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OPERATIVE NUANCES |
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| Year : 2007 | Volume
: 2
| Issue : 1 | Page : 35-38 |
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Surgery for split-cord malformation: Operative nuances
NK Venkataramana
Manipal Institute for Neurological Disorders, 98, Rustombagh, Airport Road, Bangalore - 560 017, India
Correspondence Address:
N K Venkataramana
Neurosurgeon & Director Manipal Institute for Neurological Disorders, 98, Rustombagh, Airport Road, Bangalore - 560 017
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1817-1745.32008
How to cite this article:
Venkataramana N K. Surgery for split-cord malformation: Operative nuances. J Pediatr Neurosci 2007;2:35-8 |
Split-cord malformation is being increasingly recognized as one of the causes of tethered-cord syndrome with the newer modalities of imaging [Figure - 1],[Figure - 2],[Figure - 3]. Proper surgical technique can make the surgery safe and reduce morbidity significantly [Table - 1]. I prefer to operate prophylactically before the neurological deficits appear. Under general anesthesia in prone position, the part is prepped. Midline skin incision extending across the anomalous area. The cutaneous markers are the usual indicators for marking the incision, apart from radiological guidance. The skin and subcutaneous tissue are separated; and the paraspinal muscles are separated on either side, taking note of the possibility of defective laminae [Figure - 4],[Figure - 5],[Figure - 6],[Figure - 7]. The supraspinous ligaments are cut and the spinous process is removed [Figure - 8],[Figure - 9]. One can appreciate the usual interpedicular widening around the spur. Laminectomy is performed carefully with roungers and pediatric bone nibblers around the spur, exposing the two dural tubes [Figure - 10],[Figure - 11],[Figure - 12]. Motorized devices are dangerous and may cause dural injury. The spur is removed extradurally after separating from the dural tubes [Figure - 13]. Dura is opened and the sheath around the spur is completely excised along with the surrounding bands of tethering [Figure - 14]. The dural tube is thus converted into a single canal [Figure - 15]. The dura is closed dorsally and the operative wound in layers.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10], [Figure - 11], [Figure - 12], [Figure - 13], [Figure - 14], [Figure - 15], [Figure - 16]
[Table - 1]
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