Management Of Spinal Tumors

decline in D-wave amplitude or its loss is associated with a long-term severe motor deficit [9].

The short-term neurological morbidity of intramedullary tumor surgery is about 30%. The combined use of epidural and muscle MEP recording has been shown to intraoperatively detect all post-operative motor deficits [8]. Most importantly, the combination of epidural and muscle MEPs allows for the neurophysiological identification of a reversible motor deficit. Thus, MEPs are giving information about injury to the motor system before this injury results in permanent, irreversible neurological deficit.

In particular, the resection of ventrally located intradural-extramedullary lesions requires some degree of spinal cord retraction. With the use of motor monitoring, this can be done safely, as the degree of retraction that is tolerated "functionally" can be assessed. This allows resection of anteriorly located extramedullary lesions via a simple posterior approach.

Somatosensory evoked potential (SEP) recording is of use to assess the functional integrity of the sensory system. The correlation of SEPs with post-operative motor function, however, is poor and, particularly in intra-medullary surgery, SEPs tend to disappear when the midline myelotomy is performed and are then of no further use for the critical assessment of the motor system.

Electromyographic mapping of nerve roots, that is direct electrical stimulation of exposed nerves with a handheld probe and recording from lower extremity and sphincter ani muscles, is useful during resection of tumors in the conus/cauda equina region.

Continuous monitoring of the bulbocaver-nosus reflex (BCR) provides information on the functional integrity of oligosynaptic reflex arches involved in sphincter control. This has been shown to be feasible during general anesthesia, and there is good correlation of BCR data to post-operative sphincter control.

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Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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