Intraoperative neurophysiologic monitoring during syringomyelia surgery: Lessons from a series of 13 patients

Niv Pencovich, Akiva Korn, Shlomi Constantini*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background Avoiding iatrogenic neurological injury during spinal cord surgery is crucially important. Intraoperative neurological monitoring (INM) has been widely used in a variety of spinal surgeries as a means of reducing the risk of intraoperative neurological insults. This study evaluates the benefits of INM specifically in spinal procedures for treatment of syringomyelia. Methods Thirteen patients who underwent surgery for syrinx drainage with the assistance of INM were included in this study. In all patients both somatosensory-evoked potentials (SSEP) and motor-evoked potentials (MEP) were monitored. INM data and perioperative neurological evaluations were both recorded and analyzed. Results Eleven patients underwent syringo-subarachnoid shunt (SSAS) surgery. One patient underwent syrinx drainage and foramen magnum decompression (FMD). One patient underwent syringo-pleural shunt (SPA) surgery. Baseline MEP and SSEP were recordable at the beginning of surgery in 11 patients (>84 %). In the other two cases, baseline data from specific INM modalities were absent, correlating with the antecedent neurologic symptomotology. Two patients exhibited significant intraoperative changes in MEP data that influenced the course of surgery and prompted removal or reinsertion of the shunt. Mild and transient worsening of preoperative symptoms was reported in these instances. No new postoperative neurological deficits were reported in the other 11 patients in whom INM data were preserved throughout surgery. Conclusion These data support routine use of INM in syringomyelia surgery. INM can alert the surgeon to potential intraoperative threats to the functional integrity of the spinal cord, providing a useful adjunct to spinal cord surgeries for the treatment of syringomyelia.

Original languageEnglish
Pages (from-to)785-791
Number of pages7
JournalActa Neurochirurgica
Volume155
Issue number5
DOIs
StatePublished - May 2013

Keywords

  • Arnold-Chiari malformation
  • Decompression
  • Evoked potentials
  • Shunt
  • Spinal cord tumor
  • Syrinx

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