Wen Haitao,Wang Qianyang,Chen Xiaoyan,et al.Application value of multi-mode neuroelectrophysiological monitoring during spinal cord loosening for tethered cord syndrome in children[J].Journal of Clinical Pediatric Surgery,,19():830-836.[doi:10.3969/j.issn.1671-6353.2020.09.014]
Application value of multi-mode neuroelectrophysiological monitoring during spinal cord loosening for tethered cord syndrome in children
- CLC:
- R729;R651.2
- Abstract:
- Objective To explore the efficacy of multi-mode neuroelectrophysiological monitoring during spinal cord loosening for tethered cord syndrome in children. Methods From March 2019 to December 2019,clinical data were collected and retrospectively analyzed for 64 children operated for tethered spinal cord.There were 38 boys and 26 girls with an average age of (23.5±28.9)(1-156) month.The intraoperative multi-mode examinations of nerve monitoring included somatosensory evoked potentials (SEP),motor evoked potentials (MEP),electromyography (EMG) and/or bulbocavernosus sphincter reflex (BCR).Operative handling was adjusted according to the results of neuroelectrophysiological monitoring. Results Sixty-two children with spinal cord tethered cord were completely released and 2 cases partially released due to an adhesion of spinal lipoma.MEP was not induced before and during operation in 4 cases.In 60 cases (93.75%),MEP was induced before and during operation and muscle action potential recorded.Postoperatively MEP showed no disappearance or a significant decrease.CORD/SAC was an important parameter of measuring postoperative adhesion.In 44 cases with tethered lipoma,CORD/SAC ratio was (0.81±0.22) pre-operation and (0.38±0.16) post-operation and it decreased with statistically significant difference (t=17.085,P<0.001).During postoperative follow-ups,urinary and fecal dysfunctions showed improvements (n=7) and non-improvements (n=6).One case of postoperative urinary retention recovered after catheterization training.Among 8 children with lower back pain or nerve dysfunction of lower extremities,there were improvement (n=7) and non-improvement (n=1).None had aggravation or recurrence. Conclusion During cord lysis,application of multimodal intraoperative monitoring (MIOM) may assist surgeons in differentiating normal nerve tissue,protecting nerve tissue,maximally removing lipoma and lowering CORD/SAC value.
References:
1 刘红举,于炎冰,张黎,等.脊髓栓系综合征的显微神经外科治疗[J].中华神经外科杂志,2014,30(3):279-281.DOI:10.3760/cma.j.issn.1001-2346.2014.03.021.Liu HJ,Yu YB,Zhang L,et al.Microneurosurgery for tethered cord syndrome[J].Chin J Neurosurg,2014,30(3):279-281.DOI:10.3760/cma.j.issn.1001-2346.2014.03.021.
2 鲍南,杨波,陈盛,等.腰骶部脂肪瘤型脊髓栓系的手术治疗[J].中华神经外科杂志,2011,27(8):817-820.DOI:10.3760/cma.j.issn.1001-2346.2011.08.023.Bao N,Yang B,Chen S,et a1.Surgical treatment of lipoma-type tethering of conus medullaris[J].Chin J Neurosurg,2011,27(8):817-820.DOI:10.3760/cma.j.issn.1001-2346.2011.08.023.
3 Pang D,Zovickian J,Oviedo A.Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode:part I-surgical technique[J].Neurosurgery,2009,65(3):511-529.DOI:10.1227/01.NEU.0000363598.81 101.7B.
4 符松,王苏明,刘兴存,等.影响小儿脊髓栓系综合征手术疗效的相关因素分析[J].局解手术学杂志,2014,23(2):191-192,194.DOI:10.11659/jjssx.1672-5042.201402032.Fu S,Wang SM,Liu XC,et al.Related efficacy factor analysis of pediatric tethered cord syndrome[J].Jreg Anat Oper Surg,2014,23(2):191-192,194.DOI:10.1 1659/jjssx.1672-5042.201402032.
5 Yener S,Thomas DT,Hicdonmez T,et al.The effect of untethering on urologic symptoms and urodynamic parameters in children with primary tethered cord syndrome[J].Urology,2015,85(1):221-226.D0I:10.1016/j.urology.2014.10.008.
