Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach

M. Angeles Sánchez Roldán
* ORCID logo ,
Dulce Moncho
,
Kimia Rahnama
,
Daniela Santa-Cruz
,
Elena Lainez
,
Daniel Baiget
,
Ivette Chocron
,
Dario Gandara
,
Agustin Bescos
,
Juan Sahuquillo
ORCID logo ,
María A. Poca
* ORCID logo
Version 1 : Received: 30 June 2023 / Approved: 3 July 2023 / Online: 3 July 2023 (11:53:52 CEST)

A peer-reviewed article of this Preprint also exists.

Sánchez Roldán, M.Á.; Moncho, D.; Rahnama, K.; Santa-Cruz, D.; Lainez, E.; Baiget, D.; Chocrón, I.; Gándara, D.; Bescós, A.; Sahuquillo, J.; Poca, M.A. Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach. J. Clin. Med. 2023, 12, 5200. Sánchez Roldán, M.Á.; Moncho, D.; Rahnama, K.; Santa-Cruz, D.; Lainez, E.; Baiget, D.; Chocrón, I.; Gándara, D.; Bescós, A.; Sahuquillo, J.; Poca, M.A. Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach. J. Clin. Med. 2023, 12, 5200.

Abstract

Syringomyelia can be associated with multiple etiologies. The treatment of the underlying causes is the first-line therapy, however, a direct approach to the syrinx is accepted as rescue treatment. Any direct intervention on the syrinx requires a myelotomy, posing a significant risk of iatrogenic spinal cord (SC) injury. Intraoperative neurophysiological monitoring (IONM) is crucial to detect and prevent surgically induced damage in neural SC pathways. We retrospectively reviewed the perioperative and intraoperative neurophysiological data and perioperative neurological examinations in ten cases of syringomyelia surgery. All monitored modalities remained stable throughout the surgery in six cases, correlating with no new postoperative neurological deficits. In two patients, significant transitory attenuation, or loss of motor evoked potentials (MEPs), were observed and recovered after a corrective surgical maneuver, with no new postoperative deficit. In two cases, a significant MEP decrement was noted, which lasted until the end of the surgery and was associated with postoperative weakness. A transitory train of neurotonic electromyography (EMG) discharges was reported in one case, the surgical plan was adjusted and the patient showed no postoperative deficit. The dorsal nerve roots were stimulated and identified in the seven cases where the myelotomy was performed via the dorsal root entry zone. Dorsal column mapping guided the myelotomy entry zone in four cases. In conclusion, multimodal IONM is feasible and reliable and may help prevent iatrogenic SC injury during syringomyelia surgery.

Keywords

Chiari malformation; corticospinal tract mapping; dorsal column mapping; D-wave; intraoperative neurophysiological monitoring; motor evoked potentials; root mapping; somatosensory evoked potentials; spinal cord; syringomyelia

Subject

Medicine and Pharmacology, Neuroscience and Neurology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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