The use of somatosensory evoked potentials to prevent ischemic neural damage during preoperative embolization of a vascular renal metastasis.

Abstract

Tumors at the spinal cord level present challenging surgical problems. Hypernephromas and other tumors may have copious bleeding at the time of resection. This bleeding can be reduced by preoperative embolization resulting in a dramatic decrease in surgical morbidity. However, embolization does carry a risk of spinal cord infarction and resultant neurologic injury. To monitor this, somatosensory evoked potentials (SSEPs) were evaluated during embolization, with a resultant termination of the procedure after significant SSEP changes and clinical symptoms indicated cord ischemia. The SSEP readings normalized 24 hours later, by the time of surgical resection. We present a relevant case history and review of the literature on this subject. Clearly, SSEPs, and in the future, motor evoked potentials (MEPs), serve as a valuable adjunct to monitoring spinal cord function during embolization and may prevent preoperative ischemic injury.