엉치뼈 척삭종의 수술후 방광기능에 대한 수술중 구해면체근반사 감시의 유용성

Abstract

Sacral chordoma is at risk for postoperative wound infection, massive bleeding, lumbosacral instability and bladder and bowel dysfunction. The neurophysiologic changes of intraoperative bulbocavernosus reflex (BCR) monitoring reflect a damage to the bladder function. A 52-year-old woman visited neurosurgery clinic with severe sacral pain. Other than the sensation of residual urine, there were no neurological abnormalities. Spine magnetic resonance imaging demonstrated a 39 mm-sized chordoma in S4-5. Surgical removal of the tumor at S2-4 sacral and coccyx level was done under intraoperative neurophysiological monitoring including BCR. The baseline BCR was successfully recorded bilaterally. However, bilateral BCR was disappeared during tumor removal and never recovered at the end of the surgery. Urinary retention occurred after surgery and urodynamic study revealed the evidences of neurogenic bladder. Also, she had timed suppository for constipation. The intraoperative BCR monitoring may be a useful tool to predict postoperative bladder function in patients with sacral chordoma.