The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair

TUNA ERDOĞAN, Ezgi; ALATAŞ, İbrahim; CANAZ, Hüseyin

The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair

Hüseyin CANAZ, (İstanbul Bilim Üniversitesi)

Ezgi TUNA ERDOĞAN, (İstinye Üniversitesi)

İbrahim ALATAŞ (İstanbul Bilim Üniversitesi)

Kocaeli Tıp Dergisi

6 0

Yıl: 2018 Cilt: 7 Sayı: 3 Sayfa Aralığı: 208 - 213 Metin Dili: İngilizce İndeks Tarihi: 08-03-2020

The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair

Öz:

INTRODUCTION: The safety of transcranial high currentstimulation is controversial in newborns. However,intraoperative direct stimulation techniques are safe anduseful methods even for newborns to determine thefunctional neural tissue and to provide a safer surgery. Weroutinely use direct nerve stimulation techniques duringmyelomeningocele closure in our institution unless patienthas total paraplegia. In this paper, we analyzed andpresented the results of intraoperative direct stimulation ofnerves and neural placode in 20 infants withmyelomeningocele.METHODS: Intraoperative direct stimulation was performedand electromyography was followed from lower extremitymuscles both for triggered and spontaneous activity duringmyelomeningocele repair.RESULTS: The compound muscle action potentials werecorrelated with motor examination of lower extremities. While,the level of conduction block in motor pathways involved nerveroots in some cases, most of the stimulated roots werefunctional which indicates the motor conduction block wasupper in spinal cord. In one case dysmorphic appearing rootletwas found functional and preserved throughout the surgery.DISCUSSION and CONCLUSION: In our practice,intraoperative direct stimulation is a useful and reliable methodto check the functional neural tissue and spare it to preserveduring releasing and closure of neural tube inmyelomeningocele operations.

Anahtar Kelime:

Myelomeningosel Onarımı Sırasında Kök ve Plakodun İntraoperatif Direkt Elektrik Stimülasyon Sonuçları

Öz:

GİRİŞ ve AMAÇ: Transkraniyal yüksek akım elektriksel uyarımın güvenliği yenidoğanlarda tartışmalıdır. Ancak, intraoperatif direkt stimülasyon teknikleri yenidoğanlarda da fonksiyonel sinir dokusunu belirlemek ve daha güvenli bir cerrahi sağlamak için güvenli ve faydalı yöntemlerdendir. Hastanın total paraplejisi olmadıkça, enstitümüzde myelomeningosel onarım operasyonlarında direkt sinir stimülasyon yöntemini rutin olarak kullanmaktayız. Bu yazıda, myelomeningoseli olan 20 bebekte sinir ve nöral plakodun intraoperatif direkt stimülasyonunun sonuçlarını analiz ettik ve sunduk. YÖNTEM ve GEREÇLER: İntraoperatif direkt stimülasyon uygulanan 20 myelomeningoselli hastanın sonuçları incelendi. Hastaların alt ekstremite kaslarındaki elektromiyografi aktivitesi hem tetiklenmiş hem de spontan aktivite açısından takip edildi. BULGULAR: Elde edilen bileşik kas aksiyon potansiyeli yanıtları alt ekstremitelerin preoperatif motor fonksiyonu ile ilişkilidir. Motor yollardaki iletim bloğu seviyesi bazı durumlarda sinir köklerini içerse de, stimüle edilen köklerin çoğunun işlevsel olması motor iletim bloğunun spinal kordun üst seviyelerinde olduğunu göstermiştir. Bir olguda, dismorfik görünen ince kökler fonksiyonel bulunmuş ve ameliyat boyunca korunmuştur. TARTIŞMA ve SONUÇ: İntraoperatif direkt stimülasyon, myelomeningosel operasyonlarında nöral tüpün diseksiyonu ve onarımı sırasında fonksiyonel sinir dokusunun tespit edilip korunması için yararlı ve güvenilir bir yöntemdir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Pouratian N, Elias WJ, Jane JA Jr, Phillips LH, Jane JA: Electrophysiologically guided untethering of secondary tethered spinal cord syndrome. Sr.Neurosurg Focus 2010; 29(1):E3. doi:10.3171/2010.3.FOCUS09299.
2. Hoving EW, Haitsma E, Oude Ophuis CM, Journée HL: The value of intraoperative neurophysiological monitoring in tethered cord surgery. Childs Nerv Syst 2011; 27(9):1445-52.
3. Sala F, Tramontano V, Squintani G, Arcaro C, Tot E, Pinna G, Meglio M: Neurophysiology of complex spinal cord untethering. J Clin Neurophysiol 2014; 31(4):326-36.
4. Pugh JA, Aronyk KE, Norton JA.: Neural activity generated in the neural placode and nerve roots in the neonate with spina bifida. J Neurosurg Pediatr 2012;9(4):452-6.
5. Copp AJ, Adzick NS, Chitty LS, Fletcher JM, Holmbeck GM, Shaw GM: “Spina Bifida”Nature Reviews Disease Primers 2015 Published online:30 April 2015 doi: 10.1038/nrdp.2015.7
6. Hendelman WJ: Atlas of Functional Neuroanatomy, ed 2. Boca Raton, FL: CRC Press, 2006
7. Sanes DH, Reh TA, Harris WA: Development of the Nervous System, ed 2. London: Academic Press, 2006
8. Stiefel D, Copp A J, Meuli M: Fetal spina bifida: loss of neural function in utero. J Neurosurg 2007;106, 213–221.
9. Meuli M, Meuli-Simmen C, Hutchins GM, Seller MJ, Harrison MR, Adzick NS: The spinal cord lesion in human fetuses with myelomeningocele: Implications for fetal surgery. J Pediatr Surg 1997; 32, 448–452.
10. McLone DG: Technique for closure of myelomeningocele Childs Brain 1980; 6:65-73
11. Reigel DH, Dallmann DE, Scarff TB, Woodford J: Intra-operative evoked potential studies of newborn infants with myelomeningocele. Dev Med Child Neurol Suppl 1976 ;(37):42-9.
12. Kothbauer K, Schmid UD, Seiler RW, Eisner W : Intraoperative motor and sensory monitoring of the cauda equina. Neurosurgery 1994;34(4):702- 7; discussion 707.
13. Krassioukov AV, Sarjeant R, Arkia H, Fehlings MG: Multimodality intraoperative monitoring during complex lumbosacral procedures: indications, techniques, and long-term follow-up review of 61 consecutive cases. J Neurosurg Spine 2004;1:243–53
14. Kalkman, C, Drummond J, Ribberink A : Low concentrations of isoflurane abolish motor evoked responses to transcranial electrical stimulation during nitrous oxide/opioid anesthesia in humans. Anesth Analg 1991;73, 410–5.
15. Yamada H, Transfeldt EE, Tamaki T, Torres F, Iaizzo PA : The effects of volatile anesthetics on the relative amplitudes and latencies of spinal and muscle potentials evoked by transcranial magnetic stimulation. Spine 1994; 19, 1512–7.
16. McLone DG : Results of treatment of children born with a myelomeningocele. Clin Neurosurg 1983;30:407-12
17. Ramer LM, Ramer MS, Bradbury EJ : Restoring function after spinal cord injury: towards clinical translation of experimental strategies. Lancet Neurol 2014;13(12):1241-56.
18. ChédotalA:Development and plasticity of commis sural circuits:from locomotion to brain repair Trends Neurosci 2014;37(10):551-62.
19. Kumar GS, Rajshekhar V, Babu KS: Intraoperative mapping of sacral nervous system (S2-4). Br J Neurosurg 2006;20(6):396- 402.
20. Oakeshott P, Hunt GM, Poulton A, Reid F : Open spina bifida: birth findings predict long-term outcome. Arch Dis Child 2012;97, 474–6.

