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Título

The impact of intraoperative neurophysiological monitoring on the post-surgical clinical repercussion of an ependymoma: a case report

RESUMO

CASE PRESENTATION: Patient, male, 59 years old, in 2019, started with neck pain along with paresthesia in an irradiated band for the upper limbs (UL), muscle strength in the upper limbs grade IV and normal coordination. Cervical magnetic resonance imaging showed an intramedullary expansive lesion at the level of C4-C5 with a neoplastic appearance, ependymoma. Surgery was performed through posterior cervical access with laminectomy and fixation. Direct stimulation of medullary tissue was also used for precise location of the physiological midline and determination of the best myelotomy site. There was complete resection of the lesion during microsurgery with the use of intraoperative neurophysiological monitoring, which demonstrated importance in the functional and clinical outcome of the patient, given the sensory, which is potential more than expected, and without alterations in motor potentials. Postoperatively, the patient presented ataxic gait, hypoesthesia in the lower limbs (LL), mild paresthesia on the right side, and altered proprioception. Two months after surgery, the patient progressed with significant motor improvement, without worsening muscle strength. The sensory deficit reduced significantly and gradually in postoperative evaluations. At six months after the surgery, there were no more complaints. DISCUSSION: Among the main subtypes of gliomas, ependymomas stand out, accounting for 60 to 80% of the cases. They are the most common intramedullary tumors in adults, whose peak age varies between 30 and 40 years. Due to the intramedullary location, the patient's symptoms resulted from progressive myelopathy due to compression of normal neural pathways. Intraoperative neurophysiological monitoring (IONM), used in surgery, is performed using techniques for analyzing the integrity of the neural system through somatosensory evoked potentials (SEPs), motor evoked potentials (MEP), D-wave and electroneuromyography. This technology has been the crucial factor in the post-surgical clinical repercussions, as it helps in the real-time feedback of critical pathways, preventing neurological deficits, enabling a rapid clinical evolution, in the absence of sequel, accelerating its functional status, as it happened with the patient. FINAL CONSIDERATIONS: Neurophysiological monitoring is a crucial factor to avoid nervous involvement with postoperative motor and sensory repercussions, this been, a factor for reducing the risk of sequelae in the patient's clinic.

Palavras Chave

ependymomas; neurophysiological monitoring; reducing the risk; evolution clinical; repercussions clinical