Great Ormond Street Hospital for Children, London, England.
Department of Paediatric Neurosurgery, London, England.
Childs Nerv Syst. 2024 Jan;40(1):213-218. doi: 10.1007/s00381-023-06069-x. Epub 2023 Jul 10.
The fibroneural stalk of an LDM has variable thickness, complexity, and length, which can span 5 to 6 vertebral segments from its skin attachment to its "merge point" with the dorsal spinal cord. Therefore, complete resection may require extensive multi-level laminotomies. In this technical note, a modification of the procedure is presented that avoids long segment laminectomies while ensuring complete excision of long LDM stalks.
An illustrative case of resection of LDM is presented using skip laminectomies. The technique ensures complete removal of the stalk, thus reducing the risk of future intradural dermoid development, while at the same time minimizes the risk for delayed kyphotic deformity.
A technique of "skip-hop" proximal and distal short segment laminectomies in cases of LDM optimizes the objectives of complete stalk resection with preservation of spinal integrity.
LDM 的纤维神经干粗细、复杂程度和长度不一,从皮肤附着处到与背脊髓“融合点”可能跨越 5 到 6 个椎体节段。因此,完全切除可能需要广泛的多节段椎板切除术。在本技术说明中,提出了一种改良的手术方法,可以避免长节段椎板切除术,同时确保切除长 LDM 干。
通过跳跃式椎板切除术展示了 LDM 切除的一个实例。该技术可确保干完全切除,从而降低未来硬脊膜内皮样瘤发展的风险,同时最大限度地降低迟发性脊柱后凸畸形的风险。
对于 LDM 病例,采用“跳跃式”近端和远端短节段椎板切除术的技术,可在保持脊柱完整性的同时,优化完全干切除的目标。