Sukkar Faisal A, Albalawi Sultan F, AlSindi Tala S, Alomar Soha A
Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Department of Spine Surgery, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.
Surg Neurol Int. 2024 Nov 1;15:391. doi: 10.25259/SNI_179_2024. eCollection 2024.
Intraoperative neuromonitoring is an essential tool for detecting early intraoperative neurological changes during spinal surgery. Only rarely do seizures occur during transcranial motor-evoked potentials (TcMEP).
A 44-year-old male presented with a magnetic resonance (MR)--documented L5-S1 T2-hyperintense intradural mass that heterogeneously enhanced with Gadolinium and extended through the right S1 neural foramen. Utilizing transcranial motor-evoked potential (Tc-MEP) before the skin incision, the patient developed the 1 seizure that lasted for 2 min. The 2 seizure occurred after the initial incision and lasted for around 15 min; at this point, the procedure was terminated. After brain MR studies documented no structural lesion and other etiologies of seizures were ruled out, the patient underwent an uneventful resection of the L5-S1 spinal lesion.
Although the risk of seizures from Tc-MEP is very low, it is crucial to be aware of this potential side effect. If they occur, surgical procedures should be aborted and diagnostic studies performed to rule out the presence of structural lesions and/or other reasons for seizure activity.
术中神经监测是脊柱手术中检测早期术中神经变化的重要工具。经颅运动诱发电位（TcMEP）期间很少发生癫痫发作。
一名44岁男性，磁共振成像（MR）显示L5-S1节段硬膜内T2高信号肿块，钆增强不均匀，并延伸至右侧S1神经孔。在皮肤切口前利用经颅运动诱发电位（Tc-MEP）时，患者出现1次癫痫发作，持续2分钟。第2次癫痫发作发生在初始切口后，持续约15分钟；此时，手术终止。脑部MR研究显示无结构性病变且排除了癫痫发作的其他病因后，患者顺利切除了L5-S1脊柱病变。
虽然Tc-MEP引发癫痫的风险非常低，但意识到这种潜在副作用至关重要。如果发生癫痫，应中止手术操作并进行诊断性检查，以排除结构性病变和/或癫痫活动的其他原因。
