gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Comparison of different neurophysiological monitoring techniques in the surgery of spinal cord lipomas

Vergleich verschiedener neurophysiologischer Untersuchungstechniken bei Operationen spinaler Lipome

Meeting Abstract

Suche in Medline nach

  • corresponding author Olaf Süss - Neurochirurgische Klinik, Charite-Universitätsmedizin-Berlin, Campus Benjamin Franklin (CBF), Berlin
  • S. Hammersen - Neurochirurgische Klinik, Charite-Universitätsmedizin-Berlin, Campus Benjamin Franklin (CBF), Berlin
  • T. Kombos - Neurochirurgische Klinik, Charite-Universitätsmedizin-Berlin, Campus Benjamin Franklin (CBF), Berlin
  • M. Brock - Neurochirurgische Klinik, Charite-Universitätsmedizin-Berlin, Campus Benjamin Franklin (CBF), Berlin

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.05.07

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0059.shtml

Veröffentlicht: 23. April 2004

© 2004 Süss et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Spinal cord lipomas are a common cause of cord tethering that can lead to progressive neurological deficits such as motor or sensory deficits or bladder dysfunction. Therefore, especially in patients with only minor preoperative neurological deficits, tumour removal should be combined with intraoperative monitoring techniques to prevent postoperative neurological deterioration.

Methods

Nineteen patients (mean age: 24,9 y) have been operated on spinal cord lipomas. Three lipomas were located in the thoracic spinal cord, the remaining 16 being in the conus. Three patients were almost asymptomatic at time of surgery, whereas the others were suffering from pain (14), bladder dysfunction (12), motor dysfunctions (11) or neuro-orthopaedic deformities (8).

Results

In all 19 patients tumour removal was performed under continuous intraoperative neurophysiological monitoring. Intraoperatively, nerve roots and neural tissue were identified by electromyography (free-run EMG) or direct electrical stimulation (triggered EMG) in all 19 patients. Somatosensory evoked potentials were successfully monitored in 14 of the 19 patients. Transcranial electrical stimulation evoked CMAPs in 10 patients. Further monitoring techniques tested were intraoperative reflex and F-response monitoring as well as descending neurogenic evoked potentials.

Conclusions

SSEP showed to be neither specific nor sensitive to individual nerve root function. Transcranial electrical stimulation activates less than 10 percent of the motor axons in the motor nerve root and therefore proved to be not usefull in the surgery of spinal lipomas. Only free-run EMG as well as triggered EMG reliably helped to identify where the motor axons lie within the tumor and/or scar tissue.