Comparison of multimodal intraoperative neurophysiological monitoring efficacy in early childhood and school aged children undergoing spinal surgery

Abstract

ObjectiveThe aim of this study was to compare the performance of multimodal intraoperative neurophysiological monitoring (MIONM) in children below and over 6 years of age.Methods43 children, diagnosed with spinal pathologies were divided into two cohorts according to their age and enrolled in the study. Those under the age of 6 consisted group A, whereas those between the age of 6 and 11 consisted group B. All patients underwent spinal surgical procedures according to their diagnosis. A standard anesthesia protocol was given to both groups. Baseline somatosensory evoked potentials (SSEPs) and transcranial electrical motor evoked potentials (tcMEPs) were recorded and evaluated at specific time points for each patient.ResultsExcept for the SSEPs in three cases, tcMEPs and SSEPs were recorded for all patients. There was no false-negative whereas 9 false positive recordings due to physiological conditions that all recovered intraoperatively. In 10 patients, MIOMN recorded more than %50 decrement, in which 8 had the kyphosis component. The tcMEPs fully recovered by the end of the operation except for the patient with post-tuberculosis kyphosis. There was no statistically significant difference in the mean threshold values with regard to transcranial stimulus intensity for the tcMEPs between the two groups.ConclusionCompared to school aged children, both SSEPs, tcMEPs recordings are feasible and MIONM is effective for early childhood patients undergoing spinal surgery.Level of evidenceLevel III, Diagnostic Study.

Intraoperative neurophysiology monitoring in scoliosis surgery in children

“…The risk appears to be higher for those with pre-existing deficits, especially neurological, and those with multisystem involvement. Tailored intraoperative neuromonitoring (INM) with transcranial electrical motor evoked potentials (TcMEP), somatosensory evoked potentials (SSEP), free running electromyograms (EMG) and stimulus triggered EMG (Stim EMG) may mitigate the risk of permanent injury and adverse neurological outcomes during certain surgeries ( Cheng et al, 2014 , Lieberman et al, 2008 , Senkoylu et al, 2017 , Novais et al, 2017 , Neira et al, 2016 , Piasecki et al, 2018 , Purger et al, 2015 , Samdani et al, 2016 , Galloway and Zamel, 2011 , Pastorelli et al, 2015 , Jea, 2014 , Sala et al, 2010 , Nuwer et al, 2012b , Fehlings et al, 2010 , Langeloo et al, 2003 , McIntyre et al, 2016 ).…”

Intraoperative neurophysiological monitoring in paediatric neurosurgery

“…13,14,21 Hence, modification of technical parameters such as delivering more pulses, variations in train count, etc are required to obtain satisfactory and reliable MEP waveforms in paediatric patients. 22 IONM with MEP monitoring has been used in children for deformity corrective spine surgeries [23][24][25] and intramedullary spinal cord tumour (IMSCT) surgeries. 26 Children with severe kyphoscoliosis for corrective surgery carry a high risk of spinal cord injury.…”

“…BP, blood pressure; IONM, intraoperative neurophysiological monitoring; MAP, mean arterial pressure; MEP, motor-evoked potential tracts. [23][24][25] Though technically challenging in spine tumours, midline mapping for myelotomy can be performed using phase reversal SSEP using small strip electrodes.…”

Intraoperative Neurophysiological Monitoring for Spinal Fusion

“…38 Actually, electrical stimulation enables a reduction in the risk of medial positioning, minimizing the use of intraoperative radiographs for thoracic screws. 40 Concerning pediatric neurosurgical procedures, despite their recent application, neurophysiological monitoring represents an important tool in the prevention and reduction of possible neurological lesions, 39,46,56 and in some cases it may inform the anatomical site for the corrective surgical maneuver to be performed. 57 Even in those cases considered simple spine surgeries, the use of intraoperative neurophysiological monitoring has been proved useful, enabling the dynamic neurophysiological diagnosis, the differentiation of the compression at the central or foraminal levels, and the clinical awareness of iatrogenic damage, thereby increasing safety.…”

“…[42][43][44]59 The actual trend is to use multimodal intraoperative neurophysiological monitoring on procedures near or involving neural elements. 46,56,58…”