Intraoperative changes in transcranial motor evoked potentials and somatosensory evoked potentials predicting outcome in children with intramedullary spinal cord tumors

• DOI: 10.3171/2014.2.peds1392
• Publication Date: 2014-04-04T14:06:05Z
• Authors: Jason S. Cheng; Michael E. Ivan; Christopher J. St...; Alfredo Quinones-...; Nalin Gupta; Kurtis I. Auguste
• Keywords: Somatosensory evoked potential; Evoked potential

Intraoperative dorsal column mapping, transcranial motor evoked potentials (TcMEPs), and somatosensory (SSEPs) have been used in adults to assist with the resection of intramedullary spinal cord tumors (IMSCTs) predict postoperative deficits. The authors sought determine whether changes MEP SSEP waveforms would similarly deficits children.The reviewed charts intraoperative records for children who had undergone IMSCTs as well mapping TcMEP monitoring. Motor potential data were supplemented electromyography obtained using a Kartush microstimulator (Medtronic Inc.). strength was graded Medical Research Council (MRC) scale during preoperative, immediate postoperative, follow-up periods. Reductions SSEPs documented after mechanical traction, response maneuvers cavitational ultrasonic surgical aspirator (CUSA), or both.Data from 12 patients analyzed. Three lesions encountered cervical 7 thoracic cord. Two cervicomedullary junction upper noted half patients. In these cases, normal polyphasic signals converted biphasic signals, correlated loss 1-2 grades strength. One patient lost completely recovered MRC Grade 4/5. 2 high showed neither nor postoperatively. Dorsal columns mapped patients, midline determined accurately all 7. Somatosensory decreased each decreases traction intraoperatively but no new sensory findings Another 3 traction-related intraoperatively, both that resolved. additional CUSA-related decrease which resolved postoperatively, last deficit none resolved.Intraoperative TcMEPs can degree pediatric undergoing IMSCT resection. This technique, combined is particularly useful resecting cord, are generally considered be risk this population. Furthermore, appears less tolerant repeated decreases, successive insults most likely yield Changes signal need guard against excessive manipulation thereby increasing safety tumor