title: Intraoperative monitoring of motor evoked potentials in very young children.
abstract: OBJECTIVE
  Neurophysiological monitoring of motor evoked potentials (MEPs) during complex spine procedures may reduce the risk of injury by providing feedback to the operating surgeon. While this tool is a well-established surgical adjunct in adults, clinical data in children are sparse. The purpose of this study was to determine the reliability and safety of MEP monitoring in a group of children younger than 3 years of age undergoing neurosurgical spine procedures.
  
  
  METHODS
  A total of 10 consecutive spinal procedures in 10 children younger than 3 years of age (range 5-31 months, mean 16.8 months) were analyzed between January 1, 2008, and May 1, 2010. Motor evoked potentials were elicited by transcranial electric stimulation. A standardized anesthesia protocol for monitoring consisted of a titrated propofol drip combined with bolus dosing of fentanyl or sufentanil.
  
  
  RESULTS
  Motor evoked potentials were documented at the beginning and end of the procedure in all 10 patients. A mean baseline stimulation threshold of 533 ± 124 V (range 321-746 V) was used. Six patients maintained MEP signals ≥ 50% of baseline amplitude throughout the surgery. There was a greater than 50% decrease in intraoperative MEP amplitude in at least 1 extremity in 4 patients. Two of these patients returned to baseline status by the end of the case. Two patients had a persistent decrement or variability in MEP signals at the end of the procedure; this correlated with postoperative weakness. There were no complications related to the technique of monitoring MEPs.
  
  
  CONCLUSIONS
  A transcranial electric stimulation protocol monitoring corticospinal motor pathways during neurosurgical procedures in children younger than 3 years of age was reliably and safely implemented. A persistent intraoperative decrease of greater than 50% in this small series of 10 pediatric patients younger than 3 years of age predicted a postoperative neurological deficit. The authors advocate routine monitoring of MEPs in this pediatric age group undergoing neurosurgical spine procedures.
authors: Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030, USA.
authors: Daniel H
authors: DH
authors: Fulkerson
authors: Krishna B
authors: KB
authors: Satyan
authors: Lillian M
authors: LM
authors: Wilder
authors: James J
authors: JJ
authors: Riviello
authors: Stephen A
authors: SA
authors: Stayer
authors: William E
authors: WE
authors: Whitehead
authors: Daniel J
authors: DJ
authors: Curry
authors: Robert C
authors: RC
authors: Dauser
authors: Thomas G
authors: TG
authors: Luerssen
authors: Andrew
authors: A
authors: Jea
mesh_terms: D000759:Adjuvants, Anesthesia; D000768:Anesthesia, General; D002675:Child, Preschool; D004558:Electric Stimulation; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D005283:Fentanyl; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative / Q000009:adverse effects / Q000379:methods*; D019635:Neurosurgical Procedures; D011712:Pyramidal Tracts / Q000502:physiology; D012449:Safety; D013131:Spine / Q000601:surgery
chemical_list: D000759:Adjuvants, Anesthesia; D005283:Fentanyl