Intraoperative Neuromonitoring for Pediatric Pelvic Tumors

Alessandro Crocoli; Cristina Martucci; Franco Randi; Viviana Ponzo; Alessandro Trucchi; Maria Debora De Pasquale; Carlo Efisio Marras; Alessandro Inserra

doi:10.3389/fped.2022.949037

Intraoperative Neuromonitoring for Pediatric Pelvic Tumors

Front Pediatr. 2022 Aug 30:10:949037. doi: 10.3389/fped.2022.949037. eCollection 2022.

Authors

Alessandro Crocoli¹, Cristina Martucci², Franco Randi³, Viviana Ponzo³, Alessandro Trucchi⁴, Maria Debora De Pasquale⁵, Carlo Efisio Marras³, Alessandro Inserra²

Affiliations

¹ Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy.
² General Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy.
³ Neurosurgery Unit, Department of Neuroscience and Psychiatry Sciences, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy.
⁴ Surgical Andrology Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy.
⁵ Hematology/Oncology Unit, Department of Pediatric Hematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy.

Abstract

Background: Tumors of the pre-sacral and sacral spaces are a rare occurrence in children. Total tumor excision is required due to the significant risk of relapse in the event of partial surgery, but the surgical procedure may lead to postoperative problems such as urinary, sexual, and anorectal dysfunctions. Intraoperative neuromonitoring (IONM) has gained popularity in recent years as a strategy for preventing the onset of neurologic impairments by combining several neurophysiological techniques. The aim of our study is to describe the experience of Bambino Gesù Children's Hospital in the use of IONM in pediatric pelvic surgery.

Materials and methods: The data of patients treated for pelvic malignancies at Bambino Gesù Children's Hospital from 2015 to 2019 were retrospectively collected. All patients were assessed from a neurologic and neuro-urologic point of view at different time-points (before and immediately after surgery, after 6 months, and 1-year follow-up). They were all monitored during a surgical procedure using multimodal IONM including transcranial motor evoked potentials (TcMEP), triggered-EMG (t-EMG), pudendal somatosensory evoked potentials (PSSEP), and bulbocavernosus reflex (BCR).

Results: During the study period, ten children underwent pelvic tumor removal at our Institution. In all cases, intraoperative neurophysiological recordings were stable and feasible. The preservation of neurophysiological response at the same intensity during surgical procedures correlated with no new deficits for all neurophysiological techniques.

Discussion: Although the impact of the IONM on surgical strategies and clinical follow-up is unknown, this preliminary experience suggests that the appropriate use of several neurophysiological techniques can influence both the radicality of pelvic tumor removal and the neurological and urological outcome at clinical follow-up. Finally, because of the highly complex anatomy and inter-individual variances, this is especially useful in this type of surgery.

Keywords: cancer; children; evoked potentials; neuromonitoring; pelvic surgery.