INTRAOPERATIVE MONITORING FOR TETHERED SPINAL-CORD SYNDROME
INTRAOPERATIVE MONITORING FOR TETHERED SPINAL-CORD SYNDROME
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DOI：
10.1097/00007632-199111000-00008
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发表时间：
1991-11-01
期刊：
影响因子：
3
通讯作者：
ANDOH, M
中科院分区：
文献类型：
--
作者：
SHINOMIYA, K;FUCHIOKA, M;ANDOH, M
在脊髓栓系综合征的松解手术中，必须监测下肢、肠道和膀胱的功能，因为神经元件嵌入脂肪瘤或异常组织中。 肛门外括约肌、尿道外括约肌和下肢肌肉的诱发肌肉动作电位可以在外科医生释放或切割组织以释放绳索之前迅速指示是否涉及神经元。 尽管膀胱压力升高的反应时间很慢，但由于尿道外括约肌和肛门括约肌的神经支配类型不同，监测膀胱压力也很重要。 诱发肌肉动作电位仅指示运动功能；因此，记录腰骶手术区上方脊髓的脊髓诱发电位更为合适，因为也可以监测感觉功能。 诱发肌肉动作电位是一种简单且极其灵敏的监测系统；尽管如此，还应监测膀胱压和诱发脊髓电位，以实现最佳监测。 过去5年里，已有10名患者在这种监测系统下接受了脐带松解手术，结果表明没有出现病情恶化的情况。
Functions of the lower extremities and bowel and bladder must be monitored during releasing surgery for tethered spinal cord syndrome, because neural elements are embedded in lipoma or anomalous tissues. Evoked muscle action potentials of the external anal sphincter muscle, external urethral sphincter muscle, and lower extremity muscles can indicate promptly whether or not neural elements are involved before the surgeon releases or cuts the tissue for cord release. It is also important to monitor vesical pressure because of different types of innervation from the external urethral and anal sphincters, In spite of slow reaction times of vesical pressure elevation. Evoked muscle action potential indicate only motor function; therefore, it is more appropriate to record evoked spinal cord potentials from the spinal cord above a lumbosacral operative field, because sensory function can also be monitored. Evoked muscle action potentials are an easy and extremely sensitive monitoring system; nevertheless, monitoring of vesical pressure and evoked spinal cord potentials should also be done to achieve optimum monitoring. For the past 5 years, 10 patients have undergone cord-release surgery with such a monitoring system, and the results indicate no exacerbating case.