Ezgi TUNA ERDOĞAN, Hüseyin CANAZ, İbrahim ALATAŞ

Myelomeningosel Onarımı Sırasında Kök ve Plakodun İntraoperatif Direkt Elektrik Stimülasyon Sonuçları

GİRİŞ ve AMAÇ: Transkraniyal yüksek akım elektriksel uyarımın güvenliği yenidoğanlarda tartışmalıdır. Ancak, intraoperatif direkt stimülasyon teknikleri yenidoğanlarda da fonksiyonel sinir dokusunu belirlemek ve daha güvenli bir cerrahi sağlamak için güvenli ve faydalı yöntemlerdendir. Hastanın total paraplejisi olmadıkça, enstitümüzde myelomeningosel onarım operasyonlarında direkt sinir stimülasyon yöntemini rutin olarak kullanmaktayız. Bu yazıda, myelomeningoseli olan 20 bebekte sinir ve nöral plakodun intraoperatif direkt stimülasyonunun sonuçlarını analiz ettik ve sunduk. YÖNTEM ve GEREÇLER: İntraoperatif direkt stimülasyon uygulanan 20 myelomeningoselli hastanın sonuçları incelendi. Hastaların alt ekstremite kaslarındaki elektromiyografi aktivitesi hem tetiklenmiş hem de spontan aktivite açısından takip edildi. BULGULAR: Elde edilen bileşik kas aksiyon potansiyeli yanıtları alt ekstremitelerin preoperatif motor fonksiyonu ile ilişkilidir. Motor yollardaki iletim bloğu seviyesi bazı durumlarda sinir köklerini içerse de, stimüle edilen köklerin çoğunun işlevsel olması motor iletim bloğunun spinal kordun üst seviyelerinde olduğunu göstermiştir. Bir olguda, dismorfik görünen ince kökler fonksiyonel bulunmuş ve ameliyat boyunca korunmuştur. TARTIŞMA ve SONUÇ: İntraoperatif direkt stimülasyon, myelomeningosel operasyonlarında nöral tüpün diseksiyonu ve onarımı sırasında fonksiyonel sinir dokusunun tespit edilip korunması için yararlı ve güvenilir bir yöntemdir.

The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair

INTRODUCTION: The safety of transcranial high currentstimulation is controversial in newborns. However,intraoperative direct stimulation techniques are safe anduseful methods even for newborns to determine thefunctional neural tissue and to provide a safer surgery. Weroutinely use direct nerve stimulation techniques duringmyelomeningocele closure in our institution unless patienthas total paraplegia. In this paper, we analyzed andpresented the results of intraoperative direct stimulation ofnerves and neural placode in 20 infants withmyelomeningocele.METHODS: Intraoperative direct stimulation was performedand electromyography was followed from lower extremitymuscles both for triggered and spontaneous activity duringmyelomeningocele repair.RESULTS: The compound muscle action potentials werecorrelated with motor examination of lower extremities. While,the level of conduction block in motor pathways involved nerveroots in some cases, most of the stimulated roots werefunctional which indicates the motor conduction block wasupper in spinal cord. In one case dysmorphic appearing rootletwas found functional and preserved throughout the surgery.DISCUSSION and CONCLUSION: In our practice,intraoperative direct stimulation is a useful and reliable methodto check the functional neural tissue and spare it to preserveduring releasing and closure of neural tube inmyelomeningocele operations.

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