Naslov
Intraoperative neurophysiological mapping of dorsal columns. A new tool in the prevention of surgically indced sensory deficit?

Autori
Kržan, Matevž ; Deletis, Vedran ; Išgum, Velimir

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Joint Meeting between The British Society for Clinical Neurophysiology and the Royal Society of Medicine Neurology Section with the American Academy of Clinical Neurophysiology / - London : Delhi : Royal Society of Medicine, London, 1996, 40-40

Skup
Joint Meeting between The British Society for Clinical Neurophysiology and the Royal Society of Medicine Neurology Section with the American Academy of Clinical Neurophysiology

Mjesto i datum
London, Ujedinjeno Kraljevstvo, 27.06.1996. - 28.06.1996

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
intraoperative monitoring; somatosensory evoked potentials; spinal cord mapping

Sažetak
Spinal intramedullary space occupying lesions are surgically approached by splitting the cord down the midline between left and right dorsal columns Anatomical features of the exposed spinal column can often be “ distorted, making it difficult for the surgeon to determine optimal incision placement. Accidental severing of dorsal column pathways can lead to serious postoperative neurological impairment. Using continuous intraoperative recording of somatosensory evoked potentials SEPs, such lesioning could be documented but not prevented. To offer the surgeon reliable guidance, we set out to establish functional neurophysiological landmarks on the dorsal spinal cord surface. In 15 patients undergoing resection of intramedullary lesions, a highly selective miniature mapping multielectrode was placed on the exposed dorsal cord surface before myelotomy was performed. The electrode consisted of 8 parallel Teflon coated stainless steel wires with a diameter of 76 um spaced 1 mm apart and embedded in a 1 cm2 strip of silastic. Along a length of 2mm each wire was stripped of its coating. Two sets of 100 sweeps wert averaged from the 8 recording sites after electrical stimulation of each of the tibial nerves. The responses obtained. In 12 patients resembled travelling spinal SEPs previously detected with conventional epidural electrodes. They consisted of 10 ms periods of multispike activity with mean amplitudes ranging. From 0.74 to 19.8 uV. An amplitude gradient from high to low activity after&middot ; stimulation of each tibial nerve was found. The functional mid1ine was determined to lie between the 2 recording sites with highest SEP amplitudes after stimulation on each side. On the basis of these measurements in one patient an asymmetrical myelotomy was performed with no significant SEP changes afterwards. We presurne that in patients with intramedullary lesions the described method of dorsal column mapping better indicates the site and direction of myelotomy than anatomical features on the dorsal spine cord surface and has good potentia\ in the prevention of surgically induced damage to the dorsal columns.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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