Annals of Surgical Oncology

, Volume 15, Issue 6, pp 1594–1599 | Cite as

Compound Muscle Action Potentials and Spontaneous Electromyography Can be Used to Identify and Protect the Femoral Nerve During Resection of Large Retroperitoneal Tumors

  • Lanjun Guo
  • John Patrick ClarkIII
  • Robert S. Warren
  • Eric K. Nakakura
Bone and Soft Tissue Sarcomas



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.


Retroperitoneal sarcoma Intraoperative neurophysiological monitoring Femoral nerve Electrical stimulation Electromyography 


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Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Lanjun Guo
    • 1
  • John Patrick ClarkIII
    • 1
  • Robert S. Warren
    • 2
  • Eric K. Nakakura
    • 2
  1. 1.Neurophysiological Monitoring ServiceUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of Surgery, Division of Surgical OncologyUniversity of CaliforniaSan FranciscoUSA

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