The Puborectal Muscle and External Anal Sphincter Can Act Independently of each other in Functional Defecation Disorders

Object Intraoperative neurophysiological recording techniques have found increasing use in neurosurgical practice. The development of new recording techniques feasible while the patient receives a general anesthetic have improved their practical use in a similar way to the use of digital recording, documentation, and video technology. This review intends to provide an update on the techniques used and their validity. Methods Two principal methods are used for intraoperative neurophysiological testing during tethered cord release. Mapping identifies functional neural structures, namely nerve roots, and monitoring provides continuous information on the functional integrity of motor and sensory pathways as well as reflex circuitry. Mapping is performed mostly by using direct electrical stimulation of a structure within the surgical field and recording at a distant site, usually a muscle. Sensory mapping can also be performed with peripheral stimulation and recording within the surgical site. Monitoring of the motor system is achieved with motor evoked potentials. These are evoked by transcranial electrical stimulation and recorded from limb muscles and the external anal sphincter. The presence or absence of muscle responses are the parameters monitored. Sensory potentials evoked by tibial or pudendal nerve stimulation and recorded from the dorsal columns via an epidurally inserted electrode and/or from the scalp as cortical responses are used to access the integrity of sensory pathways. Amplitudes and latencies of these responses are then interpreted. The bulbocavernosus reflex, with stimulation of the pudendal nerve and recording of muscle responses in the external anal sphincter, is used for continuous monitoring of the reflex circuitry. Presence or absence of this response is the pertinent parameter that is monitored. Conclusions Intraoperative neurophysiology provides a wide and reliable set of techniques for intraoperative identification of neural structures and continuous monitoring of their functional integrity.

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S1840 The Bowel Guarding Response As a Measure of External Anal Sphincter Function in Idiopathic Fecal Incontinence

Gastroenterology ◽

10.1016/s0016-5085(08)61307-4 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-281

Author(s):

Adeel A. Bajwa ◽

Kumaran Thiruppathy ◽

Prateesh Trivedi ◽

Anton V. Emmanuel

Keyword(s):

Fecal Incontinence ◽

Anal Sphincter ◽

External Anal Sphincter ◽

Sphincter Function ◽

Anal Sphincter Function ◽

Idiopathic Fecal Incontinence

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The Male Bulbospongiosus Muscle and its Relation to the External Anal Sphincter

The Journal of Urology ◽

10.1016/j.juro.2014.10.050 ◽

2015 ◽

Vol 193 (4) ◽

pp. 1433-1440 ◽

Cited By ~ 2

Author(s):

Kevin Peikert ◽

Ivan Platzek ◽

Thomas Bessède ◽

Christian Albrecht May

Keyword(s):

Anal Sphincter ◽

External Anal Sphincter ◽

Bulbospongiosus Muscle

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Tissue-Engineered External Anal Sphincter Using Autologous Myogenic Satellite Cells and Extracellular Matrix: Functional and Histological Studies

Annals of Biomedical Engineering ◽

10.1007/s10439-015-1468-3 ◽

2015 ◽

Vol 44 (5) ◽

pp. 1773-1784 ◽

Cited By ~ 8

Author(s):

Abdol-Mohammad Kajbafzadeh ◽

Majid Kajbafzadeh ◽

Shabnam Sabetkish ◽

Nastaran Sabetkish ◽

Seyyed Mohammad Tavangar

Keyword(s):

Extracellular Matrix ◽

Anal Sphincter ◽

Satellite Cells ◽

External Anal Sphincter ◽

Histological Studies ◽

Myogenic Satellite Cells

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