APA	CANAZ H, TUNA ERDOĞAN E, ALATAŞ İ (2018). The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair. , 208 - 213.
Chicago	CANAZ Hüseyin,TUNA ERDOĞAN Ezgi,ALATAŞ İbrahim The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair. (2018): 208 - 213.
MLA	CANAZ Hüseyin,TUNA ERDOĞAN Ezgi,ALATAŞ İbrahim The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair. , 2018, ss.208 - 213.
AMA	CANAZ H,TUNA ERDOĞAN E,ALATAŞ İ The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair. . 2018; 208 - 213.
Vancouver	CANAZ H,TUNA ERDOĞAN E,ALATAŞ İ The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair. . 2018; 208 - 213.
IEEE	CANAZ H,TUNA ERDOĞAN E,ALATAŞ İ "The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair." , ss.208 - 213, 2018.
ISNAD	CANAZ, Hüseyin vd. "The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair". (2018), 208-213.

APA	CANAZ H, TUNA ERDOĞAN E, ALATAŞ İ (2018). The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair. Kocaeli Tıp Dergisi, 7(3), 208 - 213.
Chicago	CANAZ Hüseyin,TUNA ERDOĞAN Ezgi,ALATAŞ İbrahim The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair. Kocaeli Tıp Dergisi 7, no.3 (2018): 208 - 213.
MLA	CANAZ Hüseyin,TUNA ERDOĞAN Ezgi,ALATAŞ İbrahim The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair. Kocaeli Tıp Dergisi, vol.7, no.3, 2018, ss.208 - 213.
AMA	CANAZ H,TUNA ERDOĞAN E,ALATAŞ İ The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair. Kocaeli Tıp Dergisi. 2018; 7(3): 208 - 213.
Vancouver	CANAZ H,TUNA ERDOĞAN E,ALATAŞ İ The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair. Kocaeli Tıp Dergisi. 2018; 7(3): 208 - 213.
IEEE	CANAZ H,TUNA ERDOĞAN E,ALATAŞ İ "The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair." Kocaeli Tıp Dergisi, 7, ss.208 - 213, 2018.
ISNAD	CANAZ, Hüseyin vd. "The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair". Kocaeli Tıp Dergisi 7/3 (2018), 208-213.