Total Intravenous Anesthesia for Intraoperative Neurophysiological Monitoring in a Child With Diastematomyelia: A Case Report

Intraoperative neurophysiological monitoring (IONM) has achieved popularity because it facilitates monitoring of the functional integrity of neural structures under general anesthesia. It aids in the early detection of injury and minimizes postoperative neurologic deficit or neurologic morbidity from surgical manipulations of various neurologic structures. The patient mentioned in this case report presented with lower limb radiculopathy and was diagnosed with diastematomyelia Type II, and she was planned for surgical intervention under general anesthesia. Preoperatively, a team of surgeons, anesthetists, and neurophysiologists must discuss modalities of IONM to be used, expected changes, and alarm criteria. Anesthesia drugs need to be appropriately selected to facilitate IONM, as they affect the somatosensory evoked potential (SSEP) and motor evoked potential (MEP) responses obtained. We have facilitated IONM by avoiding muscle relaxants and inhalational agents for this specific patient. Risk-benefit must be assessed before the selection of a patient for evoked potential (EP) monitoring, as it may be rarely associated with complications such as burns, seizures, bite injuries to the lips, tongue, and endotracheal tube. Teamwork with meticulous planning, preparation, and multidisciplinary communication is essential for the safe conduct of spine surgeries with SSEP and MEP monitoring. In this case report, we discuss various considerations for anesthesia management in a patient with diastematomyelia undergoing spine surgery with intraoperative EP monitoring.