학술논문
Mapping and Monitoring During Surgery for Congenital Spinal Malformation/Konjenital Spinal Malformasyon Cerrahisinde Haritalama ve Monitorizasyon
Original Article
Original Article
Document Type
Report
Source
Bezmialem Science. May-June 2022, Vol. 10 Issue 3, p312, 7 p.
Subject
Language
English
Abstract
Introduction Congenital spinal malformations may present in a wide spectrum; ranging from mere junctional defects in the posterior vertebrae elements in its simplest benign form to severe neural malformations accompanied [...]
Objective: Surgery of complex congenital spinal malformations has a risk to damage functional neural structures. Intraoperative neurophysiological monitoring for congenital spinal pathologies is suggested to reduce this risk for neural tissues and thus improve the surgical results. Our aim is to evaluate which patients are liable to reveal critical neurophysiological changes during surgery by presenting our intraoperative neurophysiological approach and the early clinical outcome of patients with congenital spinal malformations. Methods: Nineteen patients (8 males and 11 females) were included in the study. Demographic data, symptoms and signs, radiological investigations, and other diagnostic tests for accompanying pathologies were evaluated together with neurophysiological findings. Results: The mean age of patients was 13.6 years (range: 16 months-62 years). Neurophysiological changes were seen in 7 patients (36.8%) during surgery. Most of them had mass lesion including dermoid and epidermoid tumor or intradural abscess. Motor evoked potential (MEP) changes were seen in 3 patients without any new postoperative motor deficit. Bulbocavernosus reflex (BCR) changed in 4 patients; stimulation threshold (15-25 mA) increased in 3 of them while the other one had additional morphological changes in BCR response and worsening of preexistent urological dysfunction. Conclusion: Mapping is the most critical part of surgery in terms of neurophysiology before cutting any structure in the operating area for preventing neurological deficit postoperatively. Among the spinal congenital malformations, MEP and BCR changes seem to occur during surgery for concomitant space occupying lesions or diastometamyelia and dermal sinus tract rather than isolated filum lipoma or tethered cord. Keywords: Spinal congenital anomaly, dermal sinus tract, diastomatomyelia, mapping, neuromonitoring Amac: Kompleks spinal malformasyonlarin cerrahisi fonksiyonel noral yapilara hasar verme riskine sahiptir. Kompleks spinal patolojiler icin kullanilan intraoperatif norofizyolojik monitorizasyon, noral yapilar icin olan bu riski azaltmak ve dolayisiyla cerrahi sonuclari iyilestirmek icin onerilmektedir. Amacimiz konjenital spinal malformasyonlu hastalarda intraoperatif norofizyolojik yaklasimlarimizi ve erken klinik bulgulari sunarak, cerrahi boyunca hangi olgularin kritik norofizyolojik degisikliklere yatkin oldugunu degerlendirmektir. Yontemler: On dokuz hasta (8 erkek and 11 kadin) calismaya dahil edildi. Demografik bilgiler, semptom ve bulgular, radyolojik degerlendirmeler ve eslik eden patolojiler icin diger testler norofizyolojik bulgularla birlikte degerlendirildi. Bulgular: Hastalarin ortalama yasi 13,6 (dagilim: 16 ay-62 yil) idi. Cerrahi suresince norofizyolojik degisiklikler hastalarin 7sinde (%36,8) goruldu. Cogunda dermoid, epidermoid veya intradural abseyi iceren kitle lezyonu vardi. Motor uyarilmis potansiyel (MEP) degisikligi postoperatif yeni motor defisit olmaksizin uc hastada goruldu. Bulbokavernoz refleks (BKR) 4 hastada degisti: Ucunde uyari esigi artarken digerinde BKR yanitinda ek olarak morfolojik degisiklik ve postoperatif mevcut urolojik disfonksiyonda kotulesme oldu. Sonuc: Postoperatif norolojik defisiti onlemek icin cerrahinin en kritik kismi, cerrahi alandaki herhangi bir yapiyi kesmeden once norofizyolojik olarak haritalama yapmaktir. MEP ve BKR degisiklikleri, spinal konjenital malformasyonlar icerisinde izole filum lipomu veya gergin omurilikten ziyade es zamanli yer isgal eden lezyon, diastematomyeli veya dermal sinus traktinin cerrahisinde gorunmektedir. Anahtar Sozcukler: Spinal konjenital anomali, dermal sinus trakti, diastematomyeli, haritalama, noromonitorizasyon
