Compound Muscle Action Potentials and Spontaneous Electromyography Can be Used to Identify and Protect the Femoral Nerve During Resection of Large Retroperitoneal Tumors
- Lanjun GuoAffiliated withNeurophysiological Monitoring Service, University of California San Francisco Email author
- , John Patrick ClarkIIIAffiliated withNeurophysiological Monitoring Service, University of California San Francisco
- , Robert S. WarrenAffiliated withDepartment of Surgery, Division of Surgical Oncology, University of California
- , Eric K. NakakuraAffiliated withDepartment of Surgery, Division of Surgical Oncology, University of California
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Resection of large retroperitoneal neoplasms may injure the femoral nerve, thereby causing a permanent neurological deficit. We used electrical neurophysiological monitoring to identify, map, and preserve the femoral nerve during surgical resection to reduce the risk of neurological deficit.
Seven patients with retroperitoneal neoplasms underwent eight resections.
Compound muscle action potentials (CMAPs) were recorded from needle electrodes placed in the iliacus, quadriceps, and sartorius muscles. Spontaneous electromyography (EMG) was contnuously monitored from the same muscle groups. A handheld monopolar stimulator was used to elicit evoked EMG responses to identify and map the course of the femoral nerve. A stimulating strength of 10 mA was used to map the nerve. The stimulation threshold was tested after neoplasm resection to predict postoperative femoral nerve function.
Electrical stimulation with CMAP recording and a stimulating strength of 10 mA successfully localized the femoral nerve in six cases. Monitoring with a stimulating threshold between 0.6 and 1.6 mA predicted postoperative femoral nerve preservation after tumor resection in four of the six cases.
Neurophysiological monitoring using CMAP and spontaneous EMG can protect the femoral nerve during resection of large retroperitoneal neoplasms.
KeywordsRetroperitoneal sarcoma Intraoperative neurophysiological monitoring Femoral nerve Electrical stimulation Electromyography
- Compound Muscle Action Potentials and Spontaneous Electromyography Can be Used to Identify and Protect the Femoral Nerve During Resection of Large Retroperitoneal Tumors
Annals of Surgical Oncology
Volume 15, Issue 6 , pp 1594-1599
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Retroperitoneal sarcoma
- Intraoperative neurophysiological monitoring
- Femoral nerve
- Electrical stimulation
- Industry Sectors
- Author Affiliations
- 1. Neurophysiological Monitoring Service, University of California San Francisco, 533 Parnassus Avenue, U-491, Box 0220, San Francisco, CA, 94143-0112, USA
- 2. Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA, 94143, USA