O'Neill Brannan E, Godil Jamila A, Brown Nolan J, Loya Joshua, Silva Ana, Winer Jesse
Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA.
School of Medicine, University of California, Irvine, Orange, CA, USA.
World Neurosurg X. 2024 Feb 28;22:100348. doi: 10.1016/j.wnsx.2024.100348. eCollection 2024 Apr.
Surgical treatment for tethered cord syndrome (TCS) involves a laminotomy for intradural lysis of filum terminale (LFT), with the goal of releasing excess tension on the conus medullaris by dividing the filum terminale. While LFT alleviates clinical symptoms, it is associated with risks and complications, including cerebrospinal fluid (CSF) leak and infection, either superficial or deep. Some risks and complications of LFT relate to efficiency and quality of primary dural closure and its downstream effects. We sought to assess the utility of nonpenetrating titanium clips (TC) for primary dural closure with a particular focus on operative duration, associated costs, and complication profiles in a series of pediatric patients undergoing LFT, hypothesizing that TC utilization leads to more efficient closure and therefore potentially lower costs and potentially associated anesthetic length and risks.
A 4-surgeon, single institution series of 28 pediatric patients underwent LFT with subsequent dural closure performed with either the AnastoClip® nonpenetrating titanium clips or traditional suture technique between July 2022 and May 2023. In order to compare the safety, efficacy, and cost-effectiveness between the two dural closure techniques, relevant data were collected including patient demographics and rates of CSF leak, infection at three-month follow-up, and reoperation. Operative durations and times from beginning to end of dural closure were recorded.
A total of 28 pediatric patients (mean age: 5.9 years, 43% female, range: 0.71-17 years) with TCS underwent LFT. All patients underwent procedures involving intradural surgery of the lumbar region. Dural closure was performed using traditional suturing in 19 patients (67.9%) and TC in 9 (32.1%). With respect to duration of dural closure, the average time to closure using traditional suturing techniques was 1271 s (or 21 min and 11 s), while the average time for TC was 265 s (or 4 min and 25 s). At three-month follow-up, one case of cerebrospinal fluid (CSF) leak or infection was observed in the suture cohort and required reoperation.
Clinical outcomes in the TC group were excellent, consistent with previous reports; our findings further suggest that TCs result in more efficient dural closure than traditional suturing techniques. Our findings suggest that TC may be a safe, efficacious, and more efficient alternative to traditional suture for achieving dural closure in pediatric patients with TCS undergoing LFT surgery.
脊髓拴系综合征（TCS）的外科治疗包括进行椎板切开术以行终丝硬膜内松解术（LFT），目的是通过切断终丝来解除脊髓圆锥上的过度张力。虽然LFT可缓解临床症状，但它存在风险和并发症，包括脑脊液（CSF）漏以及浅表或深部感染。LFT的一些风险和并发症与初次硬膜关闭的效率和质量及其下游影响有关。我们试图评估非穿透性钛夹（TC）用于初次硬膜关闭的效用，特别关注一系列接受LFT的儿科患者的手术持续时间、相关成本和并发症情况，假设使用TC可实现更有效的关闭，从而可能降低成本以及潜在的麻醉时长和风险。
2022年7月至2023年5月期间，在一家单机构中，由4位外科医生为28例儿科患者实施了LFT，随后使用AnastoClip®非穿透性钛夹或传统缝合技术进行硬膜关闭。为了比较两种硬膜关闭技术的安全性、有效性和成本效益，收集了相关数据，包括患者人口统计学资料以及三个月随访时的脑脊液漏发生率、感染情况和再次手术情况。记录了手术持续时间以及从开始到硬膜关闭结束的时间。
共有28例患有TCS的儿科患者（平均年龄：5.9岁，43%为女性，范围：0.71 - 17岁）接受了LFT。所有患者均接受了涉及腰椎硬膜内手术的操作。19例患者（67.9%）采用传统缝合进行硬膜关闭，9例（32.1%）采用TC进行硬膜关闭。关于硬膜关闭的持续时间，使用传统缝合技术的平均关闭时间为1271秒（即21分11秒），而使用TC的平均时间为265秒（即4分25秒）。在三个月随访时，缝合组观察到1例脑脊液（CSF）漏或感染病例，需要再次手术。
TC组的临床结果良好，与先前报告一致；我们的研究结果进一步表明，与传统缝合技术相比，TC可实现更有效的硬膜关闭。我们的研究结果表明，对于接受LFT手术的患有TCS的儿科患者，TC可能是一种比传统缝合更安全、有效且更高效的硬膜关闭替代方法。
