Neonatal intraoperative neuromonitoring in thoracic myelocystocele: a case report

  • Tracy M. Flanders
  • Alier J. Franco
  • Scott J. Hines
  • Jesse A. Taylor
  • Gregory G. HeuerEmail author
Case Report


Thoracic myelocystocele are extremely rare, non-terminal, closed neural tube defects. Intraoperative neuromonitoring (IONM) is a mainstay of pediatric spinal surgery. However, in neonates and infants, incomplete myelination of the corticospinal tract presents unique challenges to successful use of IONM in this vulnerable patient population. Surgery can often be delayed until patients are older, but there are circumstances in which early intervention is necessary. We report a case of T6 myelocystocele resection and wound closure in an infant on day of life 15 with the use of IONM. To our knowledge, this is the youngest reported patient to undergo successful IONM in the spinal cord. Given that the majority of thoracic myelocystoceles present without any neurological deficits, early intervention for this rare closed spinal dysraphism is sometimes necessary. This case study reports the possibility of IONM use in neonatal patients and also highlights the techniques that make its use more possible.


Thoracic myelocystocele Intraoperative neuromonitoring (IONM) Spinal surgery Infant 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of NeurosurgeryChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Division of Pediatric Intraoperative NeuromonitoringSpecialtyCareNashvilleUSA
  3. 3.Division of Anesthesiology and Critical Care MedicineChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  4. 4.Division of Plastic and Reconstructive SurgeryChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  5. 5.The Center for Fetal Diagnosis and TreatmentChildren’s Hospital of PhiladelphiaPhiladelphiaUSA

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