title: Intraoperative neurophysiologic monitoring during syringomyelia surgery: lessons from a series of 13 patients.
abstract: BACKGROUND
  Avoiding iatrogenic neurological injury during spinal cord surgery is crucially important. Intraoperative neurological monitoring (INM) has been widely used in a variety of spinal surgeries as a means of reducing the risk of intraoperative neurological insults. This study evaluates the benefits of INM specifically in spinal procedures for treatment of syringomyelia.
  
  
  METHODS
  Thirteen patients who underwent surgery for syrinx drainage with the assistance of INM were included in this study. In all patients both somatosensory-evoked potentials (SSEP) and motor-evoked potentials (MEP) were monitored. INM data and perioperative neurological evaluations were both recorded and analyzed.
  
  
  RESULTS
  Eleven patients underwent syringo-subarachnoid shunt (SSAS) surgery. One patient underwent syrinx drainage and foramen magnum decompression (FMD). One patient underwent syringo-pleural shunt (SPA) surgery. Baseline MEP and SSEP were recordable at the beginning of surgery in 11 patients (>84 %). In the other two cases, baseline data from specific INM modalities were absent, correlating with the antecedent neurologic symptomotology. Two patients exhibited significant intraoperative changes in MEP data that influenced the course of surgery and prompted removal or re-insertion of the shunt. Mild and transient worsening of preoperative symptoms was reported in these instances. No new postoperative neurological deficits were reported in the other 11 patients in whom INM data were preserved throughout surgery.
  
  
  CONCLUSIONS
  These data support routine use of INM in syringomyelia surgery. INM can alert the surgeon to potential intraoperative threats to the functional integrity of the spinal cord, providing a useful adjunct to spinal cord surgeries for the treatment of syringomyelia.
authors.affiliation: Department of Pediatric Neurosurgery, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Niv
authors.initials: N
authors.lastname: Pencovich
authors.forename: Akiva
authors.initials: A
authors.lastname: Korn
authors.forename: Shlomi
authors.initials: S
authors.lastname: Constantini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D005539:Foramen Magnum / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D019635:Neurosurgical Procedures; D013595:Syringomyelia / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult