Search

Purpose: The occurrence of urinary incontinence and erectile dysfunction after surgical treatment for prostate cancer is a significant and lingering problem. The aim of this study is to revise and improve older techniques of intraoperative cavernous nerve mapping already in use to improve accuracy and reliability., Methods: We prospectively studied this technique in 12 patients suffering from prostate cancer. Inhalation or intravenous anesthetic regimen was used with nondepolarizing muscle relaxants. Stimulation protocol was 30 Hz, 0.2 ms, 10 to 20 mA intensity and a maximum duration of 30 seconds. Recording was performed with a system for measuring pressure changes using a stainless steel needle electrode inside the cavernous bodies. Stimulation was systematically performed at three distinct moments during the surgery at various points. An increase or decrease in pressure of 4 cm of H20 in the cavernous bodies was considered a positive result and negative response when no changes occurred after 30 seconds of continuous stimulation., Results: Of patients, 91.6% had positive responses to initial stimulation. The anesthetic regimen did not appear to significantly influence the responses in our series., Conclusions: In light of the results of this study, the stimulation of the cavernous nerves may be a viable technique in the right context, which includes good patient selection (young patients with a localized tumor and with preserved potency). The major limitation is that mapping techniques are useful to localize functional nerves, but not to monitor function in a continuous manner.

Background: It has been described that many Charcot-Marie-Tooth syndrome type 2 patients are affected by a very disabling type of tremor syndrome, the pathophysiology of which remains unclear. Deep brain stimulation (DBS) has been successfully applied to treat most types of tremors by implanting electrodes in the ventral intermediate nucleus of the thalamus (Vim)., Methods: We used DBS applied to the Vim in 2 patients with severe axonal inherited polyneuropathies who developed a disabling tremor., Results: Both patients responded positively to stimulation, with a marked reduction of the tremor and with an improvement of their quality of life., Conclusion: We report 2 cases of tremor associated with a hereditary neuropathy with a good response to DBS., (© 2017 S. Karger AG, Basel.)

Motor involvement in herpes zoster is very infrequent, occurring in 3%-5% of cases, and it is caused by extension of the inflammatory process to the anterior horn motor neurons, with the subsequent development of segmental motor paralysis. The authors report a 37-yr-old woman with history of paresis in both lower limbs secondary to spinal cord atrophy associated with Vogt-Koyanagi-Harada disease and immunosuppression caused by chronic corticosteroid and azathioprine treatment of ulcerative colitis, who developed worsening of her baseline residual muscle strength in the right lower limb shortly after herpes zoster eruption. Electromyography revealed acute denervation in territories corresponding to L3-L4 and moderate widespread axonal polyneuropathy affecting both lower limbs. The patient recovered her baseline muscle strength after this event. To the best of the authors' knowledge, this is the first reported case of herpes zoster motor neuropathy in a patient with a previous motor sequel.

Introduction: Neurophysiological monitoring in spine surgery can be performed by a number of methods, although there is no general agreement about which is the best., Aim: The aim of this study was to evaluate our experiences using the method of spinal cord stimulation with recording carried out on the peripheral nerve., Patients and Methods: We studied 51 patients with scoliosis who were submitted to surgical correction. Stimuli were administered with the cathode located in the dorsal epidural space, two levels above the curve to be corrected, and recording was performed on the posterior tibial nerve in the popliteal fossa., Results: Potential was obtained in 78% of cases, with a very low number of averages and the maximum reduction in the amplitude of the potential was found to be 33%. Spinal cord stimulation evokes muscular responses in several muscles and sensory responses in the sural nerve. None of the patients who were monitored using this method presented postoperative neurological deficits added to their previous pathology., Conclusions: The neurogenic potentials obtained by epidural spinal cord stimulation are very useful for monitoring spine surgery because they are very stable, they can be obtained quickly, they avoid the need to interfere with the anaesthetist's field and because, albeit to a small extent, they may contain information about motor pathways. The main drawback is that it is not always possible to place the electrode and that in 22% of cases we have not managed to obtain the motor component and we have therefore had to be cautious in evaluating it, since its disappearance would only give rise to a partial reduction in the potential.