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False negative intraoperative somatosensory evoked potentials with simultaneous bilateral stimulation
Clinical EEG (Electroencephalography)
|January 1, 1986
Summary
Spinal cord surgery for filum terminale lipoma caused temporary SSEP loss. Postoperative leg deficits highlight the need for independent nerve stimulation to prevent false negative intraoperative somatosensory evoked potential results.
Area of Science:
- Neurosurgery
- Neurology
- Spinal Cord Monitoring
Background:
- Filum terminale lipomas are congenital tumors requiring surgical removal.
- Intraoperative monitoring using somatosensory evoked potentials (SSEP) is crucial for preserving neurological function during spinal cord surgery.
Observation:
- A 43-year-old male patient experienced a transient loss of SSEP response during simultaneous bilateral posterior tibial nerve (PTN) stimulation.
- This SSEP monitoring abnormality resolved within 20 minutes.
- Postoperatively, the patient developed right leg paralysis and impaired proprioception.
Findings:
- Postoperative SSEP recordings showed an abnormal response to right PTN stimulation but a normal response to bilateral PTN stimulation.
- The initial transient intraoperative SSEP loss did not accurately predict the postoperative neurological deficit.
Implications:
- Simultaneous bilateral nerve stimulation may lead to false-negative SSEP results, masking true neurological compromise.
- Independent, alternating stimulation of each posterior tibial nerve is recommended for more reliable intraoperative SSEP monitoring during spinal cord surgery.
- This approach can help prevent potentially devastating postoperative neurological deficits.