Neurosurgery
doi: 10.25005/2074-0581-2021-23-1-39-45
DEVELOPMENT AND PRACTICAL APPLICATION OF AN ORIGINAL METHOD OF MONITORING THE PATENCY OF THE SPINAL SPACES DURING THE REMOVAL OF LUMBOSACRAL LIPOMA
1Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
2Federal Center for Neurosurgery, Tyumen, Russian Federation
Objective: To assess the effectiveness of reconstructive plasty of the dura mater in patients with lumbosacral lipomas (LSL) using an original method for controlling the patency of the spinal spaces.
Methods: The results of examination and treatment of 34 patients with LSL, who were operated on under the control of intraoperative ultrasonography, were analyzed. Before and after reconstructive plasty of the spinal cord and dura mater (DM), the patients underwent measurements of the anterior sagittal, posterior sagittal, common sagittal and common frontal spaces. The control group was represented by 34 patients with craniosynostosis, in whom the pathology of the spine and spinal cord was excluded, and the measurements of the above spinal spaces were taken as the anatomical norm.
Results: Statistically significant differences were revealed between the value of the posterior sagittal space before opening the DM and this indicator under conditions of anatomical norm (p<0.001). No statistically significant differences between this parameter and the anatomical norm were found after reconstruction (p=0.1). The total sagittal and total frontal spaces before opening the DM did not have a statistically significant correlation with the patient’s age (r=0.222, p=0.7 and r=0.214, p=0.82, respectively), while the same values after reconstructive surgery had a significant correlation with the patient’s age (r=0.327, p=0.007 and r=0.392, p=0.001, respectively).
Conclusion: The data obtained using the original method for monitoring the patency of the spinal spaces indicate a high efficiency of reconstructive plasty of the spinal cord and dura mater for lumbosacral lipomas, which is confirmed by statistical calculations.
Keywords: Neurosurgery, spinal cord, lumbosacral lipoma, intraoperative ultrasonography.
References
- Sufianov AA, Gizatullin MR. Lyumbosakral’naya lipoma [Lumbosacral lipoma]. Moscow, RF: Izdatel’stvo RAMN; 2013. 136 p.
- Jones V, Wykes V, Cohen N, Thompson D, Jacques TS. The pathology of lumbosacral lipomas: macroscopic and microscopic disparity have implications for embryogenesis and mode of clinical deterioration. Histopathology. 2018;72(7):1136-44. Available from: https://doi.org/10.1111/his.13469
- Gupta P, Kumar A, Kumar A, Goel S. Congenital spinal cord anomalies: a pictorial review. Curr Probl Diagn Radiol. 2013;42(2):57-66. Available from: https://doi.org/10.1067/j.cpradiol.2012.06.002
- Tishchenko GE. Narushenie funktsii nizhnikh mochevydelitel’nykh putey na fone povrezhdeniy i zabolevaniy spinnogo mozga. Spektr diagnosticheskikh protsedur [Dysfunction of the lower urinary tract against the background of injuries and diseases of the spinal cord. Range of diagnostic procedures]. Urologiсheskie vedomosti. 2019;9(S):96-7.
