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Rehabilitation Practice and Science

Translated Title

硬膜下電極紀錄後脛神經的體感覺誘發電位在脊柱裂及脊髓牽扯症候群手術的臨床應用

Abstract

Objective: To investigate the feasibility of a subdural strip, placed just proximal to the surgical field, to record somatosensory evoked potentials (SSEPs) of the posterior tibial nerve (PTN) during detethering surgery for spinal dysraphism and/or tethered cord syndrome (TCS). Method: Twenty three patients (thirteen boys and ten girls; age, 4 months to 15 years) were enrolled in this study. Eleven patients had lipomyelomeningoceles, seven had TCS, two had split cord malformations, one with terminal myelocystocele, one with VACTERL syndrome, and one had a spinal tumor at the T11 to L4 level. Aside from the routine preparation needed for functional mapping and monitoring during surgery for spinal dysraphism and TCS, a 1×4 strip was placed rostral to the surgical field where it was secured by a surgeon after opening of the dura. Under total intravenous anesthesia, we stimulated the PTN and simultaneously recorded SSEPs with this strip and subdermal needles at Cz-Fz. Results: With the exception of one patient, SSEP amplitudes obtained by subdural recordings were much larger than cortical recordings. Moreover, much less averaging was necessary to get a clear subdural SSEP when compared to the averaging needed to obtain a clear cortical SSEP (10 vs. 200 averages, respectively). All recordings were stable throughout the surgical procedures and none of the patients sustained new functional deficits after surgery. Conclusions: Recording SSEPs of the PTN through a subdural strip proved to be a feasible and valuable tool during detethering surgery in young patients. When compared to recordings obtained byconventional cortical SSEPs, this approach could improve both the safety and efficiency of surgical procedures.

Language

English

First Page

103

Last Page

109

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