Flanders Tracy M, Franco Alier J, Hines Scott J, Taylor Jesse A, Heuer Gregory G
Division of Neurosurgery, Children's Hospital of Philadelphia, Wood Center, 6th Floor, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA.
Division of Pediatric Intraoperative Neuromonitoring, SpecialtyCare, Nashville, TN, USA.
Childs Nerv Syst. 2020 Feb;36(2):435-439. doi: 10.1007/s00381-019-04380-0. Epub 2019 Nov 10.
Thoracic myelocystocele are extremely rare, non-terminal, closed neural tube defects. Intraoperative neuromonitoring (IONM) is a mainstay of pediatric spinal surgery. However, in neonates and infants, incomplete myelination of the corticospinal tract presents unique challenges to successful use of IONM in this vulnerable patient population. Surgery can often be delayed until patients are older, but there are circumstances in which early intervention is necessary. We report a case of T6 myelocystocele resection and wound closure in an infant on day of life 15 with the use of IONM. To our knowledge, this is the youngest reported patient to undergo successful IONM in the spinal cord. Given that the majority of thoracic myelocystoceles present without any neurological deficits, early intervention for this rare closed spinal dysraphism is sometimes necessary. This case study reports the possibility of IONM use in neonatal patients and also highlights the techniques that make its use more possible.
胸段脊髓脊膜膨出极为罕见，属于非终末性、闭合性神经管缺陷。术中神经监测（IONM）是小儿脊柱手术的主要手段。然而，在新生儿和婴儿中，皮质脊髓束髓鞘形成不完全给在这一脆弱患者群体中成功使用IONM带来了独特挑战。手术通常会推迟到患者年龄稍大时进行，但在某些情况下，早期干预是必要的。我们报告了一例出生15天的婴儿在IONM辅助下进行T6脊髓脊膜膨出切除术及伤口闭合的病例。据我们所知，这是报道中接受脊髓IONM成功手术的最年幼患者。鉴于大多数胸段脊髓脊膜膨出患者并无任何神经功能缺损，对于这种罕见的闭合性脊柱裂有时需要进行早期干预。本病例研究报告了在新生儿患者中使用IONM的可能性，并强调了使其更有可能应用的技术。
