Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental Neurology2075-54732409-2533Research Center of Neurology24610.17816/psaic246UnknownThecaloscopy – newest less invasive method of diagnosis and surgical treatment in spine surgeryKashcheevAleksey A.agou@endospine.ruArestovSergey O.agou@endospine.ruGushchaArtyom O.agou@endospine.ruResearch Center of Neurology1003201371313802022017Copyright © 2013, Kashcheev A.A., Arestov S.O., Goushcha A.O.2013<p>Thecaloscopy is less invasive exploration of spinal subarachnoidspace with ultra-thin flexible endoscope and endoscopic fenestratioof scars and adhesions. Thecaloscopy was used inRussian neurosurgery at the first time. Since 2009 we operated32 patients with following diagnosis: 17 spinal adhesive arachnoiditis(8 local forms, 9 diffuse forms), 12 spinal arachnoidcysts (7 posstraumatic cysts, 5 idiopathic cysts), 3 extramedullary tumors (thecaloscopic videoassistance and biopsy).In all cases we realized exploration of subarachnoid spaceand pathologic lesion with endoscopic perforation of cyst or dissectionof adhesions using special instrumentation. Mean follow-up in our group was 11.4 months. Neurological improvement(mean 1.4 by modified Frankel scale, 1.8 by Ashworthspasticity scale) was seen in 87% of patients operated for spinalarachnopathies. Temporary neurological deterioration (milddisturbances of deep sensitivity) was seen in 9% of patients andmanaged successfully with conservative treatment. 1 patient(3.1%) was operated 3 times because of relapse of adhesions.There were no serious intraoperative complications (e.g., seriousbleeding, dura perforation etc). Postoperative complicationsincluded 1 CSF leakage and 1 postoperative neuralgic pain.Mean term of hospitalization was 7.6 days. According to ourdata, we suppose that thecaloscopy is efficient and safe method,and should be widely used for spinal arachnopaties, adhesivearachnoiditis and arachnoid cysts. Taking into account thatadhesive spinal arachnoiditis is systemic process and spinalarachnoid cysts can be extended as well, thecaloscopy may beregarded as the most radical and less-invasive way of surgicaltreatment existing currently in neurosurgery</p>
<div></div>thecaloscopyepidurosopyspinal arachnoiditisarachnoid cystssubarachnoid spaceflexible endoscopyneuroendoscopysyringomyeliaтекалоскопияэпидуроскопияспинальный арахноидитарахноидальная кистасубарахноидальное пространствогибкая эндоскопиянейроэндоскопиясирингомиелия[Полищук Н.Е., Корж Н.А. и др. Инфекционно-воспалительныезаболевания позвоночника и спинного мозга. М.: Медицина,2001.][Alvisi C., Cerisoli M., Giulioni M., Guerra L. Long-term results of surgically treated congenital intradural spinal arachnoid cysts; J Neurosurg. 1987; 67: 333–335.][Di Ieva A., Barolat G., Tschabitscher M. et al. Lumbar arachnoiditis and thecaloscopy: brief review and proposed treatment algorithm. Cent Eur Neurosurg. 2010 Nov; 71(4): 207–12. doi: 10.1055/s-0029-1243201. Epub 2009 Dec 21.][Koki Shimoji, Mai Ogura, Sanae Gamou et al. A new approach for observing cerebral cisterns and ventricles via a percutaneous lumbosacral route by using fine, flexible fiberscopes J Neurosurg 2009, 110:376–381.][Kumar K., Malik S., Schulte P.A. Symptomatic spinal arachnoid cysts: report of two cases with review of the literature.; 2003; Spine 28: E25–E29.][Warnke J.P., Tschabitscher M., Nobles A. Thecaloscopy: the endoscopy of the lumbar subarachnoid space, part I: historical review and own cadaver studies. Minim Invasive Neurosurg. 2001 Jun; 44 (2): 61–64.][Warnke J.P., Mourgela S. Endoscopic treatment of lumbar arachnoiditis. Minim Invasive Neurosurg. 2007 Feb; 50 (1): 1–6.]