Abstract
Recent improvements in instruments permit endoscopic examination of previously inaccessible
sites. We report on the clinical use of a small-diameter endoscope to examine the
spinal subarachnoid space, cord surface and syrinx cavities. Prior to clinical application,
three types of endoscopes with external diameters of 0.5, 1.4 or 2.2 mm were inserted
percutaneously in the lumbar region of five cadavers for preclinical evaluation of
the procedure and the three endoscopes. The observations permitted us to perform spinal
endoscopy preoperatively or intraoperatively using the 0.5-mm instrument in seven
patients with spinal cord lesions between 1995 and 1997. The patients included two
with spinal cord herniation through a dural defect, two with syringomyelia, one with
spinal arachnoid cyst, one with spinal epidural cyst and one undergoing lumboperitoneal
shunt for hydrocephalus. In patients in whom an endoscope was used preoperatively,
the endoscope provided morphological information useful in preoperative diagnosis
and planning surgical strategy. When the endoscope was used intraoperatively, areas
outside the field of vision of a microscope could be examined, and physiological evaluation
could include visualizing improved cord perfusion from the spinal subarachnoid space
after surgery. Endoscopes could be safely inserted and approached to the lesions under
direct vision while avoiding blood vessels and nerve roots on the spinal cord surface.
No changes in symptoms or complications occurred in association with endoscopy. Using
a small-diameter endoscope, the contents of the spinal subarachnoid space could be
examined. Further improvements to increase possible endoscopic manipulation and enhance
safety may extend the possibilities for endoscopic examination and permit endoscopic
treatment.
Key words
Endoscope - Spinal Cord - Spinal Subarachnoid Space - Syrinx
