Preliminary experience on 3D-exoscopic untethering of a type II diastematomyelia: technical note and review of literature.

OBJECTIVE: The aim of this paper is to describe the use of high-definition 3D exoscope (VITOM 3D exoscope - Karl Storz GmbH, Tuttlingen, Germany) for the neurosurgical treatment of a rare pediatric disease, type II diastematomyelia with associated tethered cord.

METHODS: A 13-year-old girl suffering diastematomyelia type II with a tethered cord was surgically treated with the aid of a high-definition 3D exoscope, with a third operator moving and pivoting its arm. Intraoperative monitoring and mapping was arranged. The surgery required a bilateral access to address both the split cord malformation and the tethering of the filum terminale. The filum terminale was identified and cut, and the connective fibrovascular tissue separating the two medullary halves were unraveled. These steps were performed with no changes of intraoperative monitoring. Pertinent literature has been carefully addressed RESULTS: The surgery was successful, and the patient was discharged home on the eleventh postoperative day without any complications. The 3-month postoperative MRI demonstrated regular surgical outcomes; no dynamic motor disturbances were reported. To our knowledge this is the first spinal congenital malformation treated with the use of a 3D exoscope.

CONCLUSIONS: The use of 3D exoscope is advancing in spinal surgery, as it provides magnification, stereopsis, lighting and definition comparable to the operating microscope; the addition of a third operator simplified the operations of moving around the arm, releasing these burdens for the surgeons. Our preliminary experience proved that the use of a 3D exoscope is feasible and safe for surgical management of a type II diastematomyelia with tethered cord.