Abstract
Purpose
The significance of intraoperative somatosensory evoked potentials (SSEP) monitoring is well known during spinal surgery. This technology could be beneficial during peripheral nerve surgery as well. In order to illustrate potential applications, two cases of successful peripheral nerve release demonstrated by on-line, intraoperative, SSEP are reported.
Clinical and technical features
The first case presents a complex brachial plexus lesion involving two mixed sensorymotor nerves: median and ulnar. The second case involved an entrapment neuropathy of the lateral femoral cutaneous nerve, a pure sensory nerve (meralgia paresthetica). For each patient we elicited specific peripheral nerve SSEP (recorded using bipolar cephalic montage) by stimulating each nerve independently. In each case, during difficult nerve dissection and after having excluded other possible factors of intraoperative SSEP variations, an increase of the SSEP amplitude was observed, and later correlated with favourable patient clinical outcome.
Conclusions
Tw o cases demonstrate that intraoperative SSEP monitoring may provide an effective tool to guide surgical dissection during peripheral nerve release. This technique has potentially beneficial clinical applications and warrants further investigation.
Résumé
Objectif
La valeur du monitorage par les potentiels évoqués somesthésiques (PES) pendant une opération de la colonne vertébrale est bien connue. Il peut offrir des avantages pendant la chirurgie des nerfs périphériques. Pour illustrer ses applications possibles, nous présentons deux cas de libération réussie de nerfs périphériques démontrée par les PES peropératoires en ligne.
Caractéristiques cliniques et techniques
Le premier cas concerne une lésion complexe du plexus brachial touchant deux nerfs mixtes sensori-moteurs: médian et cubital. Le second cas porte sur une neuropathie de compression du nerf cutané fémoral latéral, un nerf sensitif (méralgie paresthésique). Pour chaque patient, nous avons suscité les PES du nerf périphérique concerné (enregistrés selon un montage céphalique bipolaire) en stimulant chaque nerf séparément. Dans chaque cas, pendant la dissection difficile du nerf et aprs avoir exclu tout autre facteur possible de variation des PES peropératoires, une hausse de ľamplitude des PES a été observée et corrélée ensuite avec ľévolution clinique favorable du patient.
Conclusion
Les cas présentés montrent que le monitorage peropératoire par les PES peut guider efficacement la dissection chirurgicale pendant la libération ďun nerf périphérique. Il a des applications cliniques potentiellement bénéfiques et devrait être étudié plus avant.
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Salengros, J.C., Pandin, P., Schuind, F. et al. Intraoperative somatosensory evoked potentials to facilitate peripheral nerve release. Can J Anesth 53, 40–45 (2006). https://doi.org/10.1007/BF03021526
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DOI: https://doi.org/10.1007/BF03021526