Gas-filled intradural cyst with migration into the nerve root of the cauda equina.

Only 4 cases of gas-filled intradural cysts of the spine have been reported previously. All cysts were due to intradural herniation of a gas-containing disc. The authors report 2 additional patients with gas-filled intradural cysts that migrated into the nerve root of the cauda equina. After surgical treatment their severe leg pain completely resolved.

Transcranial electrical stimulation as predictor of elicitation of intraoperative muscle-evoked potentials.

STUDY DESIGN: Preoperative electrophysiological and neurologic findings from patients with cervical myelopathy were evaluated statistically to determine their predictive value relative to the success of eliciting intraoperative motor-evoked potentials. OBJECTIVES: To determine which preoperative variables accurately predicted the success of eliciting an intraoperative muscle-evoked potential. SUMMARY OF BACKGROUND DATA: Motor-evoked potential recorded from the muscles after transcranial electrical stimulation is one of the most widely used methods for intraoperative spinal cord monitoring. However, motor-evoked potentials recorded from lower limb muscles are not detectable in patients with severe cervical myelopathy. Therefore, it is helpful to know the probability of the intraoperative transcranial electrical stimulation-motor evoked potential elicitation before the operation. METHODS: There were 38 patients with cervical myelopathy. Before the operation, motor-evoked potentials following transcranial magnetic stimulation were recorded from the flexor hallucis brevis, and central motor conduction times were measured. Neurologic function was evaluated using the Japanese Orthopedic Association score. During the operation, transcranial electrical stimulation-motor evoked potential from the flexor hallucis brevis was recorded. The Japanese Orthopedic Association score, threshold intensity of magnetic stimulation, and central motor conduction times were statistically evaluated for their potential of being predictors. RESULTS: The intraoperative transcranial electrical stimulation-motor evoked potential was detectable in all cases in which the preoperative transcranial magnetic stimulation-motor evoked potential was elicited by a lower intensity than 50% of the maximum output of the stimulator. Therefore, simultaneous use of other methods of monitoring should be considered in such cases that need higher output. However, the Japanese Orthopedic Association score or central motor conduction times were not useful criteria. CONCLUSIONS.: The threshold intensity of the preoperative transcranial magnetic stimulation-motor evoked potential was helpful in predicting elicitation of the intraoperative transcranial electrical stimulation-motor evoked potential.

Visualization of conductive spinal cord activity using a biomagnetometer.

STUDY DESIGN: The authors measured conductive cervical spinal cord evoked magnetic fields (SCEFs) after thoracic spinal cord stimulation in cats and visualized spinal cord activities. OBJECTIVE: To evaluate the usefulness of magnetic field measurement. SUMMARY OF BACKGROUND DATA: Magnetic field measurement has several theoretical advantages compared with electric potential measurement. Although biomagnetometers for the brain and heart are already on the market and are widely used, methods for magnetic field measurement of the spinal cord have not been established. METHOD: Cervical laminectomy was performed on adult cats under anesthesia and the dural tube was exposed. Electrical stimuli were applied to the lower thoracic spinal cord by a catheter epidural electrode. SCEFs were recorded using a biomagnetometer specially designed for recording spinal cord action potentials. SCEFs were measured at 35 different points over the cervical spine and isomagnetic field maps of SCEFs were constructed. Thereafter, the spinal cord was transected completely at C5 and SCEFs were measured again. RESULTS: The detected SCEFs showed a clear biphasic configuration. The first deflection of the magnetic fields from the left side was directed outward, but the right-side deflection was directed inward. The second deflection showed reversed polarity. The isomagnetic field maps of SCEFs clearly demonstrated the quadrupolar pattern and propagated at a conduction velocity of 80-120 m/s. After spinal cord transection, the propagation of SCEFs stopped at the transection site, and the SCEFs could not be obtained above the site. CONCLUSIONS: The authors concluded that magnetic field measurement is useful for evaluation of spinal cord function. Moreover, it was apparent that SCEFs could indicate conduction block in the spinal cord.