Marc Sindou1,2,3, Anthony Joud2,3, George Georgoulis4,5. 1. University of Lyon, Lyon, France. 2. IRR Flavigny, UGECAM Nord-Est, Nancy, France. 3. Pediatric Neurosurgery Department, CHRU Nancy, Nancy, France. 4. Department of Neurosurgery, General Hospital of Athens "G.Gennimatas", Mesogeion Avenue 154, 11527, Athens, Greece. gdgeorgoulis@gmail.com. 5. Medical School, University of Athens, Athens, Greece. gdgeorgoulis@gmail.com.
Abstract
BACKGROUND: Dorsal rhizotomy is considered the gold standard for treating spastic diplegia/quadriplegia in children with cerebral palsy, when rehabilitation programs reveal insufficient to control excess of spasticity. METHOD: The Keyhole Interlaminar Dorsal rhizotomy modality has been developed to access-individually-all L2-S2 roots, intradurally at the corresponding dural sheath, and preserve the posterior spine architecture. Intraoperative neuromonitoring consists of stimulating each ventral root, to verify its myotomal innervation, and dorsal roots, to explore their reflexive muscular responses in order to help determination of the proportion of rootlets to be cut. CONCLUSION: This modality, which requires 5 ± 1 h duration, offers tailored accuracy.
BACKGROUND: Dorsal rhizotomy is considered the gold standard for treating spastic diplegia/quadriplegia in children with cerebral palsy, when rehabilitation programs reveal insufficient to control excess of spasticity. METHOD: The Keyhole Interlaminar Dorsal rhizotomy modality has been developed to access-individually-all L2-S2 roots, intradurally at the corresponding dural sheath, and preserve the posterior spine architecture. Intraoperative neuromonitoring consists of stimulating each ventral root, to verify its myotomal innervation, and dorsal roots, to explore their reflexive muscular responses in order to help determination of the proportion of rootlets to be cut. CONCLUSION: This modality, which requires 5 ± 1 h duration, offers tailored accuracy.