doi: 10.1007/s10877-022-00903-4.
Online ahead of print.
Affiliations
Affiliations
- 1 Department of Neurophysiology, Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA. [email protected].
- 2 Department of Neurosurgery, University of Texas Medical Branch, 1005 Harborside Drive, Galveston, TX, 77555, USA.
- 3 Medsurant Health, 100 Front Street, Suite 280, West Conshohoken, PA, 19428, USA.
- 4 Department of Neurosurgery, Houston Methodist Healthcare System, 6560 Fannin St., Houston, TX, 77030, USA.
- 5 Department of Neurology, Houston Methodist Healthcare System, 6560 Fannin St., Houston, TX, 77030, USA.
- 6 Department of Orthopedic Surgery, University of Texas Medical Branch, 1005 Harborside Drive, Galveston, TX, 77555, USA.
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David W Allison et al.
J Clin Monit Comput.
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doi: 10.1007/s10877-022-00903-4.
Online ahead of print.
Affiliations
- 1 Department of Neurophysiology, Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA. [email protected].
- 2 Department of Neurosurgery, University of Texas Medical Branch, 1005 Harborside Drive, Galveston, TX, 77555, USA.
- 3 Medsurant Health, 100 Front Street, Suite 280, West Conshohoken, PA, 19428, USA.
- 4 Department of Neurosurgery, Houston Methodist Healthcare System, 6560 Fannin St., Houston, TX, 77030, USA.
- 5 Department of Neurology, Houston Methodist Healthcare System, 6560 Fannin St., Houston, TX, 77030, USA.
- 6 Department of Orthopedic Surgery, University of Texas Medical Branch, 1005 Harborside Drive, Galveston, TX, 77555, USA.
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Abstract
Four recent cases utilizing transabdominal motor-evoked potentials (TaMEPs) are presented as illustrative of the monitoring technique during lumbosacral fusion, sciatic nerve tumor resection, cauda equina tumor resection, and lumbar decompression. Case 1: In a high-grade lumbosacral spondylolisthesis revision fusion, both transcranial motor-evoked potentials (TcMEPs) and TaMEPs detected a transient focal loss of left tibialis anterior response in conjunction with L5 nerve root decompression. Case 2: In a sciatic nerve tumor resection, TcMEPs responses were lost but TaMEPs remained unchanged, the patient was neurologically intact postoperatively. Case 3: TaMEPs were acquired during an L1-L3 intradural extramedullary cauda equina tumor resection utilizing a unique TaMEP stimulation electrode. Case 4: TaMEPs were successfully acquired with little anesthetic fade utilizing an anesthetic regimen of 1.1 MAC Sevoflurane during a lumbar decompression. While the first two cases present TaMEPs and TcMEPs side-by-side, demonstrating TaMEPs correlating to TcMEPs (Case 1) or a more accurate reflection of patient outcome (Case 2), no inference regarding the accuracy of TaMEPs to monitor nerve elements during cauda equina surgery (Cases 3) or the lumbar decompression presented in Case 4 should be made as these are demonstrations of technique, not utility.
Keywords:
IONM; Lumbosacral; TaMEP; TcMEP; Transabdominal motor evoked potential.
© 2022. The Author(s), under exclusive licence to Springer Nature B.V.
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