riirk Noro$iriirji Dergisi 9: 57 - 64, 1999 Zileli: Omuri/ik
monitor/ernesi
Ameliyat SlraSlnda Omurilik Monitorlemesi
Intraoperative Spinal Cord Monitoring
MEHMET ZiLELi, ERDAL CO$KUN, BERNA ZiLELi
Ege Universitesi Tip Fakultesi Norolojik Cerrahi Anabilim Dah,
izmir (MZ, BZ),Pamukkale Universitesi Tip Fakultesi Norolojik
Cerrahi Anabilim Dah, Denizli (EC)
Ozet: Bu l;ah~mada omurilik ve omurga cerrahisislrasmdaevoked
potansiyel monitorlemesi uyguladlglmlz32 olguluk bir klinik serinin
sonul;lan sunulmaktadlr.Dokuzhastada intrameduller tumor, 5 hastada
intraduralekstrameduller tumor, 5 hastada ekstradural tUmor,
6hastadaservikal spondilotik miyelopati, 6 hastada gerginomurilik
sendromu, 1 hastada torakal disk hernisimevcuttu. Turn hastalarda
tibial ve median sinir uyanmlilekortikal SEP'ler (Somatosensoryel
Evoked Potansiyel),29 hastada aynca spinal SEP'ler elde edildi.
Dura al;llml~saintradural, al;ilmaml~sa ekstradural kaYltlar
yaplldl.yirmibir olguda intraoperatif E' ler (Evoked
Potansiyel)degi~medi,9 olguda kotUle~ti.Postoperatif erken
donemdeklinik tablo 24 olguda degi~medi, 1 olguda duzelmeg6sterdi,
8 olguda ise kotUle~me gosterdi. iki yanh~negatiflik,3 yanh~
pozitiflik, 6 dogru pozitiflik elde
edildi.Kauda-konuspatolojilerinde anal sfinkter uyanmh SEP'lerdaha
anlamh sonul;lar verdi. Bir olguda klsa surelik6tiile~meyecerrahm
yamt vermesiyle SEP'ler duzeldi.Genel olarak norolojik defisi ti
olan hastalannmoit6rlenmesi, skolyoz cerrahisi gibi defisitsiz
olgulannmonitorlenmesinden daha zor olmaktadlr. Bu
olgulardazatenbozuk olan kortikal SEP'ler ameliyat slrasmda
ciddidalgalanmalar gosterebilmektedir. Ancak spinal
SEP'lerinkayblya da bozulmasl norolojik defisitin bir
gostergesiolup,mutlak uyan kriteri olarak kabul edilmelidir.
Anahtar Kelimeler: Omurilik monitorlenmesi,somatosensoryel
evoked potansiyeller, omurilikpotansiyelleri, pudendal SEP
GiRi$
Omurilik ve omurga cerrahisi, kanal it;inde vekanalt;evresinde
yer alan kIymetli yapdarm, omurilikvekoklerin zedelenmesine yol
at;abilir. Omuriliik ve
Abstract: This study presents a clinical series with 32
casesthat have evoked potentials monitoring during spine andspinal
cord surgery. Clinical diagnosis was intramedullarytumors in 9
patients, intradural extramedullary tumors in5 patients, extradural
tumors in 5 patients, cervicalspondylotic myelopathy in 6 patients,
tethered cordsyndrome in 6 patients, thoracic disc herniation in
onepatient. All of the patients were monitored with corticalSEPs
(Somatosensory Evoked Potentials) by tibial andmedian nerve
stimulation, 29 patients were addititonallymonitored with spinal
SEPs. In case the dura was opened,subdural recordings were done,
otherwise epiduralrecordings were done. Intraoperative SEPs did not
changein 21 patients, and worsened in 9 patients.
Postoperativeevaluation showed that clinical deficits did not
change in24 cases, progressed in one patient, deteriorated in
8patients. We reported 2 false-negative, 3 false-positive, 6true
positive monitoring. SEPs with anal sphincterstimulation were more
sensitive for monitoring of lesionsin cauda and conus region. Since
the surgeon reactedpromptly to wave loss in one patient, SEPs were
recoveredduring operation.In conclusion, monitoring of the
patientswith neurological deficits is harder than the
patientswithout deficits such as scoliosis surgery. We noted
seriousfluctuations in already hampered base line activitiy
ofcortical SEPs in these patients. However, worsening or lossof
spinal SEPs reflects the function of neurologic deficits,and should
be considered as an absolute warning criteria.
Key Words: Spinal cord monitoring, somatosensoryevoked
potentials, spinal cord potentials, pudendal SEP
kok hasan, bu yapllara kompresyon, kontiizyon ileveya omurilik
kan aklmmmm bozulmasl ile olabilir.Sonut;ta istenmeyen bir
norolojik morbiditegeli~ecektir .
Turk Noro§irurji Dergisi 9: 57 - 64, 1999
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