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Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach Sanchez Roldan, Maria de los Angeles Santa-Cruz, Daniela Lainez, Elena Baiget, Daniel Chocrón, Ivette Gándara Sabatini, Darío Bescós, Agustín Moncho, Dulce Sahuquillo, Juan Poca, Maria A. Rahnama Zand, Kimia Institut Català de la Salut [Sánchez Roldán MÁ, Rahnama K, Santa-Cruz D, Lainez E, Baiget D] Servei de Neurofisiologia Clínica, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Moncho D] Servei de Neurofisiologia Clínica, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Unitat de Recerca en Neurotraumatologia i Neurocirurgia (UNINN), Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. [Chocrón I] Servei d’Anestesiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Gándara D, Bescós A] Servei de Neurocirurgia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Sahuquillo J] Unitat de Recerca en Neurotraumatologia i Neurocirurgia (UNINN), Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Servei de Neurocirurgia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Departament de Cirurgia, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Poca MA] Unitat de Recerca en Neurotraumatologia i Neurocirurgia (UNINN), Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Servei de Neurocirurgia, Vall d’Hebron Hospital Universitari, Barcelona, Spain Vall d'Hebron Barcelona Hospital Campus Medul·la espinal - Malalties - Cirurgia Monitoratge intraoperatori DISEASES::Nervous System Diseases::Central Nervous System Diseases::Spinal Cord Diseases::Syringomyelia Other subheadings::Other subheadings::Other subheadings::/surgery ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Monitoring, Intraoperative::Intraoperative Neurophysiological Monitoring ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades de la médula espinal::siringomielia Otros calificadores::Otros calificadores::Otros calificadores::/cirugía TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::monitorización intraoperatoria::monitorización neurofisiológica intraoperatoria Intraoperative neurophysiological monitoring; Spinal cord; Syringomyelia Monitorización neurofisiológica intraoperatoria; Médula espinal; Siringomielia Monitorització neurofisiològica intraoperatoria; Medul·la espinal; Siringomielia Syringomyelia can be associated with multiple etiologies. The treatment of the underlying causes is first-line therapy; however, a direct approach to the syrinx is accepted as rescue treatment. Any direct intervention on the syrinx requires a myelotomy, posing a significant risk of iatrogenic spinal cord (SC) injury. Intraoperative neurophysiological monitoring (IONM) is crucial to detect and prevent surgically induced damage in neural SC pathways. We retrospectively reviewed the perioperative and intraoperative neurophysiological data and perioperative neurological examinations in ten cases of syringomyelia surgery. All the monitored modalities remained stable throughout the surgery in six cases, correlating with no new postoperative neurological deficits. In two patients, significant transitory attenuation, or loss of motor evoked potentials (MEPs), were observed and recovered after a corrective surgical maneuver, with no new postoperative deficits. In two cases, a significant MEP decrement was noted, which lasted until the end of the surgery and was associated with postoperative weakness. A transitory train of neurotonic electromyography (EMG) discharges was reported in one case. The surgical plan was adjusted, and the patient showed no postoperative deficits. The dorsal nerve roots were stimulated and identified in the seven cases where the myelotomy was performed via the dorsal root entry zone. Dorsal column mapping guided the myelotomy entry zone in four of the cases. In conclusion, multimodal IONM is feasible and reliable and may help prevent iatrogenic SC injury during syringomyelia surgery. This research was partially supported by grant FIS PI22/01082, which was co-financed by the European Regional Development Fund (ERDF), awarded to M.A. Poca and by grant 2021SGR/00810 from the Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR), Departament de Recerca i Universitats de la Generalitat de Catalunya, Spain. ASM is the recipient of a predoctoral fellowship from grant 2021SGR/00810 from the Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR). The following nongovernmental associations have generously donated funding to support this research: 1. Asociación Nacional de Amigos de Arnold-Chiari (ANAC, http://www.arnoldchiari.es (accessed on 7 June 2023)); 2. Asociación Chiari y Siringomielia del Principado de Asturias (CHySPA, https://chyspa.org (accessed on 7 June 2023)); 3. Federación Española de Malformación de Chiari y Patologías Asociadas (FEMACPA); and 4. Mariana Dañobeitia (https://references. neurotrauma.com/chiari (accessed on 7 June 2023)). 2023-08-31T11:49:26Z 2023-08-31T11:49:26Z 2023-08-10 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Sánchez Roldán MÁ, Moncho D, Rahnama K, Santa-Cruz D, Lainez E, Baiget D, et al. Intraoperative Neurophysiological Monitoring in Syringomyelia Surgery: A Multimodal Approach. J Clin Med. 2023 Aug 10;12(16):5200. 2077-0383 https://hdl.handle.net/11351/10198 10.3390/jcm12165200 37629243 http://hdl.handle.net/11351/10198 eng Journal of Clinical Medicine;12(16) https://doi.org/10.3390/jcm12165200 info:eu-repo/grantAgreement/ES/PEICTI2021-2023/PI22%2F01082 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf MDPI Scientia