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Erschienen in: Child's Nervous System 2/2013

01.02.2013 | Original Paper

Neurophysiologic intraoperative monitoring in children with Down syndrome

verfasst von: Akash J. Patel, Satish Agadi, Jonathan G. Thomas, Robert J. Schmidt, Steven W. Hwang, Daniel H. Fulkerson, Chris D. Glover, Andrew Jea

Erschienen in: Child's Nervous System | Ausgabe 2/2013

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Abstract

Objective

Neurophysiological monitoring during complex spine procedures may reduce risk of injury by providing feedback to the operating surgeon. This tool is a well-established and important surgical adjunct in adults, but clinical data in children are not well described. Moreover, to the best of our knowledge, neurophysiologic intraoperative monitoring data have not been reported in children with neurodevelopmental disorders, such as Down syndrome, who commonly present with craniocervical instability requiring internal fixation. The purpose of this study is to determine the reliability and safety of neurophysiologic intraoperative monitoring in a group of children with Down syndrome undergoing neurosurgical spine procedures.

Methods

A total of six consecutive spinal procedures in six children with Down syndrome (three boys and three girls; mean age 10 years, range 4–16 years) were analyzed between January 1, 2008 and June 31, 2011. Somatosensory evoked potentials were stimulated at the ulnar nerve and tibial nerve for upper and lower extremities, respectively, and recorded at Erb’s point and the scalp. Motor evoked potentials were elicited by transcranial electrical stimulation and recorded at the extensor carpi ulnaris muscle and tibialis anterior muscle for upper and lower extremities, respectively. A standardized anesthesia protocol for monitoring consisted of a titrated propofol drip combined with bolus dosing of fentanyl or sufentanil.

Results

Somatosensory and motor evoked potentials were documented at the beginning and end of the procedure in all six patients. Changes during the surgery were recorded. Five patients maintained somatosensory potentials throughout surgery. One patient demonstrated a >10 % increase in latency or >50 % decrease in amplitude suggesting spinal cord dysfunction. A mean baseline stimulation threshold for motor evoked potentials of 485 + 85 V (range 387–600 V) was used. Four patients maintained motor evoked potentials throughout surgery. One patient had loss of left lower somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) after rod placement; upon removal of the rod, SSEPs returned but not MEPs. Another patient did not have consistent MEPs on one side and had absent MEPs on the contralateral side throughout the case. Loss of MEPs in these two patients did not correlate with postoperative neurological status. There were no complications directly related to neurophysiologic intraoperative monitoring technique.

