Thecaloscopy is less invasive exploration of spinal subarachnoid space with ultra-thin flexible
endoscope and endoscopic fenestration of
scars and adhesions. Thecalopscopy was used in Russian neurosurgery at the first time. Since 2009 we operated 32 patients with following diagnosis: 17--spinal adhesive
arachnoiditis (8--local forms, 9--diffuse forms), 12--spinal
arachnoid cysts (7--posstraumatic cysts, 5--idiopathic cysts), 3--extramedullary
tumors (thecaloscopic videoassistance and biopsy). In all cases we realized exploration of subarachnoid space and pathologic lesion with endoscopic perforation of
cyst or dissection of adhesions using special instrumentation. Mean follow-up in our group was 11.4 months. Neurological improvement (mean 1.4 by modified Frankel scale, 1.8 by Ashworth spasticity scale) was seen in 87% of patients operated for spinal arachnopathies. Temporary neurological deterioration (mild disturbances of deep sensitivity) was seen in 9% of patients and managed successfully with
conservative treatment. 1 (3.1%) patient was operated 3 times because of relapse of adhesions. There were no serious
intraoperative complications (e.g., serious
bleeding, dura perforation etc). Postoperative complications included 1 CSF leakage and 1 postoperative neuralgic
pain. Mean term of hospitalization was 7.6 days. According to our data, we suppose that thecaloscopy is efficient and safe method, and should be widely used for spinal arachnopaties, adhesive
arachnoiditis and
arachnoid cysts. Taking into account that adhesive
spinal arachnoiditis is systemic process and spinal
arachnoid cysts can be extended as well, thecaloscopy may be regarded as the most radical and less-invasive way of surgical treatment existing currently in neurosurgery.