Prevention of postoperative posterior tethering of spinal cord after resection of ependymoma.
OBJECTIVE
The authors evaluated an alternative method to avoid postoperative posterior tethering of the spinal cord following resection of spinal ependymomas.


METHODS
Twenty-five patients with spinal ependymoma underwent surgery between 1978 and 2002. There were 16 male and nine female patients whose ages at the time of surgery ranged from 14 to 64 years (mean 41.8 years). The follow-up period ranged from 6 to 279 months (mean 112.4 months). In the initial 17 patients (Group A), the procedure to prevent arachnoidal adhesion consisted of the layer-to-layer closure of three meninges and laminoplasty. In the subsequently treated eight patients (Group B), the authors performed an alternative technique that included pial suturing, dural closure with Gore-Tex membrane-assisted patch grafting, and expansive laminoplasty. In Group A, postoperative adhesion was radiologically detected in eight cases (47%), and delayed neurological deterioration secondary to posterior tethering of the cord was found in five cases. In Group B, there was no evidence of adhesive posterior tethering or delayed neurological deterioration. A significant intergroup statistical difference was demonstrated for radiologically documented posterior tethering (p < 0.05, Fisher exact test). Moreover, patients with radiologically demonstrated posterior tethering suffered a significant delayed neurological functional deterioration (p < 0.01, Fisher exact test).


CONCLUSIONS
This new technique for closure of the surgical wound is effective in preventing of postoperative posterior spinal cord tethering after excision of spinal ependymoma.
Goto
Takeo
T
Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Ohata
Kenji
K
Takami
Toshihiro
T
Nishikawa
Misao
M
Nishio
Akimasa
A
Morino
Michiharu
M
Tsuyuguchi
Naohiro
N
Hara
Mitsuhiro
M
D000293:Adolescent; D000328:Adult; D004806:Ependymoma / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods*; D013116:Spinal Cord / Q000473:pathology; D013118:Spinal Cord Diseases / Q000209:etiology / Q000517:prevention & control*; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control