Bulbocavernosus Reflex (BCR) Monitoring During Intramedullary Conus Tumor Surgery
By Admin | March 13, 2020
Kathryn Overzet, MS, CNIM1, Faisal R Jahangiri, MD, CNIM, D.ABNM, FASNM, FASET1,2, Robert Funk, MD3
1Axis Neuromonitoring, Richardson, TX, USA; 2Global Innervation LLC, Dallas, TX, USA; 3Neurosurgery, United Regional Health Care System, Wichita Falls, TX USA.
Published: March 10, 2020
A T10 to L2 spinal cord tumor exploration and biopsy was performed with intraoperative neurophysiological monitoring (IONM) on a 75-year-old male diagnosed with an intradural intramedullary appearing spinal cord lesion with no other lesions in the central nervous system, chest, abdomen or pelvis.
Intraoperative neurophysiology consisted of transcranial electrical motor evoked potentials (TCeMEPs), somatosensory evoked potentials (SSEPs), triggered and spontaneous electromyography (S-EMG, T-EMG), bulbocavernosus reflex (BCR) and train of four (TOF) monitoring. Loss of BCR responses during conus exposure and identification were resolved with multiple small pauses in manipulation throughout the procedure. T-EMG mapping aided in identification and avoiding the removal of nervous tissue.
Postoperatively the patient experienced some mild weakness in his left foot and leg that correlated with a significant amplitude drop in the left abductor hallucis TCeMEP. By the following day, the patient was almost back to preoperative baseline. The patient’s bowel and bladder function were preserved, consistent with final BCR recordings. The patient was discharged to rehabilitation postoperatively. Pathology results indicated glioblastoma.
This case study demonstrates the utility of a multimodality approach with bulbocavernosus reflex and urethral sphincter monitoring to optimize intraoperative data to the surgeon during conus tumor surgeries.
Keywords: conus medullaris, bulbocavernosus reflex, transcranial electrical motor evoked potentials, electromyography, neurophysiology, spine tumor, ionm, urethral sphincter monitoring, bcr, intraoperative neurophysiological monitoring
Cite this article as: Cite this article as: Overzet K, Jahangiri F R, Funk R (March 10, 2020) Bulbocavernosus Reflex Monitoring During Intramedullary Conus Tumor Surgery. Cureus 12(3): e7233. doi:10.7759/cureus.7233.