Ameliyat sırasında omurilik monitörlemesi
Küçük Resim Yok
Tarih
1999
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada omurilik ve omurga cerrahisi sırasında evoked potansiyel monitörlemesi uyguladığımız 32 olguluk bir klinik serinin sonuçları sunulmaktadır. Dokuz hastada intramedüller tümör, 5 hastada intradural ekstramedüller tümör, 5 hastada ekstradural tümör, 6 hastada servikal spondilotik miyelopati, 6 hastada gergin omurilik sendromu, 1 hastada torakal disk hernisi mevcuttu. Tüm hastalarda tibial ve median sinir uyarımı ile kortikal SEP'ler (Somatosensoryel Evoked Potansiyel), 29 hastada ayrıca spinal SEP'ler elde edildi. Dura açılmışsa intradural, açılmamışsa ekstradural kayıtlar yapıldı, yirmibir olguda intraoperatif E'ler (Evoked Potansiyel) değişmedi, 9 olguda kötüleşti. Postoperatif erken dönemde klinik tablo 24 olguda değişmedi, 1 olguda düzelme gösterdi, 8 olguda ise kötüleşme gösterdi, iki yanlış negatiflik, 3 yanlış pozitiflik, 6 doğru pozitiflik elde edildi. Kauda-konus patolojilerinde anal sfinkter uyarımlı SEP'ler daha anlamlı sonuçlar verdi. Bir olguda kısa süreli kötüleşmeye cerrahın yanıt vermesiyle SEP'ler düzeldi. Genel olarak nörolojik defisiti olan hastaların monitörlenmesi, skolyoz cerrahisi gibi defisitsiz olguların monitörlenmesinden daha zor olmaktadır. Bu olgularda zaten bozuk olan kortikal SEP'ler ameliyat sırasında ciddi dalgalanmalar gösterebilmektedir. Ancak spinal SEP'lerin kaybı ya da bozulması nörolojik defisitin bir göstergesi olup, mutlak uyarı kriteri olarak kabul edilmelidir.
This study presents a clinical series with 32 cases that have evoked potentials monitoring during spine and spinal cord surgery. Clinical diagnosis was intramedullary tumors in 9 patients, intradural extramedullary tumors in 5 patients, extradural tumors in 5 patients, cervical spondylotic myelopathy in 6 patients, tethered cord syndrome in 6 patients, thoracic disc herniation in one patient. All of the patients were monitored with cortical SEPs (Somatosensory Evoked Potentials) by tibial and median nerve stimulation, 29 patients were additionally monitored with spinal SEPs. In case the dura was opened, subdural recordings were done, otherwise epidural recordings were done. Intraoperative SEPs did not change in 21 patients, and worsened in 9 patients. Postoperative evaluation showed that clinical deficits did not change in 24 cases, progressed in one patient, deteriorated in 8 patients. We reported 2 false-negative, 3 false-positive, 6 true positive monitoring. SEPs with anal sphincter stimulation were more sensitive for monitoring of lesions in cauda and conus region. Since the surgeon reacted promptly to wave loss in one patient, SEPs were recovered during operation.In conclusion, monitoring of the patients with neurological deficits is harder than the patients without deficits such as scoliosis surgery. We noted serious fluctuations in already hampered base line activitiy of cortical SEPs in these patients. However, worsening or loss of spinal SEPs reflects the function of neurologic deficits, and should be considered as an absolute warning criteria.
This study presents a clinical series with 32 cases that have evoked potentials monitoring during spine and spinal cord surgery. Clinical diagnosis was intramedullary tumors in 9 patients, intradural extramedullary tumors in 5 patients, extradural tumors in 5 patients, cervical spondylotic myelopathy in 6 patients, tethered cord syndrome in 6 patients, thoracic disc herniation in one patient. All of the patients were monitored with cortical SEPs (Somatosensory Evoked Potentials) by tibial and median nerve stimulation, 29 patients were additionally monitored with spinal SEPs. In case the dura was opened, subdural recordings were done, otherwise epidural recordings were done. Intraoperative SEPs did not change in 21 patients, and worsened in 9 patients. Postoperative evaluation showed that clinical deficits did not change in 24 cases, progressed in one patient, deteriorated in 8 patients. We reported 2 false-negative, 3 false-positive, 6 true positive monitoring. SEPs with anal sphincter stimulation were more sensitive for monitoring of lesions in cauda and conus region. Since the surgeon reacted promptly to wave loss in one patient, SEPs were recovered during operation.In conclusion, monitoring of the patients with neurological deficits is harder than the patients without deficits such as scoliosis surgery. We noted serious fluctuations in already hampered base line activitiy of cortical SEPs in these patients. However, worsening or loss of spinal SEPs reflects the function of neurologic deficits, and should be considered as an absolute warning criteria.
Açıklama
Anahtar Kelimeler
Cerrahi, Nörolojik Bilimler
Kaynak
Türk Nöroşirürji Derg.
WoS Q Değeri
Scopus Q Değeri
Cilt
9
Sayı
1