- Pang D, Zovickian J, Wong ST, Hou YJ, Moes GS. Surgical treatment of complex spinal cord lipomas. Childs Nerv Syst. 2013;29(9):1485-513. Available from: https://doi.org/10.1007/s00381-013-2187-4
- Da Rosa SP, Scavarda D, Choux M. Results of the prophylactic surgery of lumbosacral lipomas 20 years of experience in the Paediatric Neurosurgery Department La Timone Enfants Hospital, Marseille, France. Childs Nerv Syst. 2016;32(11):2205-9. Available from: https://doi.org/10.1007/s00381-016- 3198-8
- Vora TK, Girishan S, Moorthy RK, Rajshekhar V. Early- and long-term surgical outcomes in 109 children with lipomyelomeningocele. Childs Nerv Syst. 2021 Jan 6. Available from: https://doi.org/10.1007/s00381-020-05000-y. Epub ahead of print. PMID: 3340471
- Ficklscherer A, Zhang AZ, Baur-Melnyk A, Knösel T, Jansson V, Dürr HR. Spinal cord damage after resection of destructive spinal lipoma resembling liposarcoma: case report. Spinal Cord Ser Cases. 2016;2:16011. Available from: https://doi.org/10.1038/scsandc.2016.11
- Usami K, Lallemant P, Roujeau T, James S, Beccaria K, Levy R, et al. Spinal lipoma of the filum terminale: review of 174 consecutive patients. Childs Nerv Syst. 2016;32(7):1265-72. Available from: https://doi.org/10.1007/s00381- 016-3072-8
- Pang D. Surgical management of complex spinal cord lipomas: How, why, and when to operate. A review. J Neurosurg Pediatr. 2019;23(5):537-56. Available from: https://doi.org/10.3171/2019.2.PEDS18390
- Ganau M, Syrmos N, Martin AR, Jiang F, Fehlings MG. Intraoperative ultrasound in spine surgery: history, current applications, future developments. Quant Imaging Med Surg. 2018;8(3):261-7. Available from: https://doi. org/10.21037/qims.2018.04.02
- Han B, Wu D, Jia W, Lin S, Xu Y. Intraoperative ultrasound and contrast-enhanced ultrasound in surgical treatment of intramedullary spinal tumors. World Neurosurg. 2020;137:e570-e576. Available from: https://doi. org/10.1016/j.wneu.2020.02.059
- Vasudeva VS, Abd-El-Barr M, Pompeu YA, Karhade A, Groff MW, Lu Y. Use of intraoperative ultrasound during spinal surgery. Global Spine J. 2017;7(7):648- 56. Available from: https://doi.org/10.1177/2192568217700100
- Ivanov M, Budu A, Sims-Williams H, Poeata I. Using intraoperative ultrasonography for spinal cord tumor surgery. World Neurosurg. 2017;97:104-11. Available from: https://doi.org/10.1016/j.wneu.2016.09.097
- Ausili E, Maresca G, Massimi L, Morgante L, Romagnoli C, Rendeli C. Occult spinal dysraphisms in newborns with skin markers: Role of ultrasonography and magnetic resonance imaging. Childs Nerv Syst. 2018;34(2):285-91. Available from: https://doi.org/10.1007/s00381-017-3638-0
- Kang YR, Koo J. Ultrasonography of the pediatric hip and spine. Ultrasonography. 2017;36(3):239-51. Available from: https://doi.org/10.14366/usg.16051
- Pang D. Surgical management of complex spinal cord lipomas: A new perspective. J Korean Neurosurg Soc. 2020;63(3):279-313. Available from: https://doi.org/10.3340/jkns.2020.0024
- Dhingani DD, Boruah DK, Dutta HK, Gogoi RK. Ultrasonography and magnetic resonance imaging evaluation of pediatric spinal anomalies. J Pediatr Neurosci. 2016;11(3):206-12. Available from: https://doi.org/10.4103/1817- 1745.193374
- Currarino G, Coln D, Votteler T. Triad of anorectal, sacral, and presacral anomalies. AJR Am J Roentgenol. 1981;137(2):395-8. Available from: https://doi. org/10.2214/ajr.137.2.395
- Miller JH, Reid BS, Kemberling CR. Utilization of ultrasound in the evaluation of spinal dysraphism in children. Radiology. 1982;143(3):737-40. Available from: https://doi.org/10.1148/radiology.143.3.7079502
- Naidich TP, McLone DG, Shkolnik A, Fernbach SK. Sonographic evaluation of caudal spine anomalies in children. Am J Neuroradiol. 1983;4(3):661-4.
