| Autor: |
Uchenna Ajoku, Alysa Almojuela, Colin Kazina, Marshall Wilkinson, Lawrence Ryner, Perry Dhaliwal |
| Jazyk: |
angličtina |
| Rok vydání: |
2022 |
| Předmět: |
|
| Zdroj: |
Interdisciplinary Neurosurgery, Vol 28, Iss , Pp 101467- (2022) |
| Druh dokumentu: |
article |
| ISSN: |
2214-7519 |
| DOI: |
10.1016/j.inat.2021.101467 |
| Popis: |
Background: Intramedullary spinal cord tumours are formidable lesions in spine surgery due to the high risk of postoperative deficits associated with surgical resection. Traditional MRI imaging fails to provide a 3-D rendering of the relationship between the tumour and spinal cord sensory and motor pathways; in contrast, DTI/tractography can show this relationship with the potential to reduce surgery-related morbidity. The use of intraoperative somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (MEP) have also been considered a standard of care to minimize neurologic complications of surgery. However, in situations where both baseline SSEPs and MEPs are unobtainable, D-wave and direct cord stimulation can become invaluable intra-operative tools. Methods: A 6 year old child presented with new growth from an incompletely resected thoracic intramedullary dermoid tumour. Pre-operative DTI/tractography images were obtained. During tumour resection, SSEP and MEP signals were unable to be obtained, however intraoperative monitoring of the spinal cord was undertaken with D-wave monitoring and direct cord stimulation. Results: This multimodal monitoring technique allowed identification of the corticospinal tracts intra-operatively and allowed safe tumour resection. Post-operative MRI revealed gross total resection and the patient returned to her pre-operative neurological baseline without incurring any further deficits. Conclusions: We have presented a technical description of the clinical utility of DTI/tractography in surgical planning, and D-wave monitoring with direct cord stimulation as adjuncts in the resection of an intramedullary cord tumour. This is particularly useful in the scenario where TcMEP/SSEP signals cannot be obtained and in revision surgery for intramedullary spinal cord tumours. |
| Databáze: |
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