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Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach
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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455553/ https://www.ncbi.nlm.nih.gov/pubmed/37629243 http://dx.doi.org/10.3390/jcm12165200 |
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author | Sánchez Roldán, M. Ángeles Moncho, Dulce Rahnama, Kimia Santa-Cruz, Daniela Lainez, Elena Baiget, Daniel Chocrón, Ivette Gándara, Darío Bescós, Agustín Sahuquillo, Juan Poca, María A. |
author_facet | Sánchez Roldán, M. Ángeles Moncho, Dulce Rahnama, Kimia Santa-Cruz, Daniela Lainez, Elena Baiget, Daniel Chocrón, Ivette Gándara, Darío Bescós, Agustín Sahuquillo, Juan Poca, María A. |
author_sort | Sánchez Roldán, M. Ángeles |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10455553 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-104555532023-08-26 Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach Sánchez Roldán, M. Ángeles Moncho, Dulce Rahnama, Kimia Santa-Cruz, Daniela Lainez, Elena Baiget, Daniel Chocrón, Ivette Gándara, Darío Bescós, Agustín Sahuquillo, Juan Poca, María A. J Clin Med Article 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. MDPI 2023-08-10 /pmc/articles/PMC10455553/ /pubmed/37629243 http://dx.doi.org/10.3390/jcm12165200 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Sánchez Roldán, M. Ángeles Moncho, Dulce Rahnama, Kimia Santa-Cruz, Daniela Lainez, Elena Baiget, Daniel Chocrón, Ivette Gándara, Darío Bescós, Agustín Sahuquillo, Juan Poca, María A. Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach |
title | Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach |
title_full | Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach |
title_fullStr | Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach |
title_full_unstemmed | Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach |
title_short | Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach |
title_sort | intraoperative neurophysiological monitoring in syringomyelia surgery: a multimodal approach |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455553/ https://www.ncbi.nlm.nih.gov/pubmed/37629243 http://dx.doi.org/10.3390/jcm12165200 |
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