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Continuous mapping of the corticospinal tracts in intramedullary spinal cord tumor surgery using an electrified ultrasonic aspirator
- Source :
- Journal of neurosurgery. Spine. 27(2)
- Publication Year :
- 2017
-
Abstract
- Intramedullary spinal cord tumors (IMSCTs) represent a rare entity, accounting for 4%–10% of all central nervous system tumors. Microsurgical resection of IMSCTs is currently considered the primary treatment modality. Intraoperative neurophysiological monitoring (IONM) has been shown to aid in maximizing tumor resection and minimizing neurological morbidity, consequently improving patient outcome. The gold standard for IONM to date is multimodality monitoring, consisting of both somatosensory evoked potentials, as well as muscle-based transcranial electric motor evoked potentials (tcMEPs). Monitoring of tcMEPs is optimal when combining transcranial electrically stimulated muscle tcMEPs with D-wave monitoring. Despite continuous monitoring of these modalities, when classic monitoring techniques are used, there can be an inherent delay in time between actual structural or vascular-based injury to the corticospinal tracts (CSTs) and its revelation. Often, tcMEP stimulation is precluded by the surgeon’s preference that the patient not twitch, especially at the most crucial times during resection. In addition, D-wave monitoring may require a few seconds of averaging until updating, and can be somewhat indiscriminate to laterality. Therefore, a method that will provide immediate information regarding the vulnerability of the CSTs is still needed.The authors performed a retrospective series review of resection of IMSCTs using the tip of an ultrasonic aspirator for continuous proximity mapping of the motor fibers within the spinal cord, along with classic muscle-based tcMEP and D-wave monitoring.The authors present their preliminary experience with 6 patients who underwent resection of an IMSCT using the tip of an ultrasonic aspirator for continuous proximity mapping of the motor fibers within the spinal cord, together with classic muscle-based tcMEP and D-wave monitoring. This fusion of technologies can potentially assist in optimizing resection while preserving neurological function in these challenging surgeries.
- Subjects :
- Adult
Male
medicine.medical_specialty
Intraoperative Neurophysiological Monitoring
Central nervous system
Intramedullary spinal cord
Pyramidal Tracts
Neurosurgical Procedures
03 medical and health sciences
Ultrasonic aspirator
0302 clinical medicine
Medicine
Humans
Ultrasonics
Spinal Cord Neoplasms
Muscle, Skeletal
Retrospective Studies
business.industry
Continuous monitoring
General Medicine
Spinal cord
Evoked Potentials, Motor
Electric Stimulation
Surgery
medicine.anatomical_structure
Somatosensory evoked potential
030220 oncology & carcinogenesis
Tumor surgery
business
030217 neurology & neurosurgery
Intraoperative neurophysiological monitoring
Subjects
Details
- ISSN :
- 15475646
- Volume :
- 27
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Journal of neurosurgery. Spine
- Accession number :
- edsair.doi.dedup.....97a94a9ec15e6c9d4cf66ab2216d9998