Utility of neurophysiological monitoring using dorsal column mapping in intramedullary spinal cord surgery.

摘要: Object. Intramedullary spinal cord tumors can displace the surrounding neural tissue, causing enlargement and distortion of normal anatomy. Resection requires a midline myelotomy to avoid injury posterior columns. Locating for is often difficult because distorted Standard anatomi cal landmarks may be misleading in patients with intramedullary due rotation, edema, neovascularization, or local scar formation. Misplacement places columns at risk significant postoperative disability. The authors describe technique mapping dorsal column accurately locate midline. Methods. A group 10 cervical thoracic lesions underwent which strip electrode was used define After laminectomy durotomy, custom-designed multielectrode grid placed on exposed surface cord. made up 8 parallel Teflon-coated stainless-steel wires (76-µm diameter, spaced 1 mm apart) embedded silastic each stripped its insulating coating along length 2 mm. This maps amplitude gradient conducted somatosensory evoked potentials elicited by bilateral tibial nerve stimulation. Using these recordings, are topographically mapped as lying between two adjacent numbers. Results. retrospective analysis preoperative, immediate, short-term neurological status, focusing especially function. There were women men whose mean age 52 years. 4 ependymomas, subependymoma, gangliocytoma, anaplastic astrocytoma, cavernous malformation, symptomatic syringes requiring shunting. In all attempted identify using anatomical landmarks, then proceeded electrophysiologically. syringomyelia 5 tumors, unable anatomically any certainty. they able Dorsal allowed identification confirm authors’ localization. function preserved only side. All other had intact preoperatively. Conclusions. useful guiding surgeon locating surgery. conjunction potential, motor D-wave we have been reduce surgical morbidity related dysfunction this small patients. (DOI: 10.3171/2010.1.SPINE09112)