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San-Juan D, Vanegas JAV, López RA, Jiménez CR, Reyes LADLC. Pediatric Intraoperative Neurophysiological Monitoring and Long-Term Outcomes in a Developing Country. J Clin Neurophysiol 2023; Publish Ahead of Print:00004691-990000000-00094. [PMID: 37200528 DOI: 10.1097/wnp.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
PURPOSE Pediatric intraoperative neurophysiological monitoring (IONM) has been shown to be effective in preventing and reversing postoperative neurological deficits in developed countries. There are currently no published studies from developing countries that describe neurophysiological findings and postoperative outcomes. Our study aims to address these gaps in children undergoing neurosurgical procedures in a single center. METHODS We conducted a retrospective study of case series of children who underwent IONM (2014-2020) in the State of Mexico, Mexico. Sociodemographic characteristics, IONM modalities, changes during procedures, and short-term and long-term postoperative results were recorded. Descriptive statistics were used. RESULTS We included 35 patients (≤18 years of age), 57% (20/35) boys. A relative increase of up to 5 times in the use of IONM is observed from 2014 (5.7%) to 2020 (25.7%) in our center. The most frequent preoperative pathologies were located at the infratentorial cranium (40%), followed by the spine and spinal cord (37.1%). The IONM modalities were as follows: free-running EMG 94.3%, transcranial electrical stimulation motor-evoked potentials 91.4%, somatosensory-evoked potentials 85.7%, triggered EMG 28.6%, EEG 25.7%, and visual-evoked potentials 5.7%. Only in 8.3%, we did not obtain sufficient evoked potential baseline signals. At 24 hours postoperatively true negatives were 100%. Long-term follow-up was completed in 22/35 (63%) at 3 months, 12/35 (34.2%) at 6 months, and 5/35 (14.3%) at 12 months with progressive motor and sensory improvement. CONCLUSIONS Pediatric multimodal IONM in neurosurgeries from a single center in a developing country is mainly used in pathologies of the posterior fossa, spine, and spinal cord, with true negatives in 100% of those monitored, preventing and avoiding postoperative sequelae.
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Affiliation(s)
- Daniel San-Juan
- Clinical Neurophysiology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; and
| | | | - Raúl Aguilar López
- Neurosurgery Department, Maternal and Child Hospital, ISSEMyM, Mexico State, Mexico
| | - Christian Ramos Jiménez
- Clinical Neurophysiology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; and
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Nonaka M, Itakura T, Iwamura H, Ueno K, Naito N, Miyata M, Isozaki H, Li Y, Takeda J, Asai A. Comparison of intraoperative neurophysiological monitoring methods for lumbosacral lipoma surgery in infants. Childs Nerv Syst 2023; 39:1603-1610. [PMID: 36869907 DOI: 10.1007/s00381-023-05900-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/23/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Stable intraoperative neurophysiology monitoring of infants, especially very young infants, is challenging. In this study, motor evoked potentials (MEPs), the bulbocavernosus reflex (BCR), and somatosensory evoked potentials (SEPs) were simultaneously monitored in infants with lumbosacral lipomas, and these methods were compared retrospectively. METHODS A total of 21 surgeries performed for lumbosacral lipoma in patients less than 1 year old were studied. The mean age at surgery was 133.8 days (range 21-287 days; ≤ 120 days: 9 cases, > 120 days: 12 cases). Transcranial MEPs were measured in the anal sphincter and gastrocnemius, and tibialis anterior and other muscles were added as needed. The BCR was measured by the electromyogram of the anal sphincter muscle with stimulation of the pubic region, and SEPs were measured from the waveforms of stimulation of the posterior tibial nerves. RESULTS For the BCR, stable potentials could be recorded for all 9 cases at ≤ 120 days of age. In contrast, for MEPs, stable potentials could be recorded in only 4 of 9 cases (p < 0.05). For all patients > 120 days of age, MEPs and the BCR were measurable. SEPs were undetectable in some patients regardless of age. CONCLUSION The BCR could be more consistently measured than MEPs in infant patients with lumbosacral lipoma at ≤ 120 days of age.
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Affiliation(s)
- Masahiro Nonaka
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, 573-1010, Hirakata City, Osaka, Japan.
| | - Takeshi Itakura
- Department of Orthopedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, 573-1010, Hirakata City, Osaka, Japan
| | - Haruka Iwamura
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, 573-1010, Hirakata City, Osaka, Japan
| | - Katsuya Ueno
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, 573-1010, Hirakata City, Osaka, Japan
| | - Nobuaki Naito
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, 573-1010, Hirakata City, Osaka, Japan
| | - Mayuko Miyata
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, 573-1010, Hirakata City, Osaka, Japan
| | - Haruna Isozaki
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, 573-1010, Hirakata City, Osaka, Japan
| | - Yi Li
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, 573-1010, Hirakata City, Osaka, Japan
| | - Junichi Takeda
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, 573-1010, Hirakata City, Osaka, Japan
| | - Akio Asai
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, 573-1010, Hirakata City, Osaka, Japan
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Berchi Kankam S, Ashrafi M, Tayebi Meybodi K, Sotoudeh Anvari M, Habibi Z, Nejat F. Lumbosacral non-terminal myelocystocele associated with teratoma: case report and review of literature. Childs Nerv Syst 2022; 38:1229-1232. [PMID: 34515813 DOI: 10.1007/s00381-021-05361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
Non-terminal myelocystoceles are commonly found in the cervical or thoracic spinal region. Their sac can rarely be associated with tumor. A rare case of an infant with a lumbosacral non-terminal myelocystocele and accompanying mature teratoma is reported in whom the tumor was attached to the placode not as a part of the sac.
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Affiliation(s)
- S Berchi Kankam
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - M Ashrafi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - K Tayebi Meybodi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - M Sotoudeh Anvari
- Department of Pediatric Pathology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Z Habibi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - F Nejat
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran.
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Shalita C, Sankey EW, Bergin SM, McManigle J, Buckley AF, Radtke R, Torres C, Dear GL, Thompson EM. Successful Neonatal, Intraoperative Neuromonitoring in the Surgical Correction of a Thoracic Dermal Sinus Tract: Technical Note. Pediatr Neurosurg 2022; 57:295-300. [PMID: 35512661 DOI: 10.1159/000524924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/29/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intraoperative neuromonitoring (IONM) is commonly used during surgery of the spine and spinal cord for early surveillance of iatrogenic injury to the central and peripheral nervous system. However, for infants and young children under 3 years of age, the use of IONM is challenging due to incomplete central and peripheral myelination. CASE PRESENTATION We report a case of a T4-T6 dermal sinus tract (DST) that was resected on day of life 23, with the successful use of IONM. CONCLUSION To our knowledge, this is the youngest reported case of the use of IONM in the surgical correction of a DST in a neonatal patient. This case demonstrates the potential efficacy of IONM in neonatal spine surgery and the techniques used to adapt the technology to an immature nervous system.
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Affiliation(s)
- Chidyaonga Shalita
- Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Eric W Sankey
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Stephen M Bergin
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - John McManigle
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Anne F Buckley
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Rodney Radtke
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Claudia Torres
- Neurodiagnostic Services, Duke University Medical Center, Durham, North Carolina, USA
| | - Guy L Dear
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Eric M Thompson
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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