Intraoperative iatrogenic seizure induced by transcranial motor-evoked potential during spinal surgery: A case report and review of the literature.

Surgical neurology international Pub Date : 2024-11-01 eCollection Date: 2024-01-01 DOI:10.25259/SNI_179_2024
Faisal A Sukkar, Sultan F Albalawi, Tala S AlSindi, Soha A Alomar
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Abstract

Background: Intraoperative neuromonitoring is an essential tool for detecting early intraoperative neurological changes during spinal surgery. Only rarely do seizures occur during transcranial motor-evoked potentials (TcMEP).

Case description: A 44-year-old male presented with a magnetic resonance (MR)--documented L5-S1 T2-hyperintense intradural mass that heterogeneously enhanced with Gadolinium and extended through the right S1 neural foramen. Utilizing transcranial motor-evoked potential (Tc-MEP) before the skin incision, the patient developed the 1st seizure that lasted for 2 min. The 2nd seizure occurred after the initial incision and lasted for around 15 min; at this point, the procedure was terminated. After brain MR studies documented no structural lesion and other etiologies of seizures were ruled out, the patient underwent an uneventful resection of the L5-S1 spinal lesion.

Conclusion: Although the risk of seizures from Tc-MEP is very low, it is crucial to be aware of this potential side effect. If they occur, surgical procedures should be aborted and diagnostic studies performed to rule out the presence of structural lesions and/or other reasons for seizure activity.

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脊柱手术中经颅运动诱发电位诱发的术中医源性癫痫:1例报告及文献复习。
背景:术中神经监测是发现脊柱手术早期术中神经变化的重要工具。在经颅运动诱发电位(TcMEP)期间,癫痫发作很少发生。病例描述:一名44岁男性,磁共振(MR)显示L5-S1 t2高硬膜内肿块,钆非均匀增强,并延伸至右侧S1神经孔。切开皮肤前经颅运动诱发电位(Tc-MEP)观察,患者第一次癫痫发作持续2 min,第二次癫痫发作发生在切口后,持续约15 min;在这一点上,程序被终止。在脑MR检查未发现结构性病变和癫痫发作的其他病因被排除后,患者接受了L5-S1脊柱病变的平稳切除。结论:虽然Tc-MEP引起癫痫发作的风险很低,但了解其潜在的副作用至关重要。如果发生,应中止手术,并进行诊断性研究,以排除结构性病变和/或癫痫发作活动的其他原因。
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