Bianchi Federico, Di Monaco Giuliano, Tamburrini Gianpiero
Pediatric Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Adv Tech Stand Neurosurg. 2025;51:165-171. doi: 10.1007/978-3-031-86441-4_12.
Selective dorsal rhizotomy represents one of the major neurosurgical tools in treating pediatric spasticity. Intraoperative rootlet selection is the key step of the procedure in order to achieve good outcomes. Intraoperative monitoring (IOM) and anatomical selection of the rootlets are the gold standard in the aforementioned selection leading the surgeon during the procedure. The tendency toward minimally invasive procedures further increases IOM importance, warranting the use of electrophysiology in choosing the more suitable rootlets for cutting. Discharge pattern and percentage of resection represent the most important topics in surgical guidance, relying onto the very same pathophysiological mechanism causing spasticity to choose targets.
选择性脊神经后根切断术是治疗小儿痉挛的主要神经外科手段之一。术中神经根选择是该手术取得良好效果的关键步骤。术中监测（IOM）和神经根的解剖学选择是上述选择过程中的金标准，在手术过程中为外科医生提供指导。微创手术的趋势进一步增加了IOM的重要性，这使得在选择更适合切断的神经根时需要使用电生理学。放电模式和切除百分比是手术指导中最重要的课题，依靠导致痉挛的相同病理生理机制来选择靶点。
