Magnetic stimulation for monitoring of motor pathways in spinal procedures

Transcranial magnetic stimulation was used for intraoperative motor evoked potential monitoring during surgery of intramedullar, extramedullar, and extradural spinal tumors in 13 patients. Anesthesia was based on etomidate. Magnetic stimulation for motor evoked potential monitoring was successful in...

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Bibliographic Details
Published in:Spine (Philadelphia, Pa. 1976) Pa. 1976), 1993-04, Vol.18 (5), p.551-559
Main Authors: HERDMANN, J, LUMENTA, C. B, HUSE, K. O. W
Format: Article
Language:English
Subjects:
Adult
Aged
Anesthesia, Spinal
Biological and medical sciences
Cauda Equina - physiology
Etomidate
Evoked Potentials
Female
Fentanyl
Humans
Magnetics
Male
Medical sciences
Middle Aged
Monitoring, Intraoperative
Muscles - physiology
Neurology
Physical Stimulation
Radiography
Spinal Neoplasms - diagnostic imaging
Spinal Neoplasms - surgery
Tumors of the nervous system. Phacomatoses
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Summary:Transcranial magnetic stimulation was used for intraoperative motor evoked potential monitoring during surgery of intramedullar, extramedullar, and extradural spinal tumors in 13 patients. Anesthesia was based on etomidate. Magnetic stimulation for motor evoked potential monitoring was successful in 10 of 13 patients, 12 of whom were neurologically impaired. Motor evoked potentials were recorded from limb muscles or from the fibers of the cauda equina. Amplitudes of baseline recordings (the initial recording obtained after induction of anesthesia) were decreased by 64 +/- 34% (mean +/- SD) and baseline latencies were increased by 7 +/- 8% compared with the preoperative recordings. Subsequent recordings were analyzed for amplitude and latency changes in comparison to baseline. Amplitude changes exceeding 50% and latency changes higher than 3 ms compared with the baseline correctly indicated an impending lesion of motor pathways with increased paresis postoperatively. In cases where motor evoked potential monitoring was successful prediction of short-term postoperative motor outcome was always correct. There were no "false-negatives" or "false-positives."
ISSN:0362-2436
1528-1159
DOI:10.1097/00007632-199304000-00006