The reasons why I consider this scientific article published in 2009 a milestone on this subject are many: the authority of the Authors, the large case series of over 3000 patients, the fact that they also evaluated the mild descent of the cerebellar tonsils (Low-Lying Cerebellar Tonsils) and not only the descent of the cerebellar tonsils sufficient to configure Chiari type I malformation (CM1), and the correlation of the various descents of the cerebellar tonsils with tethered cord syndrome and occult tethered cord syndrome.
I would like to point out that the surgical treatment of tethered cord syndrome and occult tethered cord syndrome was performed under GENERAL ANESTHESIA with section of the INTRADURAL FILUM TERMINALE.
My minimally invasive surgical procedure under LOCAL ANESTHESIA for the EXTRADURAL section of the FILUM TERMINALE, which I will discuss further here and on other pages of the website, was published later in 2018, although I have been performing it since 2010.
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GRADUATION THESIS IN MEDICINE AND SURGERY UNIVERSITY OF MILAN
ACADEMIC YEAR 2015-2016
FROM 2014 TO 2016 THE CASE SERIES CONSISTED OF 48 PATIENTS IN WHOM OUR PROTOCOL WAS PERFORMED WITH LUMBAR MRI IN PRONE POSITION AND SURGERY WITH MINIMAL SKIN INCISION AND MICRO-SURGICAL TECHNIQUE (MIMS) FOR THE SECTION OF THE FILUM TERMINALE EXTERNUM UNDER LOCAL ANESTHESIA.
The data from our innovative diagnostic and therapeutic protocol, using diagnosis with lumbar MRI in the prone position and surgical intervention with a transhiatal approach for sectioning the filum terminale externum with a microsurgical technique and minimal skin incision (MIMS) under local anesthesia, were the subject of a thesis in medicine and surgery at the University of Milan.
Patients operated on with the aforementioned minimally invasive technique from 2010 to July 2014 were excluded from the case series because the diagnostic method with lumbar MRI in the prone position had not yet been published, and therefore was not performed by us.
Only the 48 patients operated on for sectioning of the filum terminale externum from 29/07/2014 to 29/06/2016 were included in the thesis.
The surgical intervention was performed under local anesthesia with a minimally invasive microsurgical technique at the SSD of Peripheral Nervous System Surgery, with operating locations at the “Umberto I” Hospital in Lugo (Ra) and the “Degli Infermi” Hospital in Faenza (Ra) of the AUSL of Romagna.
The age of the patients ranged from 18 to 70 years. There was a clear predominance of females (M/F: 15/33).
The patients were divided into three groups:
- a group with a diagnosis of occult tethered cord in Chiari type I malformation;
- a group with LLCT (tonsillar descent from 1 to 4 mm, not sufficient to configure the presence of Chiari I malformation);
- a group with a diagnosis of occult tethered cord not associated with other nervous system pathologies.
We evaluated the various types of pre- and postoperative symptoms and the indices obtained from the lumbar MRI in the prone position.
There were no complications.
Patients were able to walk freely just a few hours after the operation and were discharged the day after surgery.
To provide the overall data, without going into the details of the nearly sixty pages of the thesis, we report the assessment of the overall well-being perceived by the patient after the operation, considering the impact on daily activities and thus on overall quality of life. At the second follow-up at the six-month check-up visit, an improvement was found in 87% of patients.
LAST MODIFIED MARCH 16, 2021
© Copyright 2020 Vanni VERONESI. All rights reserved.