title: Neurophysiology of complex spinal cord untethering.
abstract: Surgery of complex spinal dysraphisms can be challenging. A number of surgical maneuvers can place the conus and the cauda equina at risk for neurological injury during cord untethering, and the identification of functional neural structures within the lumbosacral region is often not possible solely on the basis of anatomy. Therefore, the assistance of intraoperative neurophysiological monitoring can be invaluable during these procedures. We describe the intraoperative neurophysiological monitoring strategy developed at our institution over the past 12 years when dealing with tethered cord surgery. Monitoring and mapping techniques are described, with a focus on the invaluable role played by neurophysiological mapping. This latter, for a neurosurgeon, impacts tethered cord surgery at least as strongly as neurophysiological monitoring. Our results suggest that the combination of monitoring and mapping techniques increases the safety of these procedures, minimizing long-term morbidity and improving the degree of cord untethering.
authors.affiliation: *Section of Neurosurgery, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy; and Divisions of †Neurology and ‡Neurosurgery Department of Neurosciences, University Hospital, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sala
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tramontano
authors.forename: Giovanna
authors.initials: G
authors.lastname: Squintani
authors.forename: Chiara
authors.initials: C
authors.lastname: Arcaro
authors.forename: Ema
authors.initials: E
authors.lastname: Tot
authors.forename: Giampietro
authors.initials: G
authors.lastname: Pinna
authors.forename: Mario
authors.initials: M
authors.lastname: Meglio
mesh_terms: D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods*; D009482:Neurophysiology; D019635:Neurosurgical Procedures / Q000379:methods*; D016135:Spinal Dysraphism / Q000503:physiopathology / Q000601:surgery*