Conclusions

Neurophysiologic intraoperative monitoring during neurosurgical procedures in children with Down syndrome may be reliably and safely implemented. Changes in neurophysiologic parameters during surgery must be carefully interpreted, and discussed with the neurosurgeon, neurophysiologist, and neuroanesthesiologist, and may not correlate with postoperative clinical changes. These changes may be related to abnormal physiology rather than an insult at the time of surgery. Nonetheless, the authors advocate routine neurophysiologic intraoperative monitoring in this special group of children undergoing neurosurgical spine procedures.
Literatur
1.
Zurück zum Zitat Ali HH, Savarese JJ, Lebowitz PW, Ramsey FM (1981) Twitch, tetanus and train-of-four as indices of recovery from nondepolarizing neuromuscular blockade. Anesthesiology 54:294–297PubMedCrossRef Ali HH, Savarese JJ, Lebowitz PW, Ramsey FM (1981) Twitch, tetanus and train-of-four as indices of recovery from nondepolarizing neuromuscular blockade. Anesthesiology 54:294–297PubMedCrossRef
2.
Zurück zum Zitat Andersson G, Ohlin A (1999) Spatial facilitation of motor evoked responses in monitoring during spinal surgery. Clin Neurophysiol 110:720–724PubMedCrossRef Andersson G, Ohlin A (1999) Spatial facilitation of motor evoked responses in monitoring during spinal surgery. Clin Neurophysiol 110:720–724PubMedCrossRef
3.
Zurück zum Zitat Balzer JR, Rose RD, Welch WC, Sclabassi RJ (1998) Simultaneous somatosensory evoked potential and electromyographic recordings during lumbosacral decompression and instrumentation. Neurosurgery 42:1318–1324, discussion 1324–1315PubMedCrossRef Balzer JR, Rose RD, Welch WC, Sclabassi RJ (1998) Simultaneous somatosensory evoked potential and electromyographic recordings during lumbosacral decompression and instrumentation. Neurosurgery 42:1318–1324, discussion 1324–1315PubMedCrossRef
4.
Zurück zum Zitat Booke JS, Banta JV, Bunke FJ, Pelletier C (1993) Somatosensory evoked potential monitoring during Cotrel-Dubousset instrumentation. Report of a case. Spine (Phila Pa 1976) 18: 518–521 Booke JS, Banta JV, Bunke FJ, Pelletier C (1993) Somatosensory evoked potential monitoring during Cotrel-Dubousset instrumentation. Report of a case. Spine (Phila Pa 1976) 18: 518–521
5.
Zurück zum Zitat Bouchard JA, Bohlman HH, Biro C (1996) Intraoperative improvements of somatosensory evoked potentials: correlation to clinical outcome in surgery for cervical spondylitic myelopathy. Spine (Phila Pa 1976) 21: 589–594 Bouchard JA, Bohlman HH, Biro C (1996) Intraoperative improvements of somatosensory evoked potentials: correlation to clinical outcome in surgery for cervical spondylitic myelopathy. Spine (Phila Pa 1976) 21: 589–594
7.
Zurück zum Zitat Chen X, Sterio D, Ming X, Para DD, Butusova M, Tong T, Beric A (2007) Success rate of motor evoked potentials for intraoperative neurophysiologic monitoring: effects of age, lesion location, and preoperative neurologic deficits. J Clin Neurophysiol 24:281–285PubMedCrossRef Chen X, Sterio D, Ming X, Para DD, Butusova M, Tong T, Beric A (2007) Success rate of motor evoked potentials for intraoperative neurophysiologic monitoring: effects of age, lesion location, and preoperative neurologic deficits. J Clin Neurophysiol 24:281–285PubMedCrossRef
8.
Zurück zum Zitat Chen Z (2004) The effects of isoflurane and propofol on intraoperative neurophysiological monitoring during spinal surgery. J Clin Monit Comput 18:303–308PubMedCrossRef Chen Z (2004) The effects of isoflurane and propofol on intraoperative neurophysiological monitoring during spinal surgery. J Clin Monit Comput 18:303–308PubMedCrossRef
