| Autor: |
Lavano, Angelo, Guzzi, Giusy, Stroscio, Carmelino Angelo, Torre, Attilio Della, Gabriele, Donatella, Tiriolo, Raffaele, Lavano, Serena Marianna, Volpentesta, Giorgio |
| Zdroj: |
Stereotactic & Functional Neurosurgery; 2017 Supplement, Vol. 95, p410-410, 1/2p |
| Abstrakt: |
Neurological complications of SCS are exceptionally observed and result generally from intraoperative root or spinal cord injury or from compression by spinal infection or epidural hematoma. In some patients long-term SCS can result in the development of epidural mass lesion with loss of stimulation efficacy and myelopathy This rare complication may occur in majority of cases using paddle lead placed via open surgical approach and but it was reported also using percutaneous wire lead. Due to the diagnostic difficulties it is possible that it is diagnosed with delay or remains underestimated and unreported. We review the long-term complications of 439 definitive implants of SCS systems using 373 percutaneous wire leads (50/13.4% cervical and 323/86.6% thoracic) and 66 surgical paddle leads (12/18.2% cervical and 54/81.8% thoracic): in our series we found only two cases of symptomatic spinal cord compression due to epidural scar tissue formation at the site of implanted lead, one with paddle lead implanted surgically at cervical level and one with wire lead implanted percutaneously at thoracic level. In both cases leads were removed and thick scar tissue overlying the dura was dethaced by means of laminectomy with use of microscopic dissection technique. After surgery patients experienced progressive but incomplete improvement of neurological signs without the develop of new deficits. To put this complication into an appropriate context we performed a review of the pertinent literature and we discuss the pathogenetic hypothesis. In conclusion formation of hypertrophic epidural scar tissue at the level of implanted lead must be considered in presence of onset of progressive myelopathy with loss of stimulation efficacy. Resolution of CT imaging and artifacts generated by lead make difficult to detect the mass lesion around lead and its true extension. Despite severity of spinal cord compression the rapid removal of lead and scar tissue may allow satisfactory functional recovery. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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