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Neonatal intraoperative neuromonitoring in thoracic myelocystocele: a case report

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Abstract

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.

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Authors and Affiliations

  1. Division of Neurosurgery, Children’s Hospital of Philadelphia, Wood Center, 6th Floor, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA

    Tracy M. Flanders & Gregory G. Heuer

  2. Division of Pediatric Intraoperative Neuromonitoring, SpecialtyCare, Nashville, TN, USA

    Alier J. Franco

  3. Division of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Scott J. Hines

  4. Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Jesse A. Taylor

  5. The Center for Fetal Diagnosis and Treatment, Children’s Hospital of Philadelphia, Wood Center, 6th Floor, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA

    Gregory G. Heuer

Authors
  1. Tracy M. Flanders
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  2. Alier J. Franco
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  3. Scott J. Hines
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  4. Jesse A. Taylor
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  5. Gregory G. Heuer
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Correspondence to Gregory G. Heuer.

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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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Flanders, T.M., Franco, A.J., Hines, S.J. et al. Neonatal intraoperative neuromonitoring in thoracic myelocystocele: a case report. Childs Nerv Syst 36, 435–439 (2020). https://doi.org/10.1007/s00381-019-04380-0

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  • DOI: https://doi.org/10.1007/s00381-019-04380-0

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