Selective Dorsal Rhizotomy: What, When, and Why to Cut.

Selective dorsal rhizotomy represents one of the major neurosurgical tools in treating pediatric spasticity. Intraoperative rootlet selection is the key step of the procedure in order to achieve good outcomes. Intraoperative monitoring (IOM) and anatomical selection of the rootlets are the gold standard in the aforementioned selection leading the surgeon during the procedure. The tendency toward minimally invasive procedures further increases IOM importance, warranting the use of electrophysiology in choosing the more suitable rootlets for cutting. Discharge pattern and percentage of resection represent the most important topics in surgical guidance, relying onto the very same pathophysiological mechanism causing spasticity to choose targets.