 14.9 (range 19-64) years, with M: F ratio of 2:1. All the lesions were intradural and present at lumber ( = 6), thoracic ( = 9), and cervical ( = 3) regions. The average duration of surgery, blood loss, hospital stay, and duration of follow-up were 157 ± 45.3 (90-240) min, 168.8 ± 78.8 (30-300) mL, 4.29 ± 1.4 (2-7) days, and 19.3 ± 7.2 (7-36) months, respectively. There were no CSF leaks, wound-related complications, or material-induced adverse events.
In endoscopic IDEM excision, dural closure with artificial dura is efficient in preventing CSF leak. It shortens the steep learning curve and improves the surgical outcome due to technical ease.
在内镜下脊柱手术（ESS）中，用于髓外硬膜内（IDEM）肿瘤切除的硬脑膜闭合的现有技术增加了陡峭的学习曲线和手术时间。我们旨在评估人工硬脑膜增强硬脑膜成形术的疗效，并分享我们进行ESS切除IDEM的初步经验。
我们回顾性分析了18例连续接受ESS手术的IDEM肿瘤患者，手术使用Destandau内镜系统。根据Nurick分级和Oswestry功能障碍指数记录术前、术后及最新随访时的临床状况。从医院信息系统和患者记录中记录术后即刻并发症和术中发现。
患者的平均（±标准差）年龄为40.3±14.9（范围19 - 64）岁，男女比例为2:1。所有病变均位于硬膜内，分别位于腰椎（= 6）、胸椎（= 9）和颈椎（= 3）区域。手术平均持续时间、失血量、住院时间和随访时间分别为157±45.3（90 - 240）分钟、168.8±78.8（30 - 300）毫升、4.29±1.4（2 - 7）天和19.3±7.2（7 - 36）个月。未发生脑脊液漏、伤口相关并发症或材料引起的不良事件。
在内镜下IDEM切除术中，使用人工硬脑膜进行硬脑膜闭合可有效预防脑脊液漏。由于技术简便，它缩短了陡峭的学习曲线并改善了手术效果。
