Bulbocavernosus Reflex Monitoring During Intramedullary Conus Tumor Surgery
Autor: | Kathryn Overzet, Robert Funk, Faisal R Jahangiri |
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Rok vydání: | 2020 |
Předmět: |
electromyography
medicine.medical_specialty urethral sphincter monitoring Neurosurgery Electromyography 030204 cardiovascular system & hematology bcr 03 medical and health sciences 0302 clinical medicine Bulbocavernosus reflex medicine conus medullaris medicine.diagnostic_test business.industry Urethral sphincter General Engineering medicine.disease Neuromuscular monitoring ionm Conus medullaris Spinal cord tumor medicine.anatomical_structure Neurology Oncology Somatosensory evoked potential bulbocavernosus reflex transcranial electrical motor evoked potentials spine tumor Radiology neurophysiology intraoperative neurophysiological monitoring business 030217 neurology & neurosurgery Intraoperative neurophysiological monitoring |
Zdroj: | Cureus |
ISSN: | 2168-8184 |
DOI: | 10.7759/cureus.7233 |
Popis: | A T10 to L2 spinal cord tumor exploration and biopsy was performed with intraoperative neurophysiological monitoring (IONM) on a 75-year-old male diagnosed with an intradural intramedullary appearing spinal cord lesion with no other lesions in the central nervous system, chest, abdomen or pelvis. Intraoperative neurophysiology consisted of transcranial electrical motor evoked potentials (TCeMEPs), somatosensory evoked potentials (SSEPs), triggered and spontaneous electromyography (S-EMG, T-EMG), bulbocavernosus reflex (BCR) and train of four (TOF) monitoring. Loss of BCR responses during conus exposure and identification were resolved with multiple small pauses in manipulation throughout the procedure. T-EMG mapping aided in identification and avoiding the removal of nervous tissue. Postoperatively the patient experienced some mild weakness in his left foot and leg that correlated with a significant amplitude drop in the left abductor hallucis TCeMEP. By the following day, the patient was almost back to preoperative baseline. The patient’s bowel and bladder function were preserved, consistent with final BCR recordings. The patient was discharged to rehabilitation postoperatively. Pathology results indicated glioblastoma. This case study demonstrates the utility of a multimodality approach with bulbocavernosus reflex and urethral sphincter monitoring to optimize intraoperative data to the surgeon during conus tumor surgeries. |
Databáze: | OpenAIRE |
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