Intraoperative neurophysiological monitoring during thoracoscopic removal of the paravertebral spinal tumor (from practice)
https://doi.org/10.17650/1683-3295-2018-20-4-75-79
Abstract
Bol’shaya Sukharevskaya Sq., Moscow 129090, Russia
The study objective is to describe the clinical case of intraoperative neurophysiologic monitoring (IONM) using the electromyography-triggered stimulation during the thoracoscopic removal of an extradural Th2 –Th3 level tumor.
Materials and methods. The case describes the removal of the right Th2 –Th3 pleural cavity paravertebral tumor that has compressed the phrenic nerve. The patient underwent thoracoscopic surgery supported by IONM. An electromyography-triggered stimulation with a monopolar stimulator that was inserted through the thoracoscopic access into the thoracic cavity under video control identified the phrenic nerve.
Results. The thoracoscopy in combination with electromyography-triggered stimulation allowed to avoid open surgery. The use of traditional IONM for spinal surgery would not identify the diaphragmatic nerve and prevent its unintentional damage.
Conclusion. IONM scenarios can be successfully enhanced with a electromyography-triggered stimulation of the phrenic nerve. Adhesive disposable electrodes for muscle response recording and stimulus return are useful without any deterioration of informativity.
About the Authors
A. A. Grin’
N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department
Russian Federation
3 Bol’shaya Sukharevskaya Sq., Moscow 129090
Russian Federation
3 Bol’shaya Sukharevskaya Sq., Moscow 129090
M. V. Sinkin
N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department
Russian Federation
3 Bol’shaya Sukharevskaya Sq., Moscow 129090
Russian Federation
3 Bol’shaya Sukharevskaya Sq., Moscow 129090
I. B. Aleynikova
N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department
Russian Federation
3 Bol’shaya Sukharevskaya Sq., Moscow 129090
Russian Federation
3 Bol’shaya Sukharevskaya Sq., Moscow 129090
А. Yu. Kordonskiy
N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department
Russian Federation
3 Bol’shaya Sukharevskaya Sq., Moscow 129090
Russian Federation
3 Bol’shaya Sukharevskaya Sq., Moscow 129090
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Review
For citations:
Grin’ A.A., Sinkin M.V., Aleynikova I.B., Kordonskiy А.Yu. Intraoperative neurophysiological monitoring during thoracoscopic removal of the paravertebral spinal tumor (from practice). Russian journal of neurosurgery. 2018;20(4):75-79. (In Russ.) https://doi.org/10.17650/1683-3295-2018-20-4-75-79
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