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

Yanni, Daniel S.; Ulkatan, Sedat; Deletis, Vedran; Barrenechea, Ignacio J.; Sen, Chandranath; Perin, Noel I.

doi:10.3171/2010.1.spine09112

Cited by 73 publications

(38 citation statements)

References 11 publications

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“…Such complications may be particularly incapacitating and slow the patient's progress toward rehabilitation. 135 As preoperative functional status has been assessed as a strong predictor of postoperative functional outcome, it is commonly agreed that early diagnosis and intervention are critical to optimizing neurological status. Thus, treatment should not be postponed until symptomatic functional decline, as severe or long-standing preoperative deficits rarely improve regardless of optimal surgical outcome.…”

Section: Neurological Complicationsmentioning

confidence: 99%

“…Yanni and colleagues 135 reported results from their combined approach with intraoperative functional dorsal column mapping, preoperative radiographic imaging, and intraoperative ultrasonography to identify the most appropriate location for their midline myelotomy. 102,135 A miniature multielectrode spinal cord grid was used to define the amplitude gradient of conducted SSEPs following bilateral tibial nerve stimulation, thereby correlating the functional anatomy of the patient with the surgical anatomy of the dorsal column (Fig. 3).…”

Section: Neurophysiological Monitoringmentioning

confidence: 99%

“…The entry point of the dorsal median sulcal vein into the midline raphe, as well as the midway point between the opposing root entry zones, may be useful when approximating the medullary midline. 135 While some institutions also rely on identification of posterior spinal arteries in the healthy spinal cord proximally and distally to the tumor to estimate their myelotomy incision site, others use ultrasonography and dorsal cord mapping to localize surgical landmarks. 70,72 As dorsal column manipulation is an inherent component of spinal cord ependymoma resection, one of the most serious neurological complications is dorsal column dysfunction.…”

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confidence: 99%

“…82 Occasionally, resection may become complicated by cord edema, arachnoid fibrosis, or capillary neovascularization, resulting in cord rotation, asymmetrical enlargement, and obscured delineation of the medullary midline. 135 This can result in an unintentional myelotomy through the dorsal column and subsequent sensory defects, including proprioception loss with secondary gait instability. 28,35,52,56,79,93,114 As the thermal energy emitted from bipolar electrocautery may cause damage to adjacent spinal tracts, the utilization of sharp dissection in the plane of spinal fibers is the preferred method around these vital areas during tumor resection.…”

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confidence: 99%

“…Furthermore, debulking the center of the tumor early may aid in establishing the tumor/spinal cord plane prior to dorsal column retraction. 135 Additionally, one author noted that pial retraction stitches may increase the tension on the dorsal columns, and thus should be avoided if possible to reduce the potential damage to these sensitive structures. 70 Halvorsen and colleagues 52 reported that 28% of 85 patients experienced deterioration of neurological function in the period immediately following surgery, twothirds of which were due to midline myelotomy.…”

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confidence: 99%

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Complications associated with the treatment for spinal ependymomas

Nagasawa

Smith

Cremer

et al. 2011

FOC

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Spinal cord ependymomas are rare neoplasms, comprising approximately 5% of all CNS tumors and 15% of all spinal cord tumors. Although surgery was once reserved for diagnosis alone, the evolution of surgical practices has elevated resection to the treatment of choice for these lesions. While technological advances continue to improve the capacity for gross-total resections and thus decrease the risk of recurrence, ependymoma spinal surgery still contains a variety of potential complications. The presence of neurological deficits and deterioration are not uncommonly associated with spinal cord ependymoma surgery, including sensory loss, dorsal column dysfunction, dysesthetic syndrome, and bowel and bladder dysfunction, particularly in the immediate postoperative period. Surgical treatment may also lead to wound complications and CSF leaks, with increased risk when radiotherapy has been involved. Radiation therapy may also predispose patients to radiation myelopathy and ultimately result in neurological damage. Additionally, resections of spinal ependymomas have been associated with postoperative spinal instability and deformities, particularly in the pediatric population. Despite the advances in microsurgical techniques and intraoperative cord monitoring modalities, there remain a number of serious complications related to the treatment of spinal ependymoma tumors. Identification and acknowledgment of these potential problems may assist in their prevention, early detection, and increased quality of life for patients afflicted with this disease.

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Section: Neurological Complicationsmentioning

confidence: 99%