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FORUM: Fellowship and research programs in neurosurgery
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TOPIC: IOM in terthered cord surgery
#682
jacintha
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Posts: 29
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IOM in terthered cord surgery 6 Years, 1 Month ago  
hi there,
I am currently doin my 2nd year in neurosurgical residency, i have chosen the topic of intraoperative monitoring in terthered cord surgery as my thesis topic. I am humbly in need of some suggestions on this topic ,eg; any new papers on it or experience in the topic would be very helpful, currently we will be trying this for the first time in my centre , any kind input on the approach to this topic is humbly welcomed. Thank You
 
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#683
Thomas S
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Re:IOM in terthered cord surgery 6 Years, 1 Month ago  
Hi!

Two free papers to begin with:

The value of intraoperative neurophysiological monitoring in tethered cord surgery. Hoving EW et al. Childs Nerv Syst. 2011 Sep;27(9):1445-52.
http://www.springerlink.com/content/m357...678432/fulltext.html

and a bit older:

Intraoperative monitoring for tethered cord surgery: an update
Kothbauer and Novak, Neurosurgical Focus 16:2:Page E8, 2004.
http://thejns.org/doi/full/10.3171/foc.2004.16.2.1

More references:
www.ncbi.nlm.nih.gov/pubmed?term=intraop...onitoring%20tethered

Maybe someone of NEUROSURGIC's members has personal experience?
 
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#899
ci0
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Re:IOM in terthered cord surgery 3 Years, 12 Months ago  
the 2011 link is more of MOTOR monitoring. a good study on this rare technique.

i tried searching sensory monitoring and found this:

Evaluation of motor- and sensory-evoked potentials for spinal cord monitoring during thoracoabdominal aortic aneurysm surgery.

T Sueda, K Okada, M Watari, K Orihashi, H Shikata, Y Matsuura
First Department of Surgery, Hiroshima University School of Medicine, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery 02/2000; 48(1):60-5. DOI:10.1007/BF03218086
Source: PubMed
ABSTRACT To assess the utility of spinal cord monitorings for prediction of spinal cord ischemia, we investigated the role of both motor evoked potentials and sensory evoked potentials during thoracoabdominal aortic aneurysm surgeries.
We monitored two kinds of sensory evoked potentials; descending evoked spinal cord potentials from the lumbar enlargement after cervical spinal cord stimulation and segmental evoked spinal cord potentials at the lumbar enlargement elicited by peroneal nerve stimulation, and motor evoked potentials from the lumbar enlargement elicited by direct subcranial stimulation in 9 thoracoabdomonal aortic aneurysm surgeries.
Postoperative paraplegia occurred in one case in which the patients died during the perioperative period. One case showed transient paraparesis, but recovered following rehabilitatation. These cases showed a decrease in the amplitude of descending evoked spinal cord potentials and motor evoked potentials.
The recovery of the amplitude of the motor evoked potentials and the descending evoked spinal cord potentials after declamping correlated with the neurologic outcome.
 
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#900
ci0
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http://thejns.org/doi/full/10.3171/foc.2004.16.2.1 3 Years, 12 Months ago  
Two principal methods are used for intraoperative neurophysiological testing during tethered cord release.

1. Mapping identifies functional neural structures, namely nerve roots, and
2. monitoring provides continuous information on the functional integrity of a. motor and
b. sensory pathways as well as
c. reflex circuitry.

Mapping is performed mostly by using
1. direct electrical stimulation of a structure within the surgical field and
2. recording at a distant site, usually a muscle.

Sensory mapping can also be performed with
1. peripheral stimulation and
2. recording within the surgical site.

Monitoring of the motor system is achieved with motor evoked potentials. These are
1. evoked by transcranial electrical stimulation and
2.recorded from limb muscles and the external anal sphincter. The presence or absence of muscle responses are the parameters monitored.


Sensory potentials
1. evoked by tibial or pudendal nerve stimulation and
2. recorded from the dorsal columns via an epidurally inserted electrode and/or from the scalp as cortical responses are used to access the integrity of sensory pathways. Amplitudes and latencies of these responses are then interpreted.

The bulbocavernosus reflex, with
1. stimulation of the pudendal nerve and
2.recording of muscle responses in the external anal sphincter, is used for continuous monitoring of the reflex circuitry. Presence or absence of this response is the pertinent parameter that is monitored.


CLARIFICATION SOUGHT: so mapping is initial screening and monitoring is continuous observation following mapping?
 
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