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Child's Nervous System

, Volume 35, Issue 10, pp 1769–1776 | Cite as

Intraoperative neurophysiological monitoring in paediatric Chiari surgery—help or hindrance?

  • Fahid T. Rasul
  • Samir A. Matloob
  • Nikolaos Haliasos
  • Ivana Jankovic
  • Stewart Boyd
  • Dominic N. P. ThompsonEmail author
Special Annual Issue

Abstract

Introduction

The role of intraoperative neurophysiological monitoring (IONM) during surgery for Chiari I malformation has not been fully elucidated. Questions remain regarding its utility as an adjunct to foramen magnum decompression surgery, specifically, does IONM improve the safety profile of foramen magnum decompression surgery and can IONM parameters help in intraoperative surgical decision-making. This study aimed to describe a single institution experience of IOM during paediatric Chiari I surgery.

Methods

The methodology comprised a retrospective review of prospectively collected electronic neurosurgical departmental operative database. Inclusion criteria were children under 16 years of age who had undergone foramen magnum decompression for Chiari I malformation with IONM. In addition to basic demographic data, details pertaining to presenting features and post-operative outcomes were obtained. These included primary symptoms of Chiari I malformation and indications for surgery. MRI findings, including the presence of syringomyelia on pre-and post-operative imaging, were reviewed. Details of the surgical technique for each patient were recorded. Only patients with either serial brainstem auditory evoked potential (BAEP) and/or upper limb somatosensory evoked potential (SSEP) recordings were included. Two time points were used for the purposes of analysing IONM data; initial baseline before skin incision and final at the time of skin closure.

Results

Thirty-seven children underwent foramen magnum decompression (FMD) with IONM. Mean age was 10.5 years (range 1–16 years) with a male:female ratio 13:24. The commonest clinical features on presentation included headaches (15) and scoliosis (13). Twenty-four patients had evidence of associated syringomyelia (24/37 = 64.9%). A reduction in the SSEP latency was observed in all patients. SSEP amplitude was more variable, with a decrease seen in 18 patients and an increase observed in 12 patients. BAEP recordings decreased in 13 patients and increased in 4 patients. There were no adverse neurological events following surgery; the primary symptom was resolved or improved in all patients at 3-month follow-up. Resolution or improvement in syringomyelia was observed in 19/24 cases.

Conclusions

Our data shows that FMD for Chiari malformation (CM) is associated with changes in SSEPs and BAEPs. However, we did not identify a definite link between clinical outcomes and IONM, nor did syrinx outcome correlate with IONM. There may be a role for IONM in CM surgery but more robust data with better-defined parameters are required to further understand the impact of IONM in CM surgery.

Keywords

Chiari Neurophysiology Intraoperative monitoring Foramen magnum decompression 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was registered as a Service Evaluation study with the Great Ormond Street Hospital for Children NHS Foundation Trust.

Informed consent

Informed consent was not sought, as this was a retrospective study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Fahid T. Rasul
    • 1
  • Samir A. Matloob
    • 1
  • Nikolaos Haliasos
    • 2
  • Ivana Jankovic
    • 3
  • Stewart Boyd
    • 3
  • Dominic N. P. Thompson
    • 4
    Email author
  1. 1.Department of Paediatric NeurosurgeryGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
  2. 2.Department of NeurosurgeryQueens HospitalRomfordUK
  3. 3.Department of NeurophysiologyGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
  4. 4.Consultant Paediatric NeurosurgeonGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK

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