Objective: Surgery of complex congenital spinal malformations has a risk to damage functional neural structures. Intraoperative neurophysiological monitoring for congenital spinal pathologies is suggested to reduce this risk for neural tissues and thus improve the surgical results. Our aim is to evaluate which patients are liable to reveal critical neurophysiological changes during surgery by presenting our intraoperative neurophysiological approach and the early clinical outcome of patients with congenital spinal malformations. Methods: Nineteen patients (8 males and 11 females) were included in the study. Demographic data, symptoms and signs, radiological investigations, and other diagnostic tests for accompanying pathologies were evaluated together with neurophysiological findings. Results: The mean age of patients was 13.6 years (range: 16 months-62 years). Neurophysiological changes were seen in 7 patients (36.8%) during surgery. Most of them had mass lesion including dermoid and epidermoid tumor or intradural abscess. Motor evoked potential (MEP) changes were seen in 3 patients without any new postoperative motor deficit. Bulbocavernosus reflex (BCR) changed in 4 patients; stimulation threshold (15-25 mA) increased in 3 of them while the other one had additional morphological changes in BCR response and worsening of preexistent urological dysfunction. Conclusion: Mapping is the most critical part of surgery in terms of neurophysiology before cutting any structure in the operating area for preventing neurological deficit postoperatively. Among the spinal congenital malformations, MEP and BCR changes seem to occur during surgery for concomitant space occupying lesions or diastometamyelia and dermal sinus tract rather than isolated filum lipoma or tethered cord. Keywords: Spinal congenital anomaly, dermal sinus tract, diastomatomyelia, mapping, neuromonitoring Amac: Kompleks spinal malformasyonlarin cerrahisi fonksiyonel noral yapilara hasar verme riskine sahiptir. Kompleks spinal patolojiler icin kullanilan intraoperatif norofizyolojik monitorizasyon, noral yapilar icin olan bu riski azaltmak ve dolayisiyla cerrahi sonuclari iyilestirmek icin onerilmektedir. Amacimiz konjenital spinal malformasyonlu hastalarda intraoperatif norofizyolojik yaklasimlarimizi ve erken klinik bulgulari sunarak, cerrahi boyunca hangi olgularin kritik norofizyolojik degisikliklere yatkin oldugunu degerlendirmektir. Yontemler: On dokuz hasta (8 erkek and 11 kadin) calismaya dahil edildi. Demografik bilgiler, semptom ve bulgular, radyolojik degerlendirmeler ve eslik eden patolojiler icin diger testler norofizyolojik bulgularla birlikte degerlendirildi. Bulgular: Hastalarin ortalama yasi 13,6 (dagilim: 16 ay-62 yil) idi. Cerrahi suresince norofizyolojik degisiklikler hastalarin 7sinde (%36,8) goruldu. Cogunda dermoid, epidermoid veya intradural abseyi iceren kitle lezyonu vardi. Motor uyarilmis potansiyel (MEP) degisikligi postoperatif yeni motor defisit olmaksizin uc hastada goruldu. Bulbokavernoz refleks (BKR) 4 hastada degisti: Ucunde uyari esigi artarken digerinde BKR yanitinda ek olarak morfolojik degisiklik ve postoperatif mevcut urolojik disfonksiyonda kotulesme oldu. Sonuc: Postoperatif norolojik defisiti onlemek icin cerrahinin en kritik kismi, cerrahi alandaki herhangi bir yapiyi kesmeden once norofizyolojik olarak haritalama yapmaktir. MEP ve BKR degisiklikleri, spinal konjenital malformasyonlar icerisinde izole filum lipomu veya gergin omurilikten ziyade es zamanli yer isgal eden lezyon, diastematomyeli veya dermal sinus traktinin cerrahisinde gorunmektedir. Anahtar Sozcukler: Spinal konjenital anomali, dermal sinus trakti, diastematomyeli, haritalama, noromonitorizasyon