9.
Zurück zum Zitat DiCindio S, Theroux M, Shah S, Miller F, Dabney K, Brislin RP, Schwartz D (2003) Multimodality monitoring of transcranial electric motor and somatosensory-evoked potentials during surgical correction of spinal deformity in patients with cerebral palsy and other neuromuscular disorders. Spine (Phila Pa 1976) 28: 1851–1855; discussion 1855–1856 DiCindio S, Theroux M, Shah S, Miller F, Dabney K, Brislin RP, Schwartz D (2003) Multimodality monitoring of transcranial electric motor and somatosensory-evoked potentials during surgical correction of spinal deformity in patients with cerebral palsy and other neuromuscular disorders. Spine (Phila Pa 1976) 28: 1851–1855; discussion 1855–1856
10.
Zurück zum Zitat Frei FJ, Ryhult SE, Duitmann E, Hasler CC, Luetschg J, Erb TO (2007) Intraoperative monitoring of motor-evoked potentials in children undergoing spinal surgery. Spine (Phila Pa 1976) 32: 911–917 Frei FJ, Ryhult SE, Duitmann E, Hasler CC, Luetschg J, Erb TO (2007) Intraoperative monitoring of motor-evoked potentials in children undergoing spinal surgery. Spine (Phila Pa 1976) 32: 911–917
11.
Zurück zum Zitat Fudickar A, Bein B (2009) Propofol infusion syndrome: update of clinical manifestation and pathophysiology. Minerva Anestesiol 75:339–344PubMed Fudickar A, Bein B (2009) Propofol infusion syndrome: update of clinical manifestation and pathophysiology. Minerva Anestesiol 75:339–344PubMed
12.
Zurück zum Zitat Fulkerson DH, Satyan KB, Wilder LM, Riviello JJ, Stayer SA, Whitehead WE, Curry DJ, Dauser RC, Luerssen TG, Jea A (2011) Intraoperative monitoring of motor evoked potentials in very young children. J Neurosurg Pediatr 7:331–337PubMedCrossRef Fulkerson DH, Satyan KB, Wilder LM, Riviello JJ, Stayer SA, Whitehead WE, Curry DJ, Dauser RC, Luerssen TG, Jea A (2011) Intraoperative monitoring of motor evoked potentials in very young children. J Neurosurg Pediatr 7:331–337PubMedCrossRef
13.
Zurück zum Zitat Ginsburg HH, Shetter AG, Raudzens PA (1985) Postoperative paraplegia with preserved intraoperative somatosensory evoked potentials. Case report. J Neurosurg 63:296–300PubMedCrossRef Ginsburg HH, Shetter AG, Raudzens PA (1985) Postoperative paraplegia with preserved intraoperative somatosensory evoked potentials. Case report. J Neurosurg 63:296–300PubMedCrossRef
14.
Zurück zum Zitat Gundanna M, Eskenazi M, Bendo J, Spivak J, Moskovich R (2003) Somatosensory evoked potential monitoring of lumbar pedicle screw placement for in situ posterior spinal fusion. Spine J 3:370–376PubMedCrossRef Gundanna M, Eskenazi M, Bendo J, Spivak J, Moskovich R (2003) Somatosensory evoked potential monitoring of lumbar pedicle screw placement for in situ posterior spinal fusion. Spine J 3:370–376PubMedCrossRef
15.
Zurück zum Zitat Hays SR, Schwengel DA (1999) Transient hypotension as a complication of monitoring transcervical motor evoked potentials. Anesthesiology 90:314–317PubMedCrossRef Hays SR, Schwengel DA (1999) Transient hypotension as a complication of monitoring transcervical motor evoked potentials. Anesthesiology 90:314–317PubMedCrossRef
16.
Zurück zum Zitat Inoue S, Kawaguchi M, Kakimoto M, Sakamoto T, Kitaguchi K, Furuya H, Morimoto T, Sakaki T (2002) Amplitudes and intrapatient variability of myogenic motor evoked potentials to transcranial electrical stimulation during ketamine/N2O- and propofol/N2O-based anesthesia. J Neurosurg Anesthesiol 14:213–217PubMedCrossRef Inoue S, Kawaguchi M, Kakimoto M, Sakamoto T, Kitaguchi K, Furuya H, Morimoto T, Sakaki T (2002) Amplitudes and intrapatient variability of myogenic motor evoked potentials to transcranial electrical stimulation during ketamine/N2O- and propofol/N2O-based anesthesia. J Neurosurg Anesthesiol 14:213–217PubMedCrossRef
