Turkish Neurosurgery
Endoscopic Untethering of Tight Filum Terminale: An Operative Technique
Onder OKAY1, Ali DALGIC2, Ali Erdem YILDIRIM2, Melih UCER3, Ozhan UCKUN2, Serhat BAYDIN4, Mustafa Kemal COBAN1, Abuzer GUNGOR5
1Regional Training and Research Hospital, Department of Neurosurgery, Erzurum,
2Ankara Numune Educational and Training Hospital, Department of Neurosurgery, Ankara,
3Kanuni Sultan Süleyman Education And Research Hospital, Department of Neurosurgery, Istanbul,
4Ondokuz Mayıs University, Department of Neurosurgery, Samsun,
5Yeditepe University, Department of Neurosurgery, Istanbul,
DOI: 10.5137/1019-5149.JTN.29771-20.2

Aim:Tethered cord syndrome (TCS) is a clinical syndrome characterized by radiological and clinical signs. The treatment of tight filum terminale is untethering of the tight filum terminale. The minimally invasive endoscopic technique is associated with minimal tissue trauma; however, only a few reports describing this technique have been published. Minimally invasive operative techniqes could have several benefits, such as decreased reoperation rates, shorter length of hospital stay, and reduced perioperative blood loss compared with other techniques. In this retrospective cohort study, we aimed to demonstrate the various technical advantages of endoscopic untethering to treat cases of tight filum terminale.Material and Methods:In five pediatric cases of TCS, we performed untethering using the endoscopic technique. The age of the patients were 6, 7, 8, 9, and 12 years old. We used a nasal speculum for the transsphenoidal approach during the procedure.Results:All the procedures were performed uneventfully, except for one case with a split cord malformation that showed neurologic deterioration caused by excision of the diastematomyelic fibrous septum at the thoracic level (unrelated to the endoscopic procedure at the L5-S1 level). This patient was referred to a rehabilitation clinic 5 days after surgery and showed significant improvement by the third postoperative month. The other four patients were discharged 1 day after the operation.Conclusion:Endoscopic release of filum terminale is a safe technique especially if it is performed with neuromonitoring. This technique may shorten the length of hospital stay and reduce perioperative blood loss. However, futher studies with a larger number of patients and long-term follow-up are needed.

Corresponding author : Abuzer GUNGOR