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

Impact of intraoperative neurophysiological monitoring on sacral tumor surgery

Intraoperatives neurophysiologisches Monitoring bei der Behandlung von Sakrumtumoren

Meeting Abstract

Suche in Medline nach

  • corresponding author Theodoros Kombos - Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
  • O. Süss - Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
  • S. Hammersen - Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
  • M. Brock - Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, 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.05.08

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0060.shtml

Veröffentlicht: 23. April 2004

© 2004 Kombos 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

Surgical treatment of sacral tumors bears a high risk of postoperative neurological deficits. These surgery-related neurological deficits are accompanied by social aspects that reach beyond the functional impairment.

Methods

Intraoperative neurophysiological monitoring was applied to 12 patients (18 to 59 years of age) with a sacral tumor (10 chordomas, 1 chondrom, 1 lipoma). The minimum size of the tumors was 3cm. Intraoperative localization of the sacral roots was performed by electromyography of the target muscles and direct electrical stimualtion of the nerve roots (Intensity 3 mA). A pair of needle electrodes placed in the perianal muscles was used for recording. Functional monitoring was performed by intraoperative recording of the bulbocavernosus reflex (BCR). BCR was elicited by stimulating the pudendal nerve (Frequency 2.3 Hz; Intensity 50 mA) and was recorded by electrodes in the perianal muscles. All procedures were performed under general anesthesia without muscle relaxants.

Results

In all cases a macroscopical total tumor removal was achieved. No clinical deterioration was observed postoperatively. Localization of the nerve roots S2 to S5 was achieved by direct electrical stimulation in 11 (11/12) patients. BCR consists of two peaks: the first at 30 ms (P30) and the second at 50 ms (P50). Intraoperative changes of P50 were observed in 9 of the 12 patients. None of these correlated with the postoperative clinical condition. P30 remained unchanged in all cases.

Conclusions

Intraopeative mapping of the sacral nerve roots can be achieved by direct electrical stimulation. Intraoperative recording of the BCR allows functional monitoring of the bladder. However, the P50 component of the BCR is not sensitive for these purpose. Combining EMG and BCR recording reduces morbidity during surgery for sacral tumors.