Fractured Lumbar Drain Catheter Retrieval Using an Endoscopic Transforaminal Approach to the Lumbar Spine.

Suraj Sulhan, Saeed S Sadrameli, Sean Barber, Paul Holman, Gavin Britz, Meng Huang
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Abstract

Background and importance: Lumbar drain placement is a common neurosurgical procedure, with several surgical and medical indications extending even beyond the specialty. One complication of placement is a fractured catheter fragment. In some circumstances, catheter retrieval is necessary which is classically performed through an open approach. Here, we present the only reported case of a retained lumbar drain catheter which was retrieved using a transforaminal endoscopic approach to the lumbar spine.

Clinical presentation: This is a 39 year-old woman who underwent an elective craniotomy with planned perioperative lumbar drain placement for cerebrospinal fluid diversion using a 14-gauge Tuohy needle. Placement was noted to be technically challenging, and during the final attempt on removal of the system, it was noted that the distal end of the catheter had been sheared and retained in the thecal sac. Postoperatively a computed tomography scan of the lumbar spine was obtained showing the catheter fragment which entered the thecal sac dorsally at the L3-4 level but penetrated the ventral dura traveling in the epidural space caudally and terminating in the left lateral recess of L4-5. Given its presumed epidural location near the left L4-5 lateral recess and foramen, the decision was made to attempt a left transforaminal endoscopic approach for catheter retrieval before resorting to a standard open surgery.

Conclusion: As minimally invasive spine techniques for spine surgery continue to evolve, we have highlighted the versatility of the endoscope in spine surgery as it was implemented in our case, allowing for reduced perioperative morbidity associated with retained spinal catheter retrieval.

经椎间孔入路腰椎骨折引流管复位。
背景和重要性:腰椎引流管置入术是一种常见的神经外科手术,有一些外科和医学适应症,甚至超出了专业范围。放置的一个并发症是导管碎片断裂。在某些情况下,导管取出是必要的,这通常是通过开放的方法进行的。在这里,我们提出了唯一的病例报告保留腰椎引流管,这是通过经椎间孔内镜入路腰椎。临床表现:这是一位39岁的女性,她接受了择期开颅手术,并计划使用14号Tuohy针放置腰椎引流管以转移脑脊液。放置在技术上具有挑战性,在最后一次尝试移除系统时,注意到导管的远端被剪断并保留在鞘囊中。术后腰椎的计算机断层扫描显示导管碎片在L3-4水平背侧进入鞘囊,但穿过腹侧硬脑膜,在尾端沿硬膜外间隙行进,并终止于L4-5的左侧隐窝。考虑到其假定的硬膜外位置靠近左侧L4-5侧隐窝和孔,在采用标准开放手术之前,我们决定尝试左侧经椎间孔内镜入路取导管。结论:随着微创脊柱手术技术的不断发展,我们强调了内窥镜在脊柱手术中的多功能性,因为它在我们的病例中得到了应用,可以减少与留置脊髓导管取出相关的围手术期发病率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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