Resident Physician Allegheny Health Network Pittsburgh, Pennsylvania, United States
Introduction: Dorsal column mapping is an innovative method to identify electrographic midline and thus theoretically provides a more accurate identification of midline and adjacent spinal cord anatomy, particularly in the setting of spinal cord pathology where anatomical landmarks are not as reliable.
Methods: We performed a retrospective review of our patients, N=5, who underwent a midline myelotomy with dorsal column mapping for various intramedullary pathologies. Technical nuances of the technique will be discussed.
Results: Of the five patients, two patients had evidence of dorsal column dysfunction postoperatively. However, both patients showed significant improvement in symptoms prior to discharge and continued to show improvement in later follow up. All patient preoperative symptoms were either improved or unchanged postoperatively.
Age Primary Pathology Procedure Intraop SSEP Changes New Post Op Dorsal Column Dysfunction Preop Symptoms Resolved/Improved Revision Surgery 72 Cervical Syrinx Revision Syringo-Pleural Shunt No Yes Yes Yes 78 Cervical Astrocytoma Cervical Laminectomy and Resection of Mass No No Yes No 51 Dorsal Root Avulsion and Cervical Pseudomeningoceles Cervical/Thoracic Laminectomy and DREZ No No Yes No 22 Cervical Astrocytoma Cervical Laminectomy and Biopsy No Yes Unchanged No 41 Cervical Syrinx Syringo-subarachnoid shunt No No Unchanged No
Conclusion : In our experience, dorsal column mapping/stimulation for entering the spinal cord is a safe and reliable method, particularly in situations when spinal cord anatomy is distorted and typical landmarks are not reliable. Further research should include increasing the sample size and examining direct comparisons with other methods of identifying midline.
