Advantages of neuroendoscope-assisted micro neurosurgery in spina bifida

الملخص EN

Objective : The efficacy, safety and advantages of endoscope-assisted microneurosurgery were evaluated in radical operation for spina bifida.

Methods : The neuroendoscope (2 mm-diameter rigid endoscope) was applied during microsurgery in fifty cases of spina bifida that were operated upon at King Hussein Medical Centre between January 2006 and January 2008.

It was used prior to the incision of the sac in cystic cases and after the dura was opened in noncystic cases.

The cases included nearly all types of spina bifida.

Results : The neuroendoscope showed pathology with clarification of surgico-anatomical structures and defined its relation to the normal structures.

There were no technical difficulties or complications.

It was of value in assessing the type of lipoma, the extent of cord involvement, identified the roots at exit from the cord invaded by lipoma and reduced both manipulation and retraction.

It gave an excellent view of the anterior part of the malformed cord with detailed view of nerve roots and vessels before the surgical intervention.

Filum terminale and sacral roots were visualized in all cases of tethered cord making resection of the spinal lipoma easier and safer.

There was no increase in infection rate, no effect on the primary surgical procedure, no bleeding or nervous tissue injury Conclusions : Application of the neuroendoscope to microsurgery of spina bifida is very useful in showing the pathology with more clarity and its relation to normal structures.

It can enhance surgical quality and reduce possible complications, allowing meticulous and more complete resection while preserving neurological function.

There was a highly magnified panoramic view of the anatomy and pathology through the neuroendoscope.