Background

Intraoperative neurophysiologic monitoring (IONM) is an established technique and adjunct of brain and spinal lesion resection surgery. In spina bifida syndrome surgery, mapping of the surgical wound is a common and accepted method in determining the position and functionality of nerve roots of the cauda equina (CE), especially when the anatomy is not straightforward and roots are splayed across or entangled within the lesion. Here, we describe a novel technique of continuous CE mapping using an electrified cavitron ultrasonic aspirator (eCUSA) in children with lipomyelomeningocele (LMMC) lesions.

Methods

We assessed a method of dynamic CE mapping using an eCUSA as a stimulation probe. Twenty children (0.5–18 years) were included in this study, diagnosed with occult spina bifida LMMC in which the eCUSA stimulator was applied. IONM data and 2-weeks post-operative data were collected.

Results

LMMC lesions were located in the lumbar, sacral, and lumbosacral spine. eCUSA stimulation at 0.3–3.0 mA intensities elicited positive lower extremity muscle responses in 12 of the 20 patients included in the study. These responses allowed the surgeon real-time identification of the nerve roots tangent at the LMMC-cauda equina structure and intensive removal of the fat tissue in the area non-responding to the eCUSA stimulation.

Conclusion

Continuous eCUSA-based stimulation of the cauda equina during LMMC resection is a feasible mapping technique with potential added value improving safety of untethering. Future studies evaluating extension of untethering, as well as the rates of retethering and long-term neurological and urological outcomes, are warranted.

中文翻译：

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电动超声吸气器在脂膜脑膜膨出和脊髓束缚术中进行动态映射的可行性研究

背景

术中神经生理监测（IONM）是一项既定的技术，是脑和脊髓病变切除术的辅助手段。在脊柱裂综合征手术中，在确定马尾神经根（CE）的神经根的位置和功能时，对手术伤口进行定位是一种常见且可接受的方法，尤其是在解剖结构不简单且根部张开或缠绕在神经根内的情况下。病变。在这里，我们描述了一种新的连续CE映射的新技术，该技术使用了带电的Cavitron超声吸引器（eCUSA）治疗患有脂膜脑膜膨出（LMMC）病变的儿童。

方法

我们评估了使用eCUSA作为刺激探针进行动态CE映射的方法。这项研究包括20名儿童（0.5-18岁），他们被诊断出患有隐匿性脊柱裂LMMC，其中应用了eCUSA刺激器。收集IONM数据和术后2周的数据。

结果

LMMC病变位于腰椎，骨和腰s椎。在研究中纳入的20例患者中，有12例在0.3-3.0 mA强度下激发eCUSA引起下肢肌肉阳性反应。这些反应使外科医生可以实时识别LMMC-马尾神经结构的神经根切线，并在不响应eCUSA刺激的区域大量去除脂肪组织。

结论

在LMMC切除过程中，基于eCUSA的马尾神经连续刺激是一种可行的测绘技术，具有潜在的附加价值，可提高束缚的安全性。因此，有必要进行进一步的研究，以评估无栓系留术的延长，栓系留率以及长期的神经和泌尿系统结局。