Uvajanje
nevrofiziološkega nadzora med operacijami hrbtenice in
hrbtenjače v
Splošni bolnišnici
Maribor
Medoperacijski elektrofiziološki nadzor (MEN) med operacijskimi posegi na hrbtenici in hrbtenjači pri skoliozah, med rekonstrukcijskimi operacijami pri obsežnih poškodbah, tumorskih, osteoporotičnih ali degenerativnih sprememb na nosilnih strukturah hrbtenice in zlasti pri nevrokirurških posegih pri tumorjih, ob in še zlasti v hrbtenjači, ko je potrebno odstraniti tumor, ne da bi pri tem poškodovali živčno tkivo, je postal v zadnjih desetih letih že rutina v večjih zdravstvenih centrih po svetu. Pri MEN gre za evociranje in opazovanje somatosenzoričnih in motoričnih potencialov. Pri tem električno dražimo živčne strukture na enem koncu, na drugem pa detektiramo odzive. Med mestom draženja in mestom odjemanja je operacijsko polje. Med operativnim posegom lahko takšno monitoriranje zazna morebitno motnjo, ki jo s svojim poseganjem povzroči kirurg. Kirurg je tako pravočasno opozorjen na nastanek elektrofiziološke motnje, tako da lahko modificira operativni postopke in tako prepreči trajno nevrološko okvaro, saj je motnja prevajanja reverzibilna, če ne traja predolgo. V ljubljanskem kliničnem centru je MEN na voljo kot pripomoček spinalnim kirurgom že nekaj let in ker se število spinalnih operativnih posegov povečuje tudi v mariborski bolnišnici, smo sklenili to metodo vpeljati tudi pri nas. Sestavek opisuje izkušnje pri prvih treh primerih MEN v SB Maribor. |
Introduction of neurophysiological monitoring during operations on spine and spinal cord in the General
Hospital Maribor
Intraoperative electrophysiological monitoring (IEM) during operative procedures has become mandatory and rutinous in major spinal world centers for the operative procedures on the spine and spinal cord for scoliosis, reconstructive operations in extensive traumatic injuries, tumours, osteoporotic and degenerative changes on spinal structure and particularly for neurosurgical procedures on extra and intramedullary tumors where lesion should be excised with no additional harm to the nervous tissue. During "IEM" the somatosensoric and motoric potentials are evoked on one side of the nervous pathway and monitored on the another. Between these two parts lies the operative field. During operative procedure "IEM" could detect possible electrophysiological changes provoked by surgical activity. According to the information given by "IEM" the surgeon is able to modificate his operative maneuves and to prevent possible permanent neurologic deficits. Such electrophysiological impairments are reversible in most cases when they do not last to long. In the Ljubljana Clinical Centre "IEM" has been available for spinal surgeons for several years. Due to increased frequency of such procedures also in Maribor General Hospital the "IEM" was recently introduced in our institution. The first three cases with "IEM" are presented. |
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