Barzilai Ori, Lidar Zvi, Constantini Shlomi, Salame Khalil, Bitan-Talmor Yifat, Korn Akiva
Department of Neurosurgery, Tel Aviv, "Sourasky" Medical Center, Tel Aviv University; and.
Department of Pediatric Neurosurgery, "Dana" Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.
J Neurosurg Spine. 2017 Aug;27(2):161-168. doi: 10.3171/2016.12.SPINE16985. Epub 2017 May 19.
Intramedullary spinal cord tumors (IMSCTs) represent a rare entity, accounting for 4%-10% of all central nervous system tumors. Microsurgical resection of IMSCTs is currently considered the primary treatment modality. Intraoperative neurophysiological monitoring (IONM) has been shown to aid in maximizing tumor resection and minimizing neurological morbidity, consequently improving patient outcome. The gold standard for IONM to date is multimodality monitoring, consisting of both somatosensory evoked potentials, as well as muscle-based transcranial electric motor evoked potentials (tcMEPs). Monitoring of tcMEPs is optimal when combining transcranial electrically stimulated muscle tcMEPs with D-wave monitoring. Despite continuous monitoring of these modalities, when classic monitoring techniques are used, there can be an inherent delay in time between actual structural or vascular-based injury to the corticospinal tracts (CSTs) and its revelation. Often, tcMEP stimulation is precluded by the surgeon's preference that the patient not twitch, especially at the most crucial times during resection. In addition, D-wave monitoring may require a few seconds of averaging until updating, and can be somewhat indiscriminate to laterality. Therefore, a method that will provide immediate information regarding the vulnerability of the CSTs is still needed. The authors performed a retrospective series review of resection of IMSCTs using the tip of an ultrasonic aspirator for continuous proximity mapping of the motor fibers within the spinal cord, along with classic muscle-based tcMEP and D-wave monitoring. The authors present their preliminary experience with 6 patients who underwent resection of an IMSCT using the tip of an ultrasonic aspirator for continuous proximity mapping of the motor fibers within the spinal cord, together with classic muscle-based tcMEP and D-wave monitoring. This fusion of technologies can potentially assist in optimizing resection while preserving neurological function in these challenging surgeries.
脊髓髓内肿瘤（IMSCTs）是一种罕见的疾病，占所有中枢神经系统肿瘤的4%-10%。目前，IMSCTs的显微手术切除被认为是主要的治疗方式。术中神经电生理监测（IONM）已被证明有助于最大限度地切除肿瘤并将神经功能损伤降至最低，从而改善患者的预后。迄今为止，IONM的金标准是多模态监测，包括体感诱发电位以及基于肌肉的经颅电运动诱发电位（tcMEPs）。将经颅电刺激肌肉tcMEPs与D波监测相结合时，对tcMEPs的监测最为理想。尽管对这些模式进行了持续监测，但当使用传统监测技术时，在皮质脊髓束（CSTs）实际发生基于结构或血管的损伤与其显现之间可能存在固有的时间延迟。通常，由于外科医生倾向于避免患者抽搐，尤其是在切除的最关键时期，tcMEP刺激受到限制。此外，D波监测可能需要几秒钟的平均时间才能更新，并且对侧别可能有些不敏感。因此，仍然需要一种能够提供有关CSTs易损性即时信息的方法。作者对使用超声吸引器尖端进行脊髓内运动纤维连续接近映射的IMSCTs切除术进行了回顾性系列研究，并结合了传统的基于肌肉的tcMEP和D波监测。作者介绍了他们对6例患者的初步经验，这些患者接受了IMSCTs切除术，使用超声吸引器尖端对脊髓内运动纤维进行连续接近映射，并结合传统的基于肌肉的tcMEP和D波监测。这种技术融合有可能在这些具有挑战性的手术中协助优化切除，同时保留神经功能。
