Abstract
Objective To explore the surgical strategy for tethered cord syndrome with lipoma.Methods Operations for releasing of tethered conus medullaris were composed of lipomas excision,adhesion releasing, terminal filum resection and reconstruction of dura mate of spinal cord. Fascia of the surrounding muscle with nonabsorbable suture (Prolene, 5-0) was used in duraplasty operation.Microsurgical release of the tethered cord was performed in each case while using multimodality intraoperative neurophysiological monitoring. Results Complication of subcutaneous fluidify included superficial wound infection in 4 patients and cerebrospinal fluid leakage in 2 patients, which were managed by reinforcement sutures and temporary external drainage. During the follow-up of 1-3years, 28 (84.8%) cases get better obviously in symptoms, and MRI re-examination showed no tethered cord in them. The other 5 cases did not suffer from an aggravation of nervous symptoms although a significant improvement was not achieved in them. Conclusions Early operation for tethered cord release should be performed under intraoperative neurophysiological monitoring to prevent the development of neurological defect. And releasing of tethered spinal cord and repairing of meningocele should be done simultaneously. Dural repair with Prolene displays significantly less cerebrospinal fluid leakage, less subcutaneous fluidity, and less extensive chronic inflammation and meningoneural adhesions. Key words: Lipoma; Tethered cord syndrome; Dura mate of spinal cord; Reconstruction
Published Version
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