Sala Francesco, Palandri Giorgio, Basso Elisabetta, Lanteri Paola, Deletis Vedran, Faccioli Franco, Bricolo Albino
Department of Neurological and Visual Sciences, University Hospital, Verona, Italy.
Neurosurgery. 2006 Jun;58(6):1129-43; discussion 1129-43. doi: 10.1227/01.NEU.0000215948.97195.58.
The value of intraoperative neurophysiological monitoring (INM) during intramedullary spinal cord tumor surgery remains debated. This historical control study tests the hypothesis that INM monitoring improves neurological outcome.
In 50 patients operated on after September 2000, we monitored somatosensory evoked potentials and transcranially elicited epidural (D-wave) and muscle motor evoked potentials (INM group). The historical control group consisted of 50 patients selected from among 301 patients who underwent intramedullary spinal cord tumor surgery, previously operated on by the same team without INM. Matching by preoperative neurological status (McCormick scale), histological findings, tumor location, and extent of removal were blind to outcome. A more than 50% somatosensory evoked potential amplitude decrement influenced only myelotomy. Muscle motor evoked potential disappearance modified surgery, but more than 50% D-wave amplitude decrement was the major indication to stop surgery. The postoperative to preoperative McCormick grade variation at discharge and at a follow-up of at least 3 months was compared between the two groups (Student's t tests).
Follow-up McCormick grade variation in the INM group (mean, +0.28) was significantly better (P = 0.0016) than that of the historical control group (mean, -0.16). At discharge, there was a trend (P = 0.1224) toward better McCormick grade variation in the INM group (mean, -0.26) than in the historical control group (mean, -0.5).
The applied motor evoked potential methods seem to improve long-term motor outcome significantly. Early motor outcome is similar because of transient motor deficits in the INM group, which can be predicted at the end of surgery by the neurophysiological profile of patients.
脊髓髓内肿瘤手术中术中神经生理监测（INM）的价值仍存在争议。这项历史对照研究检验了INM监测可改善神经功能结局这一假设。
在2000年9月之后接受手术的50例患者中，我们监测了体感诱发电位以及经颅诱发的硬膜外（D波）和肌肉运动诱发电位（INM组）。历史对照组由从301例行脊髓髓内肿瘤手术的患者中选出的50例患者组成，这些患者之前由同一团队在未进行INM监测的情况下进行手术。根据术前神经功能状态（ McCormick量表）、组织学结果、肿瘤位置和切除范围进行匹配，对结果设盲。体感诱发电位幅度下降超过50%仅影响脊髓切开术。肌肉运动诱发电位消失会改变手术方式，但D波幅度下降超过50%是停止手术的主要指征。比较两组患者出院时及至少随访3个月时术后与术前McCormick分级的变化（Student's t检验）。
INM组随访时的McCormick分级变化（平均，+0.28）明显优于历史对照组（平均，-0.16）（P = 0.0016）。出院时，INM组（平均，-0.26）的McCormick分级变化有优于历史对照组（平均，-0.5）的趋势（P = 0.1224）。
所应用的运动诱发电位方法似乎能显著改善长期运动结局。由于INM组存在短暂性运动功能缺损，早期运动结局相似，而这可在手术结束时通过患者的神经生理特征进行预测。
