19. Intraoperative neurophysiological monitoring of spinal dural arteriovenous fistula

Autor: S. Mangiafico, C. Boccardi, S. Romoli, Antonello Grippo, S. Gabbanini, Aldo Amantini, C. Martinelli, A. Ammannati, Riccardo Carrai, G. de Scisciolo, R. Caramelli
Rok vydání: 2017
Předmět:
Zdroj: Clinical Neurophysiology. 128:e419-e420
ISSN: 1388-2457
DOI: 10.1016/j.clinph.2017.09.026
Popis: The surgical management during ligation of a spinal dural arteriovenous fistula (SDAVF) is usually based on fluorescenceangiography, intraoperative Doppler ultrasound, and intraoperative digital subtractionangiography. We investigated the potential role of intraoperative neurophysiologic monitoring (IONM) during surgical management of SDAVF. A 45 years-old woman with a history of bilateral dysesthesia in the lower limbs showed on MR myelopathy at dorsal level likely due to SDAVF. A surgical approach was planned and IONM was required. IONM included transcranial electrical stimulation Motor Evoked Potentials (tceMEPs) recorded from AH and TA bilaterally and ADM on the left arm, Somatosensory Evoked Potentials (SEP) for stimulation of left and right Posterior Tibial and left Median Nerves, continuous electroencephalogram for checking any changes due to anesthesia. The surgeon clamps for four times on vessels belonging fistula then takes into account neurophysiological changes before proceeding to the final ligation. We observed no significant SEP changes during surgery, and only transient disappearance of tceMEPs after the fourth clamp. IONM allowed a real-time functional evaluation of piramidal tract before and after microsurgical occlusion of the fistula. IONM can integrate other imaging modalities during SDAVF.
Databáze: OpenAIRE
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