Why IONM is essential in intramedullary spine tumor surgery ?.
Introduction
Ependymomas and Astrocytoma are the most commonly encountered intramedullary spinal cord tumors, followed by hemangioblastomas Spinal cord tumors are uncommon and present a challenge for patients and neurosurgeons because of the high risk of neurologic deficits from the disease process and surgical interventions.
How helps this subject to prevent post operative neurological deficits ?
As we know the great role of intraoperative neurophysiological monitoring (IONM) it is provide real time information during operation, through signal analysis. Before procedure we record a baseline voltage signal than we continue throughout the surgery.
Modalities for intramedullary spine tumor.
- As we know in our daily life major role of sensory and motor nerves to feel the sense and walk. What kind of modalities can be used to monitor sensory and motor tracts during surgery to prevent new neurological problems, to maintain our quality of life.
Motor monitor for intramedullary spine tumor.
Transcranial electrical motor evoked potential (TCEMEP) provides information of Descending tract which is motor .
Direct wave (D wave) is provide information direct from the spinal cord {without time delay} .
Corticospinal tract mapping (CST-Mapping ) This technique gives information to differentiate between functional and non functional spinal cord tissues.
Sensory
Somatosensory evoked potentials (SSEPs) is give information about sensory system this is also very much important to feel the touch . Dorsal column medial lemniscus mapping (DCML-Mapping ), this is new technique which is being used before myelotomy to prevent especially sensory deficit .
Patients Education
Patients should be adequately counselled regarding the prognosis of the disease and expected neurological and functional outcomes.
Conclusions: intramedullary spine tumor.
By using intraoperative somatosensory evoked potentials, transcranial motor evoked potentials, D-waves, dorsal column mapping and corticospinal spinal tract mapping , spinal injury can be prevented in most cases thereby will improve postoperative neurologic functioning and outcome in patients, who undergoing surgery for IMSCT.
Questions
- How will correlate between MEP and D wave?
- Where has to place Epidural Recording Electrode?
- Choice of Anesthesia Drugs?
- What kind of probe will use in mapping ?
This type of article may be useful for you please do comment and like .
In future i will be more writing about spinal cord mapping in intramedullary tumor spine.
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