Document Detail


Multi-modality neurophysiological monitoring during surgery for adult tethered cord syndrome.
MedLine Citation:
PMID:  16242934     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
During complex microneurosurgery performed in patients with tethered cord syndrome, the conus medullaris and the roots that innervate the lower limbs, bladder and bowel are potentially exposed to damage. The aim of multimodality intraoperative monitoring (IOM) is to reduce the risk of inadvertent injury of neural tissue. We simultaneously record tibial nerve somatosensory evoked potentials (SSEPs) from the scalp and free run electromyography (EMG) of limb muscles supplied by L2 to S2 roots, anal and urethral sphincters. We also identify critical neural structures in the operative field, including the conus and exiting nerve roots, with a nerve stimulator to evoke EMG. SSEPs assess the sensory pathways mainly mediated by the S1 roots. Continuous EMG provides the surgeon with immediate auditory feedback resulting from irritative discharges triggered by manipulation of nerve fibres. Microstimulation can distinguish the filum terminale, scar tissue and invasive tumors from functional neural tissue, thus minimizing the risk of iatrogenic injury. Overall multimodality IOM proves a valuable adjunct to microneurosurgery of the lumbosacral spine.
Authors:
Guillermo Paradiso; Gabriel Y F Lee; Roger Sarjeant; Michael G Fehlings
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Publication Detail:
Type:  Journal Article     Date:  2005-10-20
Journal Detail:
Title:  Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia     Volume:  12     ISSN:  0967-5868     ISO Abbreviation:  J Clin Neurosci     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-12-05     Completed Date:  2006-05-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9433352     Medline TA:  J Clin Neurosci     Country:  Scotland    
Other Details:
Languages:  eng     Pagination:  934-6     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Toronto; Division of Neurosurgery, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Electromyography*
Evoked Potentials, Somatosensory*
Humans
Intestine, Large / innervation
Leg / innervation
Monitoring, Intraoperative / methods*
Neural Tube Defects / surgery*
Spinal Nerve Roots / physiology
Tibial Nerve / physiology
Urinary Bladder / innervation

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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