Wu Tian,Wu Shuihua.Intraoperative neurophysiological monitoring for complex lipoma-type spinal cord embolism in children[J].Journal of Clinical Pediatric Surgery,2025,(06):553-558.[doi:10.3760/cma.j.cn101785-202410051-009]
Intraoperative neurophysiological monitoring for complex lipoma-type spinal cord embolism in children
- Keywords:
- Neurophysiological Monitoring; Lipoma; Spinal Cord; Surgical Procedures; Operative; Child
- Abstract:
- Objective To explore the significance of intraoperative electrophysiological monitoring for children with complex lipomatous tethered cord syndrome (C-LTCS). Methods From January 2019 to April 2024,the relevant clinical data were retrospectively reviewed for 29 children hospitalized with complex spinal cord lipomas.There were 13 boys and 16 girls with a median age of 9(2-111) month.The range was <3 year (n=14) and ≥3 year (n=15).The clinical types were dorsal (n=1),transitional (n=20) and mixed (n=8).Intraoperative neurophysiological monitoring included motion evoked potential (MEP),somatosensory evoked potential (SEP),free-run electromyography (EMG) and triggered-EMG at Day 1 post-operation.Muscle strength of bilateral lower limbs,urination and defecation were recorded. Results All operations were completed under neurophysiological monitoring.Among 14 children aged <3 year,SEP baseline was established (n=4),MEP baseline established (n=8) and the rest not established.Among 15 children aged ≥3 year,baseline was established (n=12),MEP baseline established (n=15) and the rest not established.Total/near-total resection (n=23) and partial resection (n=6) were achieved.Frequency of intraoperative electrophysiological warnings was SEP (n=2),MEP (n=8) and EMG (n=32).Total and near-total resection (n=23) and partial resection (n=6) were performed.On Day 1 post-operation,lower limb muscle strength was normal (n=23) and lower limb muscle strength decline was new/exacerbated (n=6).After 6-month rehabilitation,lower limb muscle strength normalized (n=4) and lower limb muscle strength declined (n=2).At Month 6 post-operation,none of them had a new onset or an aggravation of urinary and fecal dysfunction.Among 4 children with preoperative urinary dysfunction,2 cases had no improvement and 2 cases normalized;among the 3 children with preoperative fecal dysfunction,1 case had no improvement and 2 cases normalized. Conclusions Neurophysiological monitoring technology may monitor and guide surgical process of complex spinal cord lipoma in real time and effectively lower the risk of intraoperative nerve injury in children.Its application for complex spinal cord lipoma surgery has important clinical significance.
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Memo
收稿日期:2024-10-22。
基金项目:湖南省中医药科研课题(C2024022)
通讯作者:吴水华,Email:292454021@qq.com