Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery : A Multimodal Approach
Sánchez Roldán, M. Ángeles (Hospital Universitari Vall d'Hebron)
Moncho, Dulce (Hospital Universitari Vall d'Hebron)
Rahnama Zand, Kimia (Hospital Universitari Vall d'Hebron)
Santa-Cruz, Daniela (Hospital Universitari Vall d'Hebron)
Lainez, Elena (Hospital Universitari Vall d'Hebron)
Baiget, Daniel (Hospital Universitari Vall d'Hebron)
Chocrón, Ivette (Hospital Universitari Vall d'Hebron)
Gándara, Darío (Hospital Universitari Vall d'Hebron)
Bescós Cabestre, Agustí (Hospital Universitari Vall d'Hebron)
Sahuquillo Barris, Juan (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Poca Pastor, María Antonia (Hospital Universitari Vall d'Hebron)

Data:	2023
Resum:	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.
Ajuts:	Instituto de Salud Carlos III PI22/01082 Generalitat de Catalunya 2021/SGR-00810
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Chiari malformation ; Corticospinal tract mapping ; Dorsal column mapping ; D-wave ; Intraoperative neurophysiological monitoring ; Motor evoked potentials ; Root mapping ; Somatosensory evoked potentials ; Spinal cord ; Syringomyelia
Publicat a:	Journal of clinical medicine, Vol. 12, Num. 16 (August 2023) , ISSN 2077-0383

DOI: 10.3390/jcm12165200
PMID: 37629243

20 p, 6.2 MB

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