Neurophysiological identification and differentiation between the motor and sensory roots in pediatric spinal cord lipoma surgery.

Autor: Lutz K; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland. k_lutz@gmx.net., Müller T; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Grunt S; Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Scherer C; Department of Pediatric Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Schuhmann MU; Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Tübingen, Germany., Zeino M; Department of Pediatric Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.; Division of Pediatric Urology, Department of Pediatric Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Vulcu S; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Hakim A; University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Wermelinger J; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Abut PAA; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Pospieszny K; University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Raabe A; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Schucht P; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Seidel K; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
Jazyk: angličtina
Zdroj: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery [Childs Nerv Syst] 2024 Dec 06; Vol. 41 (1), pp. 37. Date of Electronic Publication: 2024 Dec 06.
DOI: 10.1007/s00381-024-06673-5
Abstrakt: Background: Radical resection of spinal cord lipomas reduces the rate of re-tethering. Current conventional neurophysiological mapping techniques are not able to differentiate between crucial motor nerve roots and sensory roots. Enhanced differentiation could contribute to complete resection. We present our experience with a double-train paradigm to differentiate between motor and sensory roots.
Methods: In children undergoing spinal cord lipoma resection, the double-train mapping paradigm was used with an inter-train interval of 60 ms. Given the longer recovery time due to the H-reflex, a single muscle response was presumed to be elicited from a sensory root, and a double muscle response from a motor root. The primary endpoint was postoperative neurological outcome and bladder function at discharge.
Results: We included 8 children undergoing 10 lipoma resections between 2016 and 2023. Double-train mapping was used in all cases. Motor and sensory roots were clearly differentiated in 6 cases and altered the course of surgery in 4 cases. Post-surgery, no sensory and motor function worsened within 3 months. Bladder function was stable in six and improved in two children. In two patients, bladder function worsened slightly at 3 months and 6 months, at which point one patient was re-operated on for re-tethering.
Conclusion: Intraoperative mapping with the double-train paradigm reliably differentiated between motor and sensory nerve roots. Informing the surgeon on the specific function of a tethering root may help to maximize resection without risking major neurological deficits.
Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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