gms | German Medical Science

63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

13. - 16. Juni 2012, Leipzig

Minimal invasive selective dorsal rhizotomy – The first European series

Meeting Abstract

Suche in Medline nach

  • H. Haberl - Arbeitsbereich Pädiatrische Neurochirurgie, Charité - Univeritätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.13.09

DOI: 10.3205/12dgnc286, URN: urn:nbn:de:0183-12dgnc2860

Veröffentlicht: 4. Juni 2012

© 2012 Haberl.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: After 100 years, selective dorsal rhizotomy (SDR) was reintroduced in Germany in 2007. Since then, 100 children, suffering from cerebral palsy (cp) were submitted to surgery, performed by a single pediatric neurosurgeon. The patients have been selected and followed up at a single institution by a multidisciplinary team.

Methods: Candidates for surgery were presented within a multidisciplinary consultation. The indication for surgery was based on the confirmed diagnosis of icp, an interview with the parents and a detailed neurological examination, evaluating the physical, mental and social ability of the child to improve best by SDR. Surgery was performed in a modified technique based on the concept of TS Park. Follow-up was performed by the same team excluding the neurosurgeon after 6 months, one year and two years.

Results: Surgery was performed in 100 children. The GMFM (Gross Motor Function Measure) distribution in this cohort was I in 12%, II in 38%, III in 45%, and IV and below in 5% prior to surgery. 8 patients were lost to follow-up after surgery. Results were available after 6 months in 92 patients, after 12 months in 80 patients and after 24 months in 75 patients. The average improvement in GMFM was 6%, in goal-related GMFM 12%. No patient remained worse after surgery, there was no related morbidity or mortality. Additional orthopedic interventions were planned in 14 patients. Postop x-rays for hip status were available in 40 children, showing satisfying refusion of the removed spinal arch in 100%. Subjectivly 98% of patients improved regarding gait or overall performance. A distinctive functional improvement of the upper limbs was reported by 12 patients.

Conclusions: Modified minimal invasive selective dorsal rhizotomy achieved patient satisfaction in 98%. A functional improvement could be shown in 92%. The surgical modifications we introduced aimed at further diminishing postoperative morbiditiy and the risk of long-term instability. Our first results show that the complication rate was reduced to 0 compared to an average risk of 6% in intradural spinal procedures. Refixation and revitalisation of the removed spinal arch was successful in 100% of the examined cases. Still, the functional profit regarding long-term stability remains to be shown.