ABSTRACT
The titanium rib procedure is a safe and effective way of surgically treating pediatric patients with thoracic insufficiency syndrome and scoliosis. As with any invasive surgical procedure, it is not without risks. This article explains the potential risks to neurological structures while outlining the surgical approach and the neurological anatomy in the vicinity of the implanted instrumentation. The types of potential nerve injury involve ischemia, trauma, compression, and stretch. Furthermore, a suitable compilation of modalities of intraoperative neurophysiologic monitoring is recommended to detect and avoid long-term nerve or spinal cord insult. Monitoring modalities that would be appropriate for this procedure are discussed.
Subject(s)
Electrodiagnosis/methods , Multiple Trauma/diagnosis , Multiple Trauma/etiology , Peripheral Nerve Injuries , Prostheses and Implants/adverse effects , Prosthesis Implantation/adverse effects , Ribs/surgery , Humans , Monitoring, Intraoperative/methods , Multiple Trauma/prevention & control , Risk Assessment , TitaniumABSTRACT
Jorge Mura, M.D. performed the microsurgery presented in this report on August 22, 2006 at the Institute of Neurosurgery Asenjo in Santiago, Chile. A highly vascularized tumor was present in the patient's only functional vertebral artery. Intraoperative neuromonitoring was conducted throughout the procedure. Following resection of the tumor and completion of the vertebral artery microanastomosis, somatosensory evoked potentials were improved from baseline potentials. Motor function was stable throughout the procedure. A post-operative computerized tomography (CT) angiogram showed that the reconstructed artery was normal and three times the size of the right vertebral artery. The patient had no post operative deficits. The preliminary result of the biopsy was an angiofibroma.
