Intérêt des potentiels évoqués somesthésiques dans la surveillance de la chirurgie du rachis chez l'enfant et l'adolescent : à propos de 110 cas

Somatosensory evoked potentials (SEPs) were used for continuous monitoring of 210 patients during anterior surgery for cervical myeloradiculopathy, to test how effectively they help avoid irreversible neurological damage during surgery. The pathologies differed in severity and were treated by diskectomy or by extended corporectomy using the Senegas technique. Intraoperative SEP changes were recorded in 84 patients (40%); in 13 (6.2%) of these, changes in SEP amplitude and latency were caused by mechanical stress. SEPs revealed transient episodes of regional ischaemia or neurophysiological anomalies during anaesthesia (mainly hypotension) in 27 patients (12.8%). The traces detected incipient and potentially dangerous mechanical pressure on, or metabolic anomalies of, the spinal cord during manipulation and placement procedures of spinal fixation devices. They were particularly sensitive indicators of ischaemia; one of the most common causes of irreversible injury. The traces of 44 patients (21.0%) improved markedly during surgery. There were no falsenegatives in this series and, thanks to the fact that SEPs gave immediate warnings of incipient ischaemia to the surgical team, we had no case of irreversible medullary or nerve-root deficit.

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Chiari I Malformation: Potential Role for Intraoperative Electrophysiologic Monitoring

Anderson¹,

Dowling

Feldstein³

et al. 2003

Journal of Clinical Neurophysiology

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Intraoperative electrophysiologic monitoring can diminish the risk of neurologic injury by enabling the detection of injury at a time when it can be reversed or minimized. Although it is clear that in patients with cervical spine disease monitoring during surgery reduces the incidence of neurologic injury, almost no data are available regarding its utility in patients undergoing suboccipital decompression for Chiari I malformation. Patients with Chiari I malformation have caudal displacement of the cerebellar tonsils below the skull base, thereby creating a tight foramen magnum and cervical canal. Although the majority of pediatric neurosurgeons perform a bony decompression with duraplasty for symptomatic patients, there is much controversy regarding the amount of bony decompression required for clinical improvement and whether a duraplasty is essential. The authors therefore conducted a prospective, observational study using intraoperative brainstem auditory evoked potentials (BAEPs) and somatosensory evoked potentials in pediatric patients undergoing suboccipital decompressions for Chiari I malformations to determine whether there were consistent changes in intraoperative BAEPs that could help the operating surgeon decide how extensive a decompression was needed in these patients, and whether changes in BAEPs or somatosensory evoked potentials occurred during operative positioning that could be modified to reduce the risk of neurologic injury.

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Intérêt des potentiels évoqués somesthésiques dans la surveillance de la chirurgie du rachis chez l'enfant et l'adolescent : à propos de 110 cas

Cited by 5 publications

References 21 publications

Scoliosis in Children

Scoliosis in Children

Intraoperative control by somatosensory evoked potentials in the treatment of cervical myeloradiculopathy. Results in 210 cases

Chiari I Malformation: Potential Role for Intraoperative Electrophysiologic Monitoring

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