bb8ab51e01007c61d2332045dc1cf21a jcm-12-05200.pdf c19d08921312c178162488c5923a48618a8b4b0e jcm-12-05200.pdf 54e7e4a5acc9821dd28286d33dc246cd3f1f905618d00070522709ee9e5a23a9 jcm-12-05200.pdf Title: Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach Subject: Syringomyelia can be associated with multiple etiologies. The treatment of the underlying causes is first-line therapy; however, a direct approach to the syrinx is accepted as rescue treatment. Any direct intervention on the syrinx requires a myelotomy, posing a significant risk of iatrogenic spinal cord (SC) injury. Intraoperative neurophysiological monitoring (IONM) is crucial to detect and prevent surgically induced damage in neural SC pathways. We retrospectively reviewed the perioperative and intraoperative neurophysiological data and perioperative neurological examinations in ten cases of syringomyelia surgery. All the monitored modalities remained stable throughout the surgery in six cases, correlating with no new postoperative neurological deficits. In two patients, significant transitory attenuation, or loss of motor evoked potentials (MEPs), were observed and recovered after a corrective surgical maneuver, with no new postoperative deficits. In two cases, a significant MEP decrement was noted, which lasted until the end of the surgery and was associated with postoperative weakness. A transitory train of neurotonic electromyography (EMG) discharges was reported in one case. The surgical plan was adjusted, and the patient showed no postoperative deficits. The dorsal nerve roots were stimulated and identified in the seven cases where the myelotomy was performed via the dorsal root entry zone. Dorsal column mapping guided the myelotomy entry zone in four of the cases. In conclusion, multimodal IONM is feasible and reliable and may help prevent iatrogenic SC injury during syringomyelia surgery. Keywords: Chiari malformation; corticospinal tract mapping; dorsal column mapping; D-wave; intraoperative neurophysiological monitoring; motor evoked potentials; root mapping; somatosensory evoked potentials; spinal cord; syringomyelia Author: M. Ángeles Sánchez Roldán, Dulce Moncho, Kimia Rahnama, Daniela Santa-Cruz, Elena Lainez, Daniel Baiget, Ivette Chocrón, Darío Gándara, Agustín Bescós, Juan Sahuquillo and María A. 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Ángeles Sánchez Roldán, Dulce Moncho, Kimia Rahnama, Daniela Santa-Cruz, Elena Lainez, Daniel Baiget, Ivette Chocrón, Darío Gándara, Agustín Bescós, Juan Sahuquillo and María A. Poca Subject: Syringomyelia can be associated with multiple etiologies. The treatment of the underlying causes is first-line therapy; however, a direct approach to the syrinx is accepted as rescue treatment. Any direct intervention on the syrinx requires a myelotomy, posing a significant risk of iatrogenic spinal cord (SC) injury. Intraoperative neurophysiological monitoring (IONM) is crucial to detect and prevent surgically induced damage in neural SC pathways. We retrospectively reviewed the perioperative and intraoperative neurophysiological data and perioperative neurological examinations in ten cases of syringomyelia surgery. All the monitored modalities remained stable throughout the surgery in six cases, correlating with no new postoperative neurological deficits. In two patients, significant transitory attenuation, or loss of motor evoked potentials (MEPs), were observed and recovered after a corrective surgical maneuver, with no new postoperative deficits. In two cases, a significant MEP decrement was noted, which lasted until the end of the surgery and was associated with postoperative weakness. A transitory train of neurotonic electromyography (EMG) discharges was reported in one case. The surgical plan was adjusted, and the patient showed no postoperative deficits. The dorsal nerve roots were stimulated and identified in the seven cases where the myelotomy was performed via the dorsal root entry zone. Dorsal column mapping guided the myelotomy entry zone in four of the cases. In conclusion, multimodal IONM is feasible and reliable and may help prevent iatrogenic SC injury during syringomyelia surgery. Keywords: Chiari malformation; corticospinal tract mapping; dorsal column mapping; D-wave; intraoperative neurophysiological monitoring; motor evoked potentials; root mapping; somatosensory evoked potentials; spinal cord; syringomyelia Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Aug 10 06:26:26 CEST 2023 ModDate: Thu Aug 10 06:34:01 CEST 2023 ID: 0xaaa1383951dc5f4dd5eb4b63a80e7218, 0xaaa1383951dc5f4dd5eb4b63a80e7218 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: WABLSD+SFRM1000 FontSubset: true FirstChar: 180 LastChar: 180 FontDescriptor: FontName: WABLSD+SFRM1000 Flags: Symbolic FontBBox: -189, -321, 1456, 937 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: KXEGGK+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 122 FontDescriptor: FontName: KXEGGK+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: WOWCNF+CMSY10 FontSubset: 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