Surgical Treatment Of Tethered Cord Syndrome

part I Small incision surgical treatment in children with the tight filum terminale type of tethered cord syndromeObjective:To explore the small insicion surgical treatment in children with the tight filum terminale type of tethered cord syndrome(TCS)And analysis the difference including indication,prognosis,complications between the small insicion surgical treatment and the routine microscopic surgical treatment.Methods:According to the clinical manifestations and imaging findings,including tight filum terminale type and split cord malformation(Pang Ⅱ type),a total of 43 children with TCS were classified into two groups.30 of them were subjected the routine microscopic surgery and the others were subjected the small insicion surgical treatment.to analysis the difference including prognosis,complications,hospital stays,the size of the wound between the small insicion surgical treatment and the routine microscopic surgical treatment.Results:43 Children were followed up for 3-24 months with an average of 9 months.The result indicated that the postoperative effective rate of the routine microscopic surgery was 93.3%,the postoperative effective rate of the small insicion surgical treatment was 100%.The difference between two groups was not statistically significant(P>0.05).the rate of complications of the routine microscopic surgery was 6.67%,the rate of complications of the small insicion surgical treatment was 0.00%.The difference between two groups was statistically significant(P<0.05).The difference of hospital stays and the size of the wound between two groups was statistically significant(P<0.05).Conclusion:The routine microscopic surgery and the small insicion surgical treatment have a same good clinical effect on children with TCS,and the incidence of complications of the small insicion surgical treatment is lower.Part Ⅱ Surgical treatment of Congenital dermal sinus Tract of the Spine and Neural tube defectObjective:To investigate the diagnosis,surgical treatment and its efficacy of Congenital dermal sinus tract of the spine and Neural tube defect.Methods:The clinical data of 43 patients with Congenital dermal sinus tract of the spine and Neural tube defect admitted to the Department of Neurosurgery,Chinese PLA General Hospital from January 2008 to December 2017 were analyzed retrospectively.Counting the Skin abnormalities characteristics of dermal sinus,location,and with the types of neural tube defects.According to the imaging findings,All the patients were treated with microsurgery.Spinal bifida neurological scale(SBNS)was used to evaluate the efficacy of surgical treatment.The follow-up time ranged from 6 to 96 months.Results:The most common Skin abnormalities was dimples(23/43,53.4%);Dermal sinuses occur frequently at the lumbosacral regions and account for 58.1%(25/43)of all cases;the most common coexistence of tethered cord with congenital dermal sinus tract was 51.2%(22/43).The total effective rate of 43 patients with Congenital dermal sinus tract of the Spine and neural tube defect after procedure was 90.7%(40/43).Conclusions:Skin abnormalities of Congenital dermal sinus tract is diverse,usually seen in the midline of lumbosacral regions.These tracts may be accompanied with other pathologies such as lipoma,split cord malformation,tethered cord,filum abnormality and inclusion Congenital tumors.MRI scan is necessary and treatment includes resection of tract with intradural exploration.The risks associated with surgical exploration are very low and the benefit are high.Part III Surgical treatment of lipoma types of tethered cord syndromeObjective:To explore clinical presentation and surgical treatment curative effect in patients of different ages and types with lipoma type of tethered cord syndrome(TCS).Methods:The clinical data of 183 lipoma type TCS patients admitted to the Department of Neurosurgery.Chinese PLA General Hospital from January 2015 to December 2018 were analyzed retrospectively.All patients were treated with microsurgery.According to the MRI imaging and intraoperative findings,The 183 patient were divided into five types:dorsal type,caudal type,Transitional type,chaotic type,lipo-myelomeningocele type.And were divided less than 14 years old,14 to 18 years old,older than 18 years old into three groups.Modified Karachi TCS severity scale was used to evaluate preoperative and postoperative nerve function of patients and the efficacy of surgical treatment.The follow-up time ranged from 3 to 36 months.Results:183 patients lipoma TCS were follow-up,Total/Near-Total resection rate of chaotic type was only 10.2%(5/49)(P<0.05).Different age groups that younger group of preoperative spinal nerve function score and postoperative improvement are better than adults.the score of chaotic type,lipo-myelomeningocele type was lower than other types(P<0.05).Symptom of pain and ulcer improvedobviously.Conclusions:Lumbosacral skin lesion is a kind of important diagnostic hint,Once the lipoma type TCS is diagnosed,early surgery can reduce the defecation dysfunction and both lower extremity dysfunction with the growth and development of children.Surgery should strive to total or total/near-total resection of lipomas in order to complete release of the spinal cord and cauda equine.The main factors for influencing the operative effect and prognosis were the types of lipomas,timing of operation,preoperative symptoms,complete neurolysis or not,and having retethering or not.