Neurophysiological Monitoring During Large Femoral and Pelvic Tumoral Resections

Susana Martín-Albarrán,Camilla Arvinius,Roberto Garcia-Maroto,Elena Manrique-Gamo,Juan-Luis Cebrian,Hector Marcelo

doi:10.31487/j.jscr.2020.01.02

Abstract

Background: Oncological femoral or pelvic resections and reconstruction have become an alternative to large amputations. However, one of the frequent risks is the neurological injury. The use of intraoperative evoked potentials allows its control in order to modify the surgical gestures. The purpose of this study was to evaluate the results of intraoperative neurophysiologic monitoring in large reconstructive arthroplasty surgeries. Case presentation: A prospective study (2012-2018) was performed, including 8 patients with 6 complete resections of the femur and 2 resections of the pelvis. In all cases, intraoperative lumbar plexus monitoring was performed using evoked potentials in order to analyze variations during surgery as well as a postoperative control. 100% could be correctly monitored throughout the surgery. In 4 cases, intraoperative anomalies were detected requiring modification of the surgery. Of these, postoperatively only one nerve injury persisted: a complete sciatic nerve injury due to an intraoperative vascular injury. Conclusion: Intraoperative neurophysiological monitoring is a very useful resource in large oncological resection, allowing detection of nerve distress due to manipulation or excessive limb traction during reconstruction. The use of somatosensory evoked potentials in large oncological resections can predict and minimize the risk of relevant postoperative nerve complications

Highlights

Oncological femoral or pelvic resections and reconstruction have become an alternative to large amputations
Peripheral nerve injury is a serious complication after prosthetic hip surgery, its incidence is low in primary hip arthroplasty, 0.2-0.3%, while it raises to 2.9-7.6% in revision surgery [1,2,3,4]
In order to monitor the superficial peroneal nerve electrodes were placed on peroneus longus muscle (PE), for the deep peroneal nerve they were placed on the tibialis anterior muscle (TA) and in order to monitor the lateral and medial branch of the tibial nerves they were placed on abductor hallucis (AH) and lateral gastrocnemius (GE) respectively

Summary

Background

Peripheral nerve injury is a serious complication after prosthetic hip surgery, its incidence is low in primary hip arthroplasty, 0.2-0.3%, while it raises to 2.9-7.6% in revision surgery [1,2,3,4]. There is no literature to be found concerning peripheral nerve lesions in pelvic or femoral reconstructive surgery after large tumoral resections In these surgeries there are multiple factors that can cause peripheral nerve damage. Large pelvic and femoral resection and its reconstruction with megaprosthesis implies a high incidence of postoperative dislocation, but the excessive elongation of the lower limb may cause postoperative nerve injuries. The aim of our study was to evaluate the results of intraoperative neurophysiologic monitoring in pelvic reconstruction arthroplasty surgeries after large tumoral resections in order to establish a possible benefit of its systematic use in these surgeries. A prospective study was performed between 2012 and 2017 in our center including 8 patients with pelvic reconstructive arthroplasty after large tumoral resections in which intraoperative neurophysiologic monitoring was carried out. The demographic data such as age, type of tumor and arthroplasty used are presented in (Table 1)

Procedure

SSEP femoral nerve

Findings

Conclusion