Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Department of Neurosurgery, Nara Medical University, Nara, Japan.
Childs Nerv Syst. 2023 Aug;39(8):2147-2153. doi: 10.1007/s00381-023-05895-3. Epub 2023 Mar 9.
Postoperative urinary dysfunction following untethering surgery for spinal lipoma is devastating. To assess urinary function, we invented a pediatric urinary catheter equipped with electrodes for the direct transurethral recording of myogenic potential from the external urethral sphincter (EUS). This paper presents two cases in which urinary function was monitored intraoperatively by recording of motor-evoked potential (MEP) from EUS during untethering surgery in children.
Two children (aged 2 and 6 years) were included in this study. One patient had no preoperative neurological dysfunction, while the other had frequent urination and urinary incontinence. A pair of surface electrodes was attached to a silicone rubber urethral catheter (6 or 8 Fr; diameter, 2 or 2.6 mm). The MEP from the EUS was recorded to assess the function of the centrifugal tract from the motor cortex to the pudendal nerve.
Baseline MEP waveforms from the EUS were successfully recorded with latency and amplitude of 39.5 ms and 66 µV in patient 1 and 39.0 ms and 113 µV in patient 2, respectively. A significant decrease in amplitude was not observed during surgery in the two cases. No new urinary dysfunction and complications associated with the urinary catheter-equipped electrodes developed postoperatively.
Using an electrode-equipped urinary catheter, monitoring of MEP from the EUS could be applicable during untethering surgery in pediatric patients.
脊髓脂肪瘤松解术后出现的术后尿功能障碍是毁灭性的。为了评估尿功能，我们发明了一种带有电极的小儿导尿管，用于直接经尿道记录尿道外括约肌（EUS）的肌源性电位。本文介绍了两例儿童松解术中通过记录 EUS 运动诱发电位（MEP）来监测尿功能的病例。
本研究纳入了 2 名儿童（年龄分别为 2 岁和 6 岁）。一名患者术前无神经功能障碍，另一名患者则有频繁排尿和尿失禁。将一对表面电极贴在硅胶橡胶导尿管（6 或 8 Fr；直径 2 或 2.6mm）上。记录 EUS 中的 MEP，以评估从运动皮层到阴部神经的离心束的功能。
在患者 1 中，EUS 的基线 MEP 波形成功记录，潜伏期和振幅分别为 39.5ms 和 66µV；在患者 2 中，潜伏期和振幅分别为 39.0ms 和 113µV。在这两例患者中，手术过程中未观察到振幅明显下降。术后未出现与带电极导尿管相关的新的尿功能障碍和并发症。
使用带电极的导尿管，在小儿松解术中监测 EUS 的 MEP 是可行的。