17.
Zurück zum Zitat Kalkman CJ, Drummond JC, Ribberink AA (1991) Low concentrations of isoflurane abolish motor evoked responses to transcranial electrical stimulation during nitrous oxide/opioid anesthesia in humans. Anesth Analg 73:410–415PubMedCrossRef Kalkman CJ, Drummond JC, Ribberink AA (1991) Low concentrations of isoflurane abolish motor evoked responses to transcranial electrical stimulation during nitrous oxide/opioid anesthesia in humans. Anesth Analg 73:410–415PubMedCrossRef
18.
Zurück zum Zitat Kalkman CJ, Ubags LH (1997) Motor-evoked potential monitoring. Curr Opin Anesthesiol 10:327–332CrossRef Kalkman CJ, Ubags LH (1997) Motor-evoked potential monitoring. Curr Opin Anesthesiol 10:327–332CrossRef
20.
Zurück zum Zitat Kawaguchi M, Sakamoto T, Inoue S, Kakimoto M, Furuya H, Morimoto T, Sakaki T (2000) Low dose propofol as a supplement to ketamine-based anesthesia during intraoperative monitoring of motor-evoked potentials. Spine (Phila Pa 1976) 25: 974–979 Kawaguchi M, Sakamoto T, Inoue S, Kakimoto M, Furuya H, Morimoto T, Sakaki T (2000) Low dose propofol as a supplement to ketamine-based anesthesia during intraoperative monitoring of motor-evoked potentials. Spine (Phila Pa 1976) 25: 974–979
21.
Zurück zum Zitat Khan MH, Smith PN, Balzer JR, Crammond D, Welch WC, Gerszten P, Sclabassi RJ, Kang JD, Donaldson WF (2006) Intraoperative somatosensory evoked potential monitoring during cervical spine corpectomy surgery: experience with 508 cases. Spine (Phila Pa 1976) 31: E105-113 Khan MH, Smith PN, Balzer JR, Crammond D, Welch WC, Gerszten P, Sclabassi RJ, Kang JD, Donaldson WF (2006) Intraoperative somatosensory evoked potential monitoring during cervical spine corpectomy surgery: experience with 508 cases. Spine (Phila Pa 1976) 31: E105-113
22.
Zurück zum Zitat Lesser RP, Raudzens P, Luders H, Nuwer MR, Goldie WD, Morris HH 3rd, Dinner DS, Klem G, Hahn JF, Shetter AG et al (1986) Postoperative neurological deficits may occur despite unchanged intraoperative somatosensory evoked potentials. Ann Neurol 19:22–25PubMedCrossRef Lesser RP, Raudzens P, Luders H, Nuwer MR, Goldie WD, Morris HH 3rd, Dinner DS, Klem G, Hahn JF, Shetter AG et al (1986) Postoperative neurological deficits may occur despite unchanged intraoperative somatosensory evoked potentials. Ann Neurol 19:22–25PubMedCrossRef
23.
Zurück zum Zitat Lieberman JA, Lyon R, Feiner J, Diab M, Gregory GA (2006) The effect of age on motor evoked potentials in children under propofol/isoflurane anesthesia. Anesth Analg 103:316–321, table of contentsPubMedCrossRef Lieberman JA, Lyon R, Feiner J, Diab M, Gregory GA (2006) The effect of age on motor evoked potentials in children under propofol/isoflurane anesthesia. Anesth Analg 103:316–321, table of contentsPubMedCrossRef
24.
Zurück zum Zitat MacDonald DB (2002) Safety of intraoperative transcranial electrical stimulation motor evoked potential monitoring. J Clin Neurophysiol 19:416–429PubMedCrossRef MacDonald DB (2002) Safety of intraoperative transcranial electrical stimulation motor evoked potential monitoring. J Clin Neurophysiol 19:416–429PubMedCrossRef
25.
Zurück zum Zitat Mahmoud M, Spaeth J, Sadhasivam S (2008) Protection of tongue from injuries during transcranial motor-evoked potential monitoring. Paediatr Anaesth 18:902–903PubMedCrossRef Mahmoud M, Spaeth J, Sadhasivam S (2008) Protection of tongue from injuries during transcranial motor-evoked potential monitoring. Paediatr Anaesth 18:902–903PubMedCrossRef
26.
