Usefulness of Intraoperative Motor Evoked Potential Monitoring in Surgery for Spinal Arteriovenous Fistula

Abstract

  Introduction : Spinal arteriovenous fistula (AVF) is a relatively rare spinal disorder that requires surgical interruption. However, there is a high risk of spinal cord damage during the surgery, especially in the ventral lesions. The purpose of this study was to evaluate the efficacy of intraoperative motor evoked potential (MEP) monitoring for spinal AVF.
  Methods : We analyzed data of 22 patients with perimedullary AVF and 14 patients with dural AVF retrospectively. MEPs were recorded by transcranial electrical stimulation and compound muscle action potentials. General anesthesia was maintained using propofol and remifentanil.
  Results : MEPs deteriorated during the surgery in 6 of 42 operations for perimedullary AVF ; 3 were transient, but 3 were not recovered during the surgery. These latter cases showed postoperative motor deterioration. However, there was no deterioration of MEPs and postoperative course in dural AVF patients.
  Conclusions : Intraoperative MEP monitoring is an effective and reliable method in spinal AVF surgery.