Electrophysiologically assisted by single-sided spinal hypothalamus lateral beam-break to treat stubborn pain 1 case

1Summary of medical recordsmale, 37 years old, Yichang, Hubei ProvinceHe was admitted to hospital on March 8, 2018, with convulsive convulsions and painAt 6 months of age, the patient had no obvious trigger for the head and torso to bend into a bow, unconscious disorder, muscles were strong and sweaty during the twitching attacks of the limbs, and the mind was clear at each time, after taking carbamazepine, Antan and other drugs, and after 3 years of age, he had pain in his limbsNow the symptoms are aggravated, the amount of medication does not ease, the pain can not be tolerated during the attack, can not sleep at night, to the right limb seriousspecialist physical examination: clear mind, unable to stand, extremely thin, spitting unclear, neck straight, limb muscle atrophy obvious, limbs and torso serious distortion, deformity performance, back depression, muscle tension increase, upper limbcan can complete large movements, both lower limbs of the joint movement is obviously limitedPhysiological reflexes are weakened, pathological signs are not drawn, and there is no size incontinenceHead and neck MRI flat sweep scan scan screen diffuse brain atrophy, thoracic curvature side-bend deformityAdmission Diagnosis: (1) Painful muscle spasm syndrome(2) Iexclusiveire torsional dystonia disorder(3) Spastic bilateral cerebral palsyAfter admission to improve the preoperative examination, full hemp electrophysiological assistance down the right spinal ventricular side of the hypothalamus offsurgery (Figure 1), after surgery recovery is good, quality of life significantly improved, no size of incontinence, the patient's limbs activity is not significantly reduced, the right T3 feel the pain below the plane improved, 42d after the discharge of the pain for severe pain4 months after surgery telephone follow-up, oral drugs: Medoba 14mg/d, Carmapine 200mg/d, the drug volume is 1/4 preoperative, AstraSilon tablets 2mg x 2/dThe pain is significantly less severe than before surgery, for moderate painFigure 1 Electrophysiological lyothetic assisted side-by-side beam dissection of the cerebropathic brain 1A surgery, after surgery, four limb-induced potential and free myomyoelectric map; 1B surgical motor induced potential 2 Discuss 2.1 surgical methods
one-sided spinal cord front outer beam cut-off can effectively relieve the pain caused by spinal cord lesions, but less reported reports Yan Xiongwei used spinal hypothalamus to treat stubborn pain, pain relief is obvious, the near-term effect: excellent 85.7%, good 14.3%; Tian Dezhou and others used two-sided spinal althonosic lateral mastectomy (depth 2mm) to treat stubborn pain below L3, the degree of relief is greater than 50% the case after admission to the hospital this treatment team to carry out a comprehensive assessment of the condition: (1) the patient's limbs pain, with the right limb obvious, the pain level is severe pain (2) The patient's limbs spasmcon, severe pain, up to 7 times / d, the drug to relieve pain is not effective; (3) Anaesthetic assessment can tolerate full hemp surgery (4) The patient's right limb pain is serious, while the two-sided surgery there is a risk of paraplegia, and affect the size of the stool, the current patient upper limb activity is still ok, so choose The T3 plane right spinal althralum lateral beam dissection (5) In order to avoid affecting the patient's stool, surgery is carried out under electrophysiological monitoring (6) The spinal ventricle lateral beam (about 4mm deep) is broken from the toothed ligament to the back edge of the frontal root of the T3 nerve root The key to the success or failure of surgery is to master the surgical adaptation certificate, and the real-time monitoring of electrophysiological in surgery is essential To avoid simultaneous simultaneous excision of both sides of the patient's stool and the movement of the lower limbs, a one-sided spinal thalamus lateral excision is selected Under the guidance of real-time electrophysiological monitoring in surgery, the choice of cutting spinal cord depth of 4mm can not only improve the patient's pain relief degree, but also avoid the effect of simultaneous double-sided surgery on the patient's double lower limb activity and stool function 2.2 electrophysiological monitoring methods the use of Natus-Xletek neuroelectrophysiological monitoring in the United States in this study case After the anaesthetic is satisfactory, the stimulation electrode and the recording electrode are placed, and the body sense-induced potential, free myoelectric map and motion-induced potential are continuously monitored during the operation Free myoelectric map and motion-induced potential mainly monitor the double upper limb triceps, short flexo muscles, double-sided sphincter, double lower limb femur syllitanmuscle, tibia premuscle and fibula muscles In the preoperative, intraoperative, postoperative continuous recording of a variety of nerve, muscle conduction parameters, force to protect the integrity of nerve function in the operation, guide the spinal althluic lateral beam removal depth, to ensure good surgical effect in the process of cross-sectional spinal chochio, the operation will touch the sensory and motion conduction pathways, electrophysiological monitoring can timely reflect the corresponding section of nerve function damage, timely find the spinal cord nerve function of the side injury Due to the complexity of the pain conduction pathway, the depth and scope of surgical removal of the spinal cord need swells With the development of high-resolution MRI, functional imaging of fiber beams can be performed, which is beneficial to clinicians to understand fiber beam walking, and multi-mode neuroelectrophysiological monitoring can also fully reflect the neural function of the spinal cord These provide good guidance for the treatment of stubborn pain by the lateral beam of the cerebrothary ventricle, which is conducive to further improving the surgical effect