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Intraoperative somatosensory evoked potentials to facilitate peripheral nerve release

[Les potentiels évoqués somesthésiques peropératoires pour faciliter la libération de nerfs périphériques]

Jean Corentin Salengros, MD^*, Pierre Pandin, MD^*, Frédéric Schuind, MD, PhD and Arlette Vandesteene, MD PhD^*

^* From the Departments of Anesthesiology, and
Orthopedic and Traumatologic Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.

Address correspondence to: Dr. Jean Corentin Salengros, Université Libre de Bruxelles, Department of Anesthesiology, CUB Hôpital Erasme, 808, route de Lennik, 1070 Brussels, Belgium. Phone: +32-2-555-39-19; Fax: +32-2-555-43-63; E-mail: jean.salengros{at}ulb.ac.be

Purpose: The significance of intraoperative somatosensory evoked potentials (SSEP) monitoring is well known during spinal surgery. This technology could be beneficial during peripheral nerve surgery as well. In order to illustrate potential applications, two cases of successful peripheral nerve release demonstrated by on-line, intraoperative, SSEP are reported.

Clinical and technical features: The first case presents a complex brachial plexus lesion involving two mixed sensory-motor nerves: median and ulnar. The second case involved an entrapment neuropathy of the lateral femoral cutaneous nerve, a pure sensory nerve (meralgia paresthetica). For each patient we elicited specific peripheral nerve SSEP (recorded using bipolar cephalic montage) by stimulating each nerve independently. In each case, during difficult nerve dissection and after having excluded other possible factors of intraoperative SSEP variations, an increase of the SSEP amplitude was observed, and later correlated with favourable patient clinical outcome.

Conclusions: Two cases demonstrate that intraoperative SSEP monitoring may provide an effective tool to guide surgical dissection during peripheral nerve release. This technique has potentially beneficial clinical applications and warrants further investigation.

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