The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele

Yıl: 2018 Cilt: 7 Sayı: 3 Sayfa Aralığı: 192 - 198 Metin Dili: İngilizce İndeks Tarihi: 08-03-2020

The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele

Öz:
INTRODUCTION: Using intraoperative neuromonitoringin both primary and secondary tethered cord operations isaccepted as a necessity for a safer operation and guidingsurgeon in complex surgeries.METHODS: Twenty four operations which were monitoredwith three modalities; transcranial motor evoked potentials(TcMEP), free-run electromyography and direct nervestimulations. In group 1, there were 14 patients underwenttethered cord operations due to occult spinal dysraphism, ingroup 2 there were 10 patients underwent tethered cordoperations secondary to previous myelomeningocele repair.RESULTS: TcMEP responses of lower extremity were elicitedin 92 % in group 1, 80 % in group 2. TcMEP responses of analsphincter were elicited in 83 % in group 1, 60 % in group 2. NoTcMEP change was observed during the surgeries in bothgroup. Postoperative urodynamic results of both group wereimproved in 1 year period (78 % in group 1, 43 % in group 2).In patients with hypoactive bladder, we could not take analsphincter responses in TcMEP.DISCUSSION and CONCLUSION: Untethering of spinal cordboth in asymptomatic occult spinal dysraphism and TCSsecondary to MMC, can improve impaired urodynamic results.Intraoperative neuromonitoring and direct stimulation providesinformation for a safer surgery and guide surgical maneuversespecially in secondary untethering. Intraoperativeneurophysiological monitoring is beneficial for operations ofMMC patients with neurological deficits, to preserve theirresidual motor functions. Since anal sphincter functions arecorrelated with bladder functions, it is possible to get no analsphincter TcMEP response if patient has hypoactive bladder.
Anahtar Kelime:

İntraoperatif Nöromonitörizasyon ile Birllikte Serbestleştirme İşlemlerinin Bulguları: Okült Spinall Disrafizm ve Myelomeningosele Sekonder Gergin Omurilik Sendromu

Öz:
GİRİŞ ve AMAÇ: İntraoperatif nöromonitörizasyon, hem primer hem de sekonder gergin omurilik operasyonlarında, operasyonun daha güvenli gerçekleşmesi ve kompleks operasyonlarda cerraha yol göstermesi adına bir gereklilik olarak kabul edilir. Bu makalede, çocuklarda iki farklı operasyonun nöromonitörizasyon sonuçları ve postoperatif klinik değişimleri yer almaktadır: okült spinal disrafizm ve geçmiş myelomeningosel onarımına sekonder gergin omurilik. YÖNTEM ve GEREÇLER: Yirmi dört operasyon üç modalite ile monitörize edildi: transkraniyal motor uyarılmış potansiyeller (TcMEP), sürekli elektromiyografi (EMG) ve direkt sinir stimülasyonu (DNS). Grup 1’de okült spinal disrafizme bağlı gergin omurilik operasyonu geçirmiş 14 hasta, grup 2’de geçmiş myelomeningosel onarımına sekonder gergin omurilik operasyonu geçirmiş 10 hasta bulunuyordu. BULGULAR: Alt ekstremitelerden TcMEP yanıt elde etme oranı grup 1’de %92, grup 2’de %80 olarak bulundu. Anal sfinkterden TcMEP yanıt elde etme oranı grup 1’de %83, grup 2’de %60 olarak bulundu. Her iki grupta da operasyonlar esnasında TcMEP değişikliği görülmedi. Her iki grubun postoperatif ürodinami sonuçları 1 yıl periyodu içerisinde iyileşti (grup 1’de %78, grup 2’de %43). Hipoaktif mesaneli hastalarda TcMEP’te anal sfinkter yanıtları alınamadı. Yeni ya da kötüleşmiş postoperatif nörolojik defisit görülmedi. TARTIŞMA ve SONUÇ: Hem asemptomatik okült spinal disrafizm hem de MMC’ye sekonder TCS’de spinal kordun serbestleştirilmesi bozulmuş ürodinami sonuçlarını iyileştirebilir. İntraoperatif nöromonitörizasyon ve direkt stimülasyon daha güvenli bir ameliyat için bilgi sağlayabilir ve özellikle sekonder serbestleştirmede cerrahi manevraları yönlendirebilir. İntraoperatif nörofizyolojik monitörizasyon, kalan motor fonksiyonları korumak adına nörolojik defisitli MMC hastalarının operasyonlarında yararlıdır. Anal sfinkter fonksiyonları ile mesane fonksiyonları arasında korelasyon olduğundan hasta hipoaktif mesaneye sahipse anal sfinkterden TcMEP yanıtı alınamayabilir.
Anahtar Kelime:

