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Intraoperative transabdominal MEPs: four case reports.

David W Allison1, Miranda K Hayworth2, Remi Nader2

  • 1Department of Neurophysiology, Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA. ionmmonitoring@gmail.com.

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|August 23, 2022
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Summary

Transabdominal motor-evoked potentials (TaMEPs) show promise for monitoring nerve function during spinal surgeries. These case studies illustrate TaMEPs utility in various complex procedures, highlighting its potential as a valuable neurophysiological tool.

Keywords:
IONMLumbosacralTaMEPTcMEPTransabdominal motor evoked potential

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Area of Science:

  • Neurosurgery
  • Neurophysiology
  • Spinal Surgery

Background:

  • Motor-evoked potentials (MEPs) are crucial for intraoperative neurophysiological monitoring.
  • Transcranial MEPs (TcMEPs) are widely used, but transabdominal MEPs (TaMEPs) offer an alternative for specific spinal applications.

Observation:

  • Four cases demonstrate TaMEPs during lumbosacral fusion, sciatic nerve tumor resection, cauda equina tumor resection, and lumbar decompression.
  • TaMEPs were compared with TcMEPs in two cases, showing correlation and potentially better reflection of patient outcomes.
  • TaMEPs were successfully acquired using novel techniques and anesthetic regimens in complex spinal surgeries.

Findings:

  • TaMEPs detected nerve root decompression during spinal fusion, correlating with TcMEPs.
  • In sciatic nerve tumor resection, TaMEPs remained stable while TcMEPs were lost, aligning with a positive patient outcome.
  • TaMEPs were successfully acquired during cauda equina and lumbar decompression surgeries, demonstrating technical feasibility.

Implications:

  • TaMEPs represent a viable neurophysiological monitoring technique for a range of spinal surgeries.
  • Further research is needed to establish the definitive utility and accuracy of TaMEPs in cauda equina and decompression surgeries.
  • TaMEPs may offer complementary or alternative monitoring options to TcMEPs in select spinal neurosurgical procedures.