- Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
- Department of Neurosurgery, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.
Department of Neurosurgery, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.
DOI:10.25259/SNI_331_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Turki Elarjani, Sami Khairy, Wael Alshaya. Combined Type 1 and 2 split cord malformations, kyphoscoliosis, tethered cord, and a lipoma. 27-Jun-2020;11:172
How to cite this URL: Turki Elarjani, Sami Khairy, Wael Alshaya. Combined Type 1 and 2 split cord malformations, kyphoscoliosis, tethered cord, and a lipoma. 27-Jun-2020;11:172. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=10109
Background: Split cord malformations (SCMs) are uncommon congenital anomalies. They can be divided into Type 1 (bony septum and two separate dural sheaths) and Type 2 (fibrous septum and a single dural sheath).[
Case Description: In this
Conclusion: SCM is a rare cause of spinal deformity. If left untreated, the associated neurological deficits may progress. Treatment should include a two-staged approach; first, the bony and membranous septum should be removed followed by lipoma resection and untethering the cord with adequate cord decompression, while second, a fusion may be performed to address attendant kyphoscoliosis.
Keywords: Intradural lipoma, Kyphoscoliosis, Split cord malformation, Tethered cord
After skin incision and paraspinal muscle dissection, a L3-L5 laminectomy was performed (01:10). This required careful dissection of the dura away from the bony septum. Drilling of the bony septum was initiated cranially and proceeded caudally, taking care to avoid injuring the surrounding nerve roots (01:19). It was critical to continue microdissection of the SCM away from the bony septum, especially while drilling to avoid a dural tear, and a cord injury (01:35). Arachnoidal adhesions and webs were severed to free the cord and the nerve roots (01:57). The lipoma was initially removed using microscissors and microforceps; this untethering of the cord allowed for resection of the membranous septum after excision of the lipoma (02:00). At the end of this procedure, the dura was closed using closely approximated interrupted 4–0 silk sutures to achieve a watertight closure (02:41). For a more secure closure, adding a fibrin sealant and a microfibrillar collagen utilizing a “sandwich” technique further supports the watertight dural closure.
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