- Orman G, Tijssen MPM, Seyfert D, Gassner I, Huisman TAGM. Ultrasound to evaluate neonatal spinal dysraphism: A first-line alternative to CT and MRI. J Neuroimaging. 2019;29(5):553-64. Available from: https://doi.org/10.1111/ jon.12649
- Kumar I, Sachan A, Aggarwal P, Verma A, Shukla RC. Structured MRI reporting in spinal dysraphism. Acta Radiol. 2020;61(11):1520-33. Available from: https://doi.org/10.1177/0284185120903445
- Cheon JE. Intraoperative neurosonography revisited: Effective neuronavigation in pediatric neurosurgery. Ultrasonography. 2015;34(2):79-87. Available from: https://doi.org/10.14366/usg.14054
- Prada F, Vetrano IG, Filippini A, Del Bene M, Perin A, Casali C, et al. Intraoperative ultrasound in spinal tumor surgery. J Ultrasound. 2014;17(3):195-202. Available from: https://doi.org/10.1007/s40477-014-0102-9
- Alvarado E, Leach J, Caré M, Mangano F, O Hara S. Pediatric spinal ultrasound: Neonatal and intraoperative applications. Semin Ultrasound CT MR. 2017;38(2):126-42. Available from: https://doi.org/10.1053/j. sult.2016.07.003
Authors' information:
Sufianov Albert Akramovich
Doctor of Medical Sciences, Full Professor, Head of the Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University; Chief Medical Officer, Federal Center for Neurosurgery ORCID ID: 0000-0001-7580-0385 SPIN: 1722-0448 Author ID: 446102 E-mail: sufianov@gmail.com
Shelyagin Ivan Sergeevich
Resident of the Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University ORCID ID: 0000-0002-0877-7442 SPIN: 4188-2029 Author ID: 1043290 E-mail: sheliaginivan@outlook.com
Gizatullin Marat Rimovich
Neurosurgeon, Federal Center for Neurosurgery ORCID ID: 0000-0002-6809-4694 E-mail: kutuche@yandex.ru
Sufianov Rinat Albertovich
Assistant of the Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University ORCID ID: 0000-0003-4031-0540 SPIN: 1204-2994 Author ID: 792245 E-mail: rinat.sufianov@gmail.com
Information about support in the form of grants, equipment, medications
The authors did not receive financial support from manufacturers of medicines and medical equipment
Conflicts of interest: No conflict
Address for correspondence:
Shelyagin Ivan Sergeevich
Resident of the Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University
119991, Russian Federation, Moscow, Trubetskaya Str., 8, building 2
Tel.: +7 (919) 9545381
E-mail: sheliaginivan@outlook.com
Materials on the topic:
- BIOMECHANICAL COMPARISON OF TRANSPEDICULAR FIXATION METHODS UNDER ROTATIONAL LOADING FOR OPTIMIZING SURGERY ON THE THORACOLUMBAR JUNCTION OF THE SPINE
- MICROSURGICAL TREATMENT OF DISTAL POSTERIOR INFERIOR CEREBELLAR ARTERY ANEURYSM DURING THE COLD PERIOD AFTER SPONTANEOUS INTRACRANIAL HEMORRHAGE: A CASE REPORT
- EXTERNAL VENTRICULAR DRAINAGE FOR MALIGNANT ISCHEMIC STROKE: A CASE REPORT
- IMMUNE RESISTANCE VIA A PD-1/PD-L1 MECHANISM IN GLIOBLASTOMA
- DECOMPRESSIVE HEMICRANIECTOMY AFTER UNSUCCESSFUL INTRAVENOUS THROMBOLYSIS OF MALIGNANT MIDDLE CEREBRAL ARTERY INFARCTION: A CASE REPORT
- INTRADURAL HYPOGLOSSAL SCHWANNOMA WITHOUT HYPOGLOSSAL PARALYSIS AND TONGUE ATROPHY: A CASE STUDY AND LITERATURE REVIEW
- SUPPLEMENTARY MOTOR AREA AND CLINICAL PICTURE OF ITS LESION
- A CASE OF SUCCESSFUL OPEN SURGICAL TREATMENT OF A GIANT ANEURISM OF THE SUPRACLINOID SEGMENT OF THE INTERNAL CAROTID ARTERY
- MODERN APPROACHES IN THE DIAGNOSIS AND TREATMENT OF CEREBROVASCULAR DISEASES
- SURGICAL TREATMENT OF PATIENTS WITH MULTIPLE INTRACRANIAL ANEURYSMS AND ACUTE SEVERE SUBARACHNOID HEMORRHAGE