Zurück zum Zitat Nash CL Jr, Brown RH (1989) Spinal cord monitoring. J Bone Joint Surg Am 71:627–630PubMed Nash CL Jr, Brown RH (1989) Spinal cord monitoring. J Bone Joint Surg Am 71:627–630PubMed
27.
Zurück zum Zitat Nathan N, Tabaraud F, Lacroix F, Moulies D, Viviand X, Lansade A, Terrier G, Feiss P (2003) Influence of propofol concentrations on multipulse transcranial motor evoked potentials. Br J Anaesth 91:493–497PubMedCrossRef Nathan N, Tabaraud F, Lacroix F, Moulies D, Viviand X, Lansade A, Terrier G, Feiss P (2003) Influence of propofol concentrations on multipulse transcranial motor evoked potentials. Br J Anaesth 91:493–497PubMedCrossRef
28.
Zurück zum Zitat Nezu A, Kimura S, Uehara S, Kobayashi T, Tanaka M, Saito K (1997) Magnetic stimulation of motor cortex in children: maturity of corticospinal pathway and problem of clinical application. Brain Dev 19:176–180PubMedCrossRef Nezu A, Kimura S, Uehara S, Kobayashi T, Tanaka M, Saito K (1997) Magnetic stimulation of motor cortex in children: maturity of corticospinal pathway and problem of clinical application. Brain Dev 19:176–180PubMedCrossRef
29.
Zurück zum Zitat Parikh SN, Mehlman CT, Keith RW (2003) A third-degree burn caused by a neurogenic motor-evoked potential monitoring electrode during spinal surgery: a case report. Spine (Phila Pa 1976) 28: E21-24 Parikh SN, Mehlman CT, Keith RW (2003) A third-degree burn caused by a neurogenic motor-evoked potential monitoring electrode during spinal surgery: a case report. Spine (Phila Pa 1976) 28: E21-24
30.
Zurück zum Zitat Pelosi L, Stevenson M, Hobbs GJ, Jardine A, Webb JK (2001) Intraoperative motor evoked potentials to transcranial electrical stimulation during two anaesthetic regimens. Clin Neurophysiol 112:1076–1087PubMedCrossRef Pelosi L, Stevenson M, Hobbs GJ, Jardine A, Webb JK (2001) Intraoperative motor evoked potentials to transcranial electrical stimulation during two anaesthetic regimens. Clin Neurophysiol 112:1076–1087PubMedCrossRef
31.
Zurück zum Zitat Sala F, Krzan MJ, Deletis V (2002) Intraoperative neurophysiological monitoring in pediatric neurosurgery: why, when, how? Childs Nerv Syst 18:264–287PubMed Sala F, Krzan MJ, Deletis V (2002) Intraoperative neurophysiological monitoring in pediatric neurosurgery: why, when, how? Childs Nerv Syst 18:264–287PubMed
32.
Zurück zum Zitat Scheufler KM, Zentner J (2002) Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data. J Neurosurg 96:571–579PubMedCrossRef Scheufler KM, Zentner J (2002) Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data. J Neurosurg 96:571–579PubMedCrossRef
33.
Zurück zum Zitat Sloan T (2010) Anesthesia and intraoperative neurophysiological monitoring in children. Childs Nerv Syst 26:227–235 Sloan T (2010) Anesthesia and intraoperative neurophysiological monitoring in children. Childs Nerv Syst 26:227–235
34.
Zurück zum Zitat Sloan TB, Heyer EJ (2002) Anesthesia for intraoperative neurophysiologic monitoring of the spinal cord. J Clin Neurophysiol 19:430–443PubMedCrossRef Sloan TB, Heyer EJ (2002) Anesthesia for intraoperative neurophysiologic monitoring of the spinal cord. J Clin Neurophysiol 19:430–443PubMedCrossRef
35.
Zurück zum Zitat Szalay EA, Carollo JJ, Roach JW (1986) Sensitivity of spinal cord monitoring to intraoperative events. J Pediatr Orthop 6:437–441PubMedCrossRef Szalay EA, Carollo JJ, Roach JW (1986) Sensitivity of spinal cord monitoring to intraoperative events. J Pediatr Orthop 6:437–441PubMedCrossRef
36.
