ABSTRACT
PURPOSE: We have already dealt with the technical and anatomical basics for thecaloscopy. The first results of clinical application are presented and the indications for its diagnostic and therapeutic use are described. The aetiology of aseptic arachnitis and the term "Wide spinal canal syndrome" are discussed. PATIENTS AND METHODS: Twelve patients who fulfilled the criteria for entry to the study were selected and the criteria were chosen according to German medical and legal rules. All patients underwent an endoscopic inspection and, if necessary, therapeutic manipulation under general anaesthesia. RESULTS: In all cases the procedure was safely and successfully performed. The pathomorphology of the arachnoid was detected and endoscopically treated in almost all cases. Arachnoid cysts were successfully fenestrated and an intraspinal meningocoele treated with endoscopic assistance. CONCLUSION: Thecaloscopy is a safe procedure if skilfully performed. It provides an opening for a wide range of new diagnostic and therapeutic options.
Subject(s)
Arachnoid Cysts/pathology , Arachnoid Cysts/surgery , Arachnoiditis/pathology , Arachnoiditis/surgery , Cauda Equina/abnormalities , Cauda Equina/surgery , Endoscopy/methods , Low Back Pain/pathology , Low Back Pain/surgery , Lumbosacral Region/pathology , Lumbosacral Region/surgery , Meningocele/pathology , Meningocele/surgery , Subarachnoid Space/pathology , Subarachnoid Space/surgery , Adult , Aged , Arachnoid Cysts/complications , Arachnoiditis/etiology , Female , Humans , Low Back Pain/etiology , Magnetic Resonance Imaging , Male , Meningocele/complications , Middle Aged , Minimally Invasive Surgical Procedures/methods , Outcome Assessment, Health Care , Prospective StudiesABSTRACT
Endoscopic anatomy differs from microsurgical anatomy. Topographical orientation as well as the proportion of objects, is different as they depend on the lens/object distance. Orientation under endoscopic conditions requires structures with defined positions or recognisable structures previously identified radiolologically. Structures are anatomical landmarks if the topographical relation to their surroundings is constant and they are easy and reliable to recognise. The contents of the dural sack are nerve roots with their supplying vessels, arachnoid trabeculars, filum terminale, and CSF. Safe navigation of a thecaloscope in relation to the bony structures is only possible with the simultaneous use of intraoperative fluoroscopy. To facilitate the navigation of scopes and instruments in the subarachnoid space we attempted to identify and describe reliable, and therefore constant recognisable anatomical landmarks.
