Frank E
Department of Neurosurgery, Oregon Health Sciences University, Portland 97201, USA.
Surg Neurol. 1998 Oct;50(4):333-5; discussion 335. doi: 10.1016/s0090-3019(98)00016-0.
Epidural lipomatosis can be idiopathic or associated with obesity and steroid excess. This disorder can be treated by weight control, reduction of steroid load, or operative decompression. We describe a non-obese patient with neurogenic claudication who had localized epidural fat from L4 to S1. Minimally invasive treatment consisted of a small laminotomy and endoscopically guided fat aspiration.
A small bilateral L5-S1 laminotomy was performed. Using a special malleable endoscopic aspirator, loose fat was removed both dorsal and ventral to the dural sac.
At surgery, endoscopically guided suction aspiration was successful in removing the majority of the fat. Areas of fat that were vascularized and adherent to the dura required microsurgical dissection. Postoperatively, the patient has been asymptomatic.
This minimally invasive technique was successful in treating epidural dual compression that had failed conservative measures. Further evaluation of this technology is warranted.
硬膜外脂肪增多症可为特发性，或与肥胖及类固醇过量有关。该病症可通过控制体重、减少类固醇用量或手术减压来治疗。我们描述了一名非肥胖的神经源性间歇性跛行患者，其L4至S1节段存在局限性硬膜外脂肪。微创治疗包括小型椎板切开术及内镜引导下脂肪抽吸术。
实施小型双侧L5 - S1椎板切开术。使用一种特殊的可塑形内镜抽吸器，在硬脊膜囊的背侧和腹侧去除疏松脂肪。
手术中，内镜引导下的抽吸成功去除了大部分脂肪。血管化且附着于硬脊膜的脂肪区域需要显微手术分离。术后，患者无症状。
这种微创技术成功治疗了保守治疗失败的硬膜外双重压迫。有必要对该技术进行进一步评估。
