경두개 전기자극을 이용한 경추 수술 중 횡격막 신경의 감시: 증례 보고

Abstract

To prevent phrenic nerve injuries during surgery, intraoperative monitoring has been used increasingly. Intraoperative monitoring comprises stimulation of phrenic nerves in the neck and getting compound motor action potential (CMAP) in the diaphragm. However, in high cervical lesions or in surgeries that need particular positions such as a prone position, the usage could be limited due to a difficulty in stimulating the phrenic nerve directly. To solve these problems, we tried motor evoked potential (MEP) via transcranial electrical stimulation to a diaphragm during cervical tumor resection. The monitoring revealed relatively constant MEP graphs of the diaphragm during the monitoring, and we did not notice any decrement of more than 50% in the amplitude. Sequentially, the patient recovered without any weakness or remarkable respiration rate changes which could suggest any phrenic nerve injuries. Our case supports that intraoperative MEP monitoring to diaphragm could be feasible in cases with difficulty in stimulating the phrenic nerve directly.