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  • 1. Hoving EW, Haitsma E, Oude Ophuis CM, Journée HL. The value of intraoperative neurophysiological monitoring in tethered cord surgery. Childs Nerv Syst ;27:1445–52, 2011
  • 2. Husain AM, Shah D. Prognostic value of neurophysiologic intraoperative monitoring in tethered cord syndrome surgery. J Clin Neurophysiol 26:244–7, 2009
  • 3. Kothbauer KF, Novak K: Intraoperative monitoring for tethered cord surgery: an update. Neurosurg Focus 16:E8, 2004
  • 4. Pouratian N, Elias WJ, Jane JA Jr, Phillips LH 2nd, Jane JA Sr.: Electrophysiologically guided untethering of secondary tethered spinal cord syndrome. Neurosurg Focus: 29 (1):E3, 2010
  • 5. Sala F, Squintani G, Tramontano V, Arcaro C, Faccioli F, Mazza C: Intraoperative neurophysiology in tethered cord surgey: techniques and results. Childs Nerv Syst 29: 1611–24, 2013
  • 6. Von Koch CS, Quinones-Hinojosa A, Gulati M, Lyon R, Peacock WJ, Yingling CD: Clinical outcome in children undergoing tethered cord release utilizing intraoperative neurophysiological monitoring. Pediatr Neurosurg 37:81–6, 2002
  • 7. Copp AJ, Adzick NS, Chitty LS, Fletcher JM, Holmbeck GM, Shaw GM: “Spina Bifida”Nature Reviews Disease Primers Published online:30 April 2015 doi: 10.1038/nrdp.2015.7
  • 8. Balasubramaniam C, Laurent JP, McCluggage C, Oshman D, Cheek WR: Tethered-cord syndrome after repair of meningomyelocele. Childs Nerv Syst 6:208–11, 1990
  • 9. Kothbauer K, Deletis V, Epstein FJ: Motorevoked potential monitoring for intramedullary spinal cord tumor surgery: correlation of clinical and neurophysiological data in a series of 100 consecutive procedures. Neurosurg Focus 4: Article 1, 1998
  • 10. Sala F, Palandri G, Basso E, Lanteri P, Deletis V, Faccioli F, et al: Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery 58:1129–43, 2006
  • 11. Sala F, Tramontano V, Squintani G, Arcaro C, Tot E, Pinna G, Meglio M.: Neurophysiology of complex spinal cord untethering. J Clin Neurophysiol. 31(4):326-36, 2014
  • 12. Szelényi A, Kothbauer KF, Deletis V.: Transcranial electric stimulation for intraoperative motor evoked potential monitoring: Stimulation parameters and electrode montages. Clin Neurophysiol. 118(7):1586-95, 2007
  • 13. Riviello JJ, Kull L, Troup C, Holmes GL: Cortical stimulation in children: techniques and precautions. Tech Neurosurg 7:12–18, 2001
  • 14. Kumar GS, Rajshekhar V, Babu KS. Intraoperative mapping of sacral nervous system (S2-4). Br J Neurosurg:20:396–402, 2006
  • 15. Quiñones-Hinojosa A, Gadkary CA, Gulati M, von Koch CS, Lyon R, Weinstein PR, Yingling CD: Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults. Surg Neurol 62:127–33, 2004
APA CANAZ H, TUNA ERDOĞAN E, ALATAŞ İ (2018). The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele. , 192 - 198.
Chicago CANAZ Hüseyin,TUNA ERDOĞAN Ezgi,ALATAŞ İbrahim The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele. (2018): 192 - 198.
MLA CANAZ Hüseyin,TUNA ERDOĞAN Ezgi,ALATAŞ İbrahim The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele. , 2018, ss.192 - 198.
AMA CANAZ H,TUNA ERDOĞAN E,ALATAŞ İ The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele. . 2018; 192 - 198.
Vancouver CANAZ H,TUNA ERDOĞAN E,ALATAŞ İ The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele. . 2018; 192 - 198.
IEEE CANAZ H,TUNA ERDOĞAN E,ALATAŞ İ "The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele." , ss.192 - 198, 2018.
ISNAD CANAZ, Hüseyin vd. "The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele". (2018), 192-198.
APA CANAZ H, TUNA ERDOĞAN E, ALATAŞ İ (2018). The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele. Kocaeli Tıp Dergisi, 7(3), 192 - 198.
Chicago CANAZ Hüseyin,TUNA ERDOĞAN Ezgi,ALATAŞ İbrahim The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele. Kocaeli Tıp Dergisi 7, no.3 (2018): 192 - 198.
MLA CANAZ Hüseyin,TUNA ERDOĞAN Ezgi,ALATAŞ İbrahim The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele. Kocaeli Tıp Dergisi, vol.7, no.3, 2018, ss.192 - 198.
AMA CANAZ H,TUNA ERDOĞAN E,ALATAŞ İ The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele. Kocaeli Tıp Dergisi. 2018; 7(3): 192 - 198.
Vancouver CANAZ H,TUNA ERDOĞAN E,ALATAŞ İ The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele. Kocaeli Tıp Dergisi. 2018; 7(3): 192 - 198.
IEEE CANAZ H,TUNA ERDOĞAN E,ALATAŞ İ "The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele." Kocaeli Tıp Dergisi, 7, ss.192 - 198, 2018.
ISNAD CANAZ, Hüseyin vd. "The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele". Kocaeli Tıp Dergisi 7/3 (2018), 192-198.