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Objective To explore the significance of combining applications of multi-mode electrophysiological monitoring in microsurgical resection of spinal tumors of lumbar and sacral segments.Methods A retrospective analysis of 31 patients with spinal tumors of lumbar and sacral segments accepted microsurgical resection in our hospital from December 2016 to June 2017 was performed.All tumors were located in the T12 spinal canal or lower.Multi-mode electrophysiological monitoring techniques were applied during operation:motor evoked potential (MEP) and somatosensory evoked potential (SEP) of double lower limbs,bulbocavernosus sphincter reflex (BCR),electromyogram (EMG).Spinal functions of the patients were assessed by Japanese orthopaedic association (JOA) before and after surgery.Results Total resection was achieved in 28 patients,subtotal resection in 3.There were 29 patients reaching electrophysiological warning criteria during the operation,including 27 with transient changes and 2 with permanent changes.The improvement rate of JOA score included 4 cases of cure,20 cases of obvious effect,5 cases of effectiveness and 2 cases of inefficiency after follow up 6 months to 1 year.Conclusion It is of significance of multi-mode electrophysiological monitoring techniques being used in microsurgical resection of spinal tumors of lumbar and sacral segments to protect the motor and sensory functions,bowel and bladder functions and sexual function.
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Objective To explore the changes of bulbocavemosus sphincter reflex (BCR) in male rabbit models of spinal cord ischemia injury of different levels at acute stage and their values in predicting spinal cord functions,and provide theoretical basis for protecting the spinal cord function by neurophysiology examination in clinical microsurgical operation.Methods Thirty-six adult New Zealand rabbits were randomly divided into 6 groups:a control group (n=6) was used to eliminate the effects of anesthesia and surgery on BCR;rabbits in the experimental group (n=30) were randomly divided into 5 groups (n=6) according to different levels of lumbar arteries being ligatured between the left renal artery and arterial bifurcate (subgroups of one,two,three,4 and 5 lumbar arteries being ligatured).BCR was recorded continuously within two h of ligation;rabbits in each group were subjected to double-blind Tarlov lower limb motor function scale before and 2 d after surgery;and ischemic spinal cord specimens were performed hematoxylin and eosin (HE) staining to observe pathological changes in sacral spinal cord ischemic areas after 2 days.Results There was no significant difference in BCR amplitude and latency between different time points after anesthesia (P＞0.05);there was no significant difference in BCR amplitude and latency between different time points before and after operation (P＞0.05).There was no significant change in the amplitude of BCR before and after one lumbar artery ligation;however,the BCR amplitude immediately changed after ligaturing two,three,4 or 5 lumbar arteries:the latency of BCR immediately began to extend and amplitude immediately began to reduce;amplitude was stable respectively after (0.7±0.4),(0.7±0.3),(0.7±0.3) and (0.6±0.3) min of ligation.The amplitude variation of BCR was positively correlated with Tarlov lower limb motor function scale scores 2 days after ligation (r=0.791,P=0.0001).HE staining showed that the normal sacral spinal cord structure was observed in the control group,subgroups of one and two lumbar arteries being ligatured;the basically normal sacral spinal cord structure was observed in the subgroup of three lumbar arteries being ligatured;the normal sacral spinal cord structure basically disappeared in the subgroup of 5 lumbar arteries being ligatured;the spinal cord injury of subgroup of 4 lumbar arteries being ligatured was between that of subgroup of three lumbar arteries being ligatured and subgroup of 5 lumbar arteries being ligatured.Conclusion The amplitude and latency of BCR in male rabbits are sensitive to sacral cord ischemic injury,which can help find ischemic injury in the reversible phase of the sacral cord ischemia and provide theoretical basis for the prevention of occurrence of male irreversible sacral spinal cord injury during microsurgery.
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Objective To investigate the value of electromagnetic navigation in microsurgical resection of intracranial cavernous hemangioma of different locations.Methods The microsurgical resection of intracranial cavernous hemangioma of different locations with the guide of electromagnetic navigation of COMPASS Cygnus system,There were 47 cavernous hemangioma of 43 patients,including of multiple cavernous hemangioma of 3 cases,one case had 3,the other 2 cases had 2 ; Including 25 deep in the cerebral cortex(including of 4 deep in the cerebellar cortex),twenty shallow in the cerebral cortex,two were in the orbital apex,including of 4 deep in the sensorimotor cortex,four deep in the language center,and 2 deep in the visual center.Results All 47 cavernous hemangioma of 43 patients,the accuracy was 100％.The resection rate was 100％,including of 16 patients were removed with a straight incision.There was no one with the neurological dysfunction worse postoperative,with no deaths,with 1 case of normal perfusion pressure breakthrough and was cured by conservative treatment.Thirty cases were discharged within 1 week.The blood loss of 30 cases was less than 50 ml.The average registration error of navigation was 1.6 ± 0.4 mm.Conclusion The surgical incision and surgical approach can been designed with the help of electromagnetic navigation system before operation,and can accurately resect the lesions simultaneously avoid brain function area,protect the normal brain tissue,reduce postoperative complications,with the help of the electromagnetic navigation system intraoperative in real time.It is suitable for minimally invasive surgery for intracranial cavernous hemangioma.