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Subdural Direct Wave Intraoperative Neurophysiological Monitoring in Intramedullary Spinal Cord Tumor Resection: Case Report.
- Source :
-
Neurodiagnostic Journal . Jun2022, Vol. 62 Issue 2, p87-98. 12p. - Publication Year :
- 2022
-
Abstract
- Direct wave (D-wave) intraoperative neurophysiological monitoring (IONM) is used during intramedullary spinal cord tumor (IMSCT) resection to assess corticospinal tract (CST) integrity. There are several obstacles to obtaining consistent and reliable D-wave monitoring and modifications to standard IONM procedures may improve surgical resection. We present the case of a subependymoma IMSCT resection at the T2–T6 spinal levels where subdural D-wave monitoring was implemented. A 47-year-old male was presented with a five-year history of numbness in his right foot eventually worsening to sharp upper back pain with increased lower extremity spasticity. MRI revealed an expansile non-contrast enhancing multi-loculated cystic lesion spanning T2–T6 as well as a separate T1–T2 lesion. A T2–T6 laminoplasty was performed for intramedullary resection of the lesion. A spinal electrode was placed in the epidural space caudal to the surgical site to monitor CST function; however, action potentials could not be obtained. Post durotomy, the electrode was placed in the subdural space under direct visualization. This resulted in a reliable D-wave recording, which assisted surgical decision-making during the procedure upon D-wave and limb motor evoked potential attenuation. Surgical intervention led to the recovery of the D-wave recording. Subdural D-wave monitoring serves as an alternative in patients where reliable D-waves from the epidural space are unable to be obtained. Further investigation is required to improve the recording technique, including exploring various types of contacts and lead placement locations. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ELECTRODES
*EVOKED potentials (Electrophysiology)
*SPINAL cord tumors
*NEUROPHYSIOLOGY
*PHYSICAL therapy
*CONVALESCENCE
*MAGNETIC resonance imaging
*SOMATOSENSORY evoked potentials
*LAMINOPLASTY
*TREATMENT effectiveness
*EPIDURAL space
*INTRAOPERATIVE monitoring
*ELECTROMYOGRAPHY
*THORACIC vertebrae
Subjects
Details
- Language :
- English
- ISSN :
- 21646821
- Volume :
- 62
- Issue :
- 2
- Database :
- Academic Search Index
- Journal :
- Neurodiagnostic Journal
- Publication Type :
- Academic Journal
- Accession number :
- 157518340
- Full Text :
- https://doi.org/10.1080/21646821.2022.2060011