Spinal Tumor
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INTRADURAL VS EXTRADURAL
INTRADURAL
Intramedullary
MEP, SEP, EMG, MAP Dorsal Column midline before myelotomy, using antidromic NCV technique, defines limits of safe resection
Extramedullary
If below the termination of spinal cord, primary modality for monitoring is EMG, cord terminates at approximately T12, so EMG only is used
INTRADURAL
- penetration to access the spinal cord within the intradural space
- requires microscope
- sensitive approach requires patient to be very still; no tcmep stimulation during the procedure
- the surgeon could request the activation of stimulation
- less sensitive than intradural because it does not require accessing the intradural space
- requires microscope
- the surgeon may enlist stimulation
- how to set up a stimulation window
- rules of stimulation
- monitoring of specific muscle groups for anticipated purpose of stimulation
- recommended to slowly increase stimulus from zero until observed emg activation
- always follow the direction of the surgeon
Intramedullary
MEP, SEP, EMG, MAP Dorsal Column midline before myelotomy, using antidromic NCV technique, defines limits of safe resection
Extramedullary
If below the termination of spinal cord, primary modality for monitoring is EMG, cord terminates at approximately T12, so EMG only is used