Canaz, HüseyinErdoğan, Ezgi TunaAlataş, İbrahim2025-04-182025-04-182018CANAZ, H., ERDOĞAN, E. T., ALATAŞ, İ. (2018). The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele. Kocaeli Tıp Dergisi , 7(3), 192 - 198.https://search.trdizin.gov.tr/tr/yayin/detay/328320/the-results-of-untethering-procedures-with-intraoperative-neuromonitoring-occult-spinal-dysraphism-and-tethered-spinal-cord-secondary-to-myelomeningocelehttps://hdl.handle.net/20.500.12713/6668INTRODUCTION: Using intraoperative neuromonitoringin both primary and secondary tethered cord operations isaccepted as a necessity for a safer operation and guidingsurgeon in complex surgeries.METHODS: Twenty four operations which were monitoredwith three modalities; transcranial motor evoked potentials(TcMEP), free-run electromyography and direct nervestimulations. In group 1, there were 14 patients underwenttethered cord operations due to occult spinal dysraphism, ingroup 2 there were 10 patients underwent tethered cordoperations secondary to previous myelomeningocele repair.RESULTS: TcMEP responses of lower extremity were elicitedin 92 % in group 1, 80 % in group 2. TcMEP responses of analsphincter were elicited in 83 % in group 1, 60 % in group 2. NoTcMEP change was observed during the surgeries in bothgroup. Postoperative urodynamic results of both group wereimproved in 1 year period (78 % in group 1, 43 % in group 2).In patients with hypoactive bladder, we could not take analsphincter responses in TcMEP.DISCUSSION and CONCLUSION: Untethering of spinal cordboth in asymptomatic occult spinal dysraphism and TCSsecondary to MMC, can improve impaired urodynamic results.Intraoperative neuromonitoring and direct stimulation providesinformation for a safer surgery and guide surgical maneuversespecially in secondary untethering. Intraoperativeneurophysiological monitoring is beneficial for operations ofMMC patients with neurological deficits, to preserve theirresidual motor functions. Since anal sphincter functions arecorrelated with bladder functions, it is possible to get no analsphincter TcMEP response if patient has hypoactive bladder.eninfo:eu-repo/semantics/openAccessntraoperative neuromonitoringtethered spinal cordmyelomeningocelemotor evoked potentialsArticle73192198328320