Zurück zum Zitat Ubags LH, Kalkman CJ, Been HD, Drummond JC (1997) Differential effects of nitrous oxide and propofol on myogenic transcranial motor evoked responses during sufentanil anaesthesia. Br J Anaesth 79:590–594PubMedCrossRef Ubags LH, Kalkman CJ, Been HD, Drummond JC (1997) Differential effects of nitrous oxide and propofol on myogenic transcranial motor evoked responses during sufentanil anaesthesia. Br J Anaesth 79:590–594PubMedCrossRef
37.
Zurück zum Zitat Ubags LH, Kalkman CJ, Been HD (1998) Influence of isoflurane on myogenic motor evoked potentials to single and multiple transcranial stimuli during nitrous oxide/opioid anesthesia. Neurosurgery 43:90–94, discussion 94–95PubMedCrossRef Ubags LH, Kalkman CJ, Been HD (1998) Influence of isoflurane on myogenic motor evoked potentials to single and multiple transcranial stimuli during nitrous oxide/opioid anesthesia. Neurosurgery 43:90–94, discussion 94–95PubMedCrossRef
38.
Zurück zum Zitat van Dongen EP, ter Beek HT, Schepens MA, Morshuis WJ, de Boer A, Aarts LP, Boezeman EH (1999) Effect of nitrous oxide on myogenic motor potentials evoked by a six pulse train of transcranial electrical stimuli: a possible monitor for aortic surgery. Br J Anaesth 82:323–328PubMedCrossRef van Dongen EP, ter Beek HT, Schepens MA, Morshuis WJ, de Boer A, Aarts LP, Boezeman EH (1999) Effect of nitrous oxide on myogenic motor potentials evoked by a six pulse train of transcranial electrical stimuli: a possible monitor for aortic surgery. Br J Anaesth 82:323–328PubMedCrossRef
39.
Zurück zum Zitat van Dongen EP, ter Beek HT, Schepens MA, Morshuis WJ, Langemeijer HJ, Kalkman CJ, Boezeman EH (1999) The influence of nitrous oxide to supplement fentanyl/low-dose propofol anesthesia on transcranial myogenic motor-evoked potentials during thoracic aortic surgery. J Cardiothorac Vasc Anesth 13:30–34PubMedCrossRef van Dongen EP, ter Beek HT, Schepens MA, Morshuis WJ, Langemeijer HJ, Kalkman CJ, Boezeman EH (1999) The influence of nitrous oxide to supplement fentanyl/low-dose propofol anesthesia on transcranial myogenic motor-evoked potentials during thoracic aortic surgery. J Cardiothorac Vasc Anesth 13:30–34PubMedCrossRef
40.
Zurück zum Zitat van Dongen EP, ter Beek HT, Aarts LP, Schepens MA, Morshuis WJ, Benning FJ, de Boer A, Boezeman EH (2000) The effect of two low-dose propofol infusions on the relationship between six-pulse transcranial electrical stimulation and the evoked lower extremity muscle response. Acta Anaesthesiol Scand 44:799–803PubMedCrossRef van Dongen EP, ter Beek HT, Aarts LP, Schepens MA, Morshuis WJ, Benning FJ, de Boer A, Boezeman EH (2000) The effect of two low-dose propofol infusions on the relationship between six-pulse transcranial electrical stimulation and the evoked lower extremity muscle response. Acta Anaesthesiol Scand 44:799–803PubMedCrossRef
41.
Zurück zum Zitat Wilson-Holden TJ, Padberg AM, Lenke LG, Larson BJ, Bridwell KH, Bassett GS (1999) Efficacy of intraoperative monitoring for pediatric patients with spinal cord pathology undergoing spinal deformity surgery. Spine (Phila Pa 1976) 24: 1685–1692 Wilson-Holden TJ, Padberg AM, Lenke LG, Larson BJ, Bridwell KH, Bassett GS (1999) Efficacy of intraoperative monitoring for pediatric patients with spinal cord pathology undergoing spinal deformity surgery. Spine (Phila Pa 1976) 24: 1685–1692
Metadaten
Titel
Neurophysiologic intraoperative monitoring in children with Down syndrome
verfasst von
Akash J. Patel
Satish Agadi
Jonathan G. Thomas
Robert J. Schmidt
Steven W. Hwang
Daniel H. Fulkerson
Chris D. Glover
Andrew Jea
Publikationsdatum
01.02.2013
Verlag
Springer-Verlag
Erschienen in
Child's Nervous System / Ausgabe 2/2013
Print ISSN: 0256-7040
Elektronische ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-012-1918-2

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