Abstract
Bol’shaya Sukharevskaya Sq., Moscow 129090, RussiaThe study objective is to describe the clinical case of intraoperative neurophysiologic monitoring (IONM) using the electromyography-triggered stimulation during the thoracoscopic removal of an extradural Th2–Th3level tumor.Materials and methods. The case describes the removal of the right Th2–Th3pleural cavity paravertebral tumor that has compressed the phrenic nerve. The patient underwent thoracoscopic surgery supported by IONM. An electromyography-triggered stimulation with a monopolar stimulator that was inserted through the thoracoscopic access into the thoracic cavity under video control identified the phrenic nerve. Results. The thoracoscopy in combination with electromyography-triggered stimulation allowed to avoid open surgery. The use of traditional IONM for spinal surgery would not identify the diaphragmatic nerve and prevent its unintentional damage.Conclusion. IONM scenarios can be successfully enhanced with a electromyography-triggered stimulation of the phrenic nerve. Adhesive disposable electrodes for muscle response recording and stimulus return are useful without any deterioration of informativity.
Highlights
The study objective is to describe the clinical case of intraoperative neurophysiologic monitoring (IONM) using the electromyography-triggered stimulation during the thoracoscopic removal of an extradural Th2–Th3 level tumor
The case describes the removal of the right Th2–Th3 pleural cavity paravertebral tumor that has compressed the phrenic nerve
An electromyography-triggered stimulation with a monopolar stimulator that was inserted through the thoracoscopic access into the thoracic cavity under video control identified the phrenic nerve
Summary
Интраоперационный нейрофизиологический мониторинг при удалении опухоли позвоночника с паравертебральным распространением (случай из практики). Цель исследования – представить клиническое наблюдение успешного применения стимуляционной электромиографии для нейрофизиологического мониторинга во время удаления экстрадуральной опухоли на уровне позвонков Th2–Th3. Использование традиционного нейрофизиологического мониторинга для операций на позвоночнике не позволило бы идентифицировать диафрагмальный нерв, а значит, предотвратить его непреднамеренное повреждение. Нейрофизиологический мониторинг при операциях на грудном отделе позвоночника, выполняемых через торакоскопический доступ, может быть успешно дополнен стимуляционной электромиографией. Ю. Интраоперационный нейрофизиологический мониторинг при удалении опухоли позвоночника с паравертебральным распространением (случай из практики). The study objective is to describe the clinical case of intraoperative neurophysiologic monitoring (IONM) using the electromyography-triggered stimulation during the thoracoscopic removal of an extradural Th2–Th3 level tumor. IONM scenarios can be successfully enhanced with a electromyography-triggered stimulation of the phrenic nerve.
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