Jahangiri Faisal R, Silverstein Justin W, Trausch Courtney, Al Eissa Sami, George Zachariah M, DeWal Hargovind, Tarasiewicz Izabela
a Axis Neuromonitoring LLC , Richardson , Texas.
b Neuro Protective Solutions , Hauppauge , New York.
Neurodiagn J. 2019;59(1):34-44. doi: 10.1080/21646821.2019.1572375.
Bowel and bladder function are at risk during tumor resection of the conus, cauda equina, and nerve roots. This study demonstrates the ability to acquire transcranial electrical motor evoked potentials (TCeMEPs) from the urethral sphincter muscles (USMEPs) by utilizing a urethral catheter with an embedded electrode. A retrospective analysis of intraoperative neurophysiological monitoring (IONM) data from nine intradural tumors, four tethered cord releases, and two spinal stenosis procedures was performed (n = 15). The cohort included seven females and eight males (median age: 38.91 years). A catheter with embedded urethral electrodes was used for recording TCeMEPs and spontaneous electromyograph (s-EMG) from the external urethral sphincter (EUS). USMEPs were obtained in 14 patients (93%). The reliability of TCeMEP from the external anal sphincter (EAS) was variable across all patients. In patient 7, the TCeMEP recordings from the urethral sphincter were not present before incision; however, following the resection of the tumor, the USMEP recordings were obtained and remained stable for the remainder of the procedure. Patient 7 had subsequent improvement in bladder function postoperatively. Patient 4 exhibited a 50% increase in the amplitude of the USMEP following tumor resection and exhibited improved bladder function as well postoperatively. In this small series, we were able to acquire consistent and reliable MEPs when recorded from the urethral sphincters. More study is needed to establish a better understanding of the value added by this modality. USMEPs can be attempted in surgeries that put the function of the pelvic floor at risk.
在圆锥、马尾和神经根的肿瘤切除术中，肠道和膀胱功能会面临风险。本研究展示了通过使用带有嵌入式电极的尿道导管，从尿道括约肌获取经颅电运动诱发电位（TCeMEP）的能力，即尿道括约肌运动诱发电位（USMEP）。对9例硬脊膜内肿瘤、4例脊髓栓系松解术和2例脊柱狭窄手术的术中神经生理监测（IONM）数据进行了回顾性分析（n = 15）。该队列包括7名女性和8名男性（中位年龄：38.91岁）。使用带有嵌入式尿道电极的导管记录来自尿道外括约肌（EUS）的TCeMEP和自发肌电图（s - EMG）。14例患者（93%）获得了USMEP。在所有患者中，来自肛门外括约肌（EAS）的TCeMEP的可靠性各不相同。在患者7中，切口前未获得尿道括约肌的TCeMEP记录；然而，肿瘤切除后，获得了USMEP记录，并且在手术的剩余过程中保持稳定。患者7术后膀胱功能随后有所改善。患者4在肿瘤切除后USMEP的波幅增加了50%，术后膀胱功能也有所改善。在这个小样本系列中，当从尿道括约肌记录时，我们能够获得一致且可靠的运动诱发电位。需要更多的研究来更好地理解这种方式的附加价值。在使盆底功能面临风险的手术中，可以尝试记录USMEP。
