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1- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
2- Functional Neurosurgeon, Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. , sina253@gmail.com
Abstract:   (176 Views)
Selective dorsal rhizotomy (SDR) is a neurosurgical procedure which is currently used as a surgical treatment for children with spasticity in the legs. In SDR, partial sectioning of the dorsal roots from L2 to S1 or S2 is usually performed. The primary goal of SDR is to reduce spasticity and improve the range of movement with preservation of muscle strength by identifying components of dorsal roots involved in spasticity on the basis of intraoperative electrophysiological stimulation. Currently, SDR is the most commonly performed procedure for the treatment of spastic cerebral palsy in children. We report herein an 8-year-old child with spastic cerebral palsy who underwent intraoperative neurophysiology monitoring during SDR for treating his spasticity. Before the operation, patient's examination showed more spasticity at the lower extremities, and milder one at the upper extremities, as well as fixed contracture at his both ankle joints. Intraoperative neuromonitoring (consisting of motor evoked potentials, direct nerve root stimulation, and free run electromyography) was performed during the operation. Electrophysiological monitoring was initially used to differentiate between the ventral and dorsal roots and cutting the abnormal sensory rootlets. After the operation, his motor power of the lower extremities in the proximal and distal muscles was 4 out of 5, his saddle sensation was normal, and there was no urinary and stool incontinency. Four weeks after the operation, he could walk about 10 m on his own. His examination at 2 and 4 weeks after the operation showed no sign of sensory deficits, urinary, or stool incontinency. Two months after the operation, the patient could walk independently without help while before the operation he could not. 
     
Type of Study: Case report | Subject: Intraoperative Neurophsiology
* Corresponding Author Address: Department of Neurosurgery, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.