6 Ivanov M,Budu A,Sims-Williams H,et al.Using intraoperative ultrasonography for spinal cord tumor surgery[J].World Neurosurg,2017,97:104-111.DOI:10.1016/j.wneu.2016.09.097.
7 Pang D,Zovickian J,Wong ST,et al.Surgical treatment of complex spinal cord lipomas[J].Children Nerv Syst,2013,29(9):1485-1513.DOI:10.1007/s00381-013-2187-4.
8 Korn A,Halevi D,Lidar Z,et al.Intraoperative neurophysiological monitoring during resection of intradural extramedullary spinal cord tumors:experience with 100 case[J].Acta Neuroehir (Wien),2015,157(5):819-830.DOI:10.1007/s00701-014-2307-2.
9 Dohrmann GJ,Rubin JM.Intraoperative ultrasound imaging of the spinal cord:syringomyelia,cysts and tumors-a preliminary report[J].Surg Neurol,1982,18(6):395-399.DOI:10.1016/0090-3019(82)90169-0.
10 Shamov T,Eflimov T,Kaprelyan A,et al.Ultrasound-based neuron-avigation and spinal cord tumour surgery-marriage of convenience or notified incompatibility?[J].Turk Neurosurg,2013,23(3):329-335.DOI:10.5137/1019-5149.JTN.6639-12.2.
11 Prokopienko M,Kunert P,Podgorska A,el al.Surgical treatment of intramedullary ependymomas[J].Neurol Neurochir Pol,2017,51(6):439-445.DOI:10.10166/j.pjnns.2017.06.008.
12 Kirollos RW,Van Hille PT.Evaluation of surgery for the tethered cord syndrome using a new grading system[J].Br J Neurosurg,1996,10(3):253-260.DOI:10.1080/02688699650040106.
13 Nuwer MR,Dawson EG,Carlson LG,et al.Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery:results of a large multicenter survey[J].Electrocephalogr Clin Neurophysiol,1995,96:6-11.
14 Palatinsky E,Discenna A,McDonald H.SSEP and BAEP monitoring of temporary clip application:intraoperative monitoring techniques in neurosurgery[J].New York:Mcgraw-Hill,1994:61-71.1556-1566.DOI:10.1213/ANE.0000000000001503.
15 Skinner SA,Nagib M,Bergman TA,et al.The initial use of freerunning electromyography to detect early motor tract injury during resection of intramedullary spinal cord lesions[J].Neurosurgery,2005,56(2 Suppl):299-314.DOI:10.1227/01.neu.0000156545.33814.8d.
16 Acharya S,Palukuri N,Gupta P,et al.Transcranial motor evoked potentials during spinal deformity corrections safety,efficacy,limitations,and the role of a checklist[J].Front Surg,2017,4:8.DOI:10.3389/fsurg.2017.00008.
17 廉海平,李志锦,何百祥,等.神经电生理监测在腰骶部椎管内肿瘤显微切除术中的应用[J].西安交通大学学报(医学版),2016,37(2):179-182.DOI:10.7652/jdyxb201602006.Lian HP,Li ZJ,He BX,et al.Application of intraoperative neuroelectrophysiological monitoring during lumbosacral spinal cord tumor resection[J].Journal of X’an Jiaotong University (Medical Sciences),2016,37(2):179-182.DOI:10.7652/jdyxb201602006.
18 Kulkarni AV,Pierre-Kahn A,Zerah M.Conservative management of asymptomatic spinal lipomas of the conus[J].Neurosurgery,2004,54(4):868-875.DOI:10.1227/01.NEU.0000114923.76542.81.
19 王勇强,陈民,王杭州.肌电图监测在儿童脊髓栓系松解术中的应用[J].临床小儿外科杂志,2018,17(12):922-926.DOI:10.3969/j.issn.1671-6353.2018.12.010.Wang YQ,Chen M,Wang HZ.Application of electromyogram monitoring during spinal cord loosening for tethered cord syndrome in children[J].J Clin Ped Sur,2018,17(12):922-926.DOI:10.3969/j.issn.1671-6353.2018.12.010.
Memo
收稿日期:2020-02-25。
基金项目:湖南省中医药科研计划项目（编号：2020108）；湖南省出生缺陷协同防治科技重大专项（编号：2019SK1010）；湖南省卫生健康委员会一般项目（编号：2017118）
通讯作者:吴水华,Email:292454021@qq.com