术中监测在脊髓肿瘤切除术中的应用：基于肿瘤位置和解剖部位的分析。

Utility of Intraoperative Monitoring in the Resection of Spinal Cord Tumors: An Analysis by Tumor Location and Anatomical Region.

机构信息

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY.

Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN.

出版信息

Spine (Phila Pa 1976). 2018 Feb 15;43(4):287-294. doi: 10.1097/BRS.0000000000002300.

DOI:10.1097/BRS.0000000000002300

PMID:28658041

Abstract

STUDY DESIGN

Retrospective review of institutional data.

OBJECTIVE

The aim of this study was to assess the utility of somatosensory-evoked potentials (SSEP) and transcranial electric motor-evoked potentials (MEP) in the resection of spine tumors and evaluate the ability of both single and multi-modal monitoring to predict postoperative neurological deficits.

SUMMARY OF BACKGROUND DATA

Although the utility of intraoperative monitoring (IOM) is well established in scoliosis and degenerative surgery, studies in spine tumor patients have been limited.

METHODS

A series of consecutive patients who underwent resection with the use of IOM at a single institution between August 2009 and March 2013 was identified. Demographic, clinical, and neuromonitoring data were collected preoperatively, during surgery, at the moment of discharge, and at a 6-month follow-up visit. Three cohorts were established based on the anatomical location of the tumor: intramedullary, intradural extramedullary, and extradural. Additional groupings were formed based on spinal region. Patients with significant changes in SSEPs or MEPs during surgery were identified and the rate of neurological deficits was assessed.

RESULTS

A total of 52 patients were analyzed. A change in SSEPs or MEPs was detected in 11 (21.2%) cases whereas 14 patients (26.9%) developed permanent postoperative deficits. SSEPs predicted deficits in the resection of intramedullary tumors (P = 0.015) (area under cover, AUC = 0.83), and intradural extramedullary tumors (P = 0.048; AUC = 0.70). MEP monitoring did not predict postoperative deficits in the resection of intramedullary (P = 0.21; AUC = 0.69) or intradural extramedullary tumors (P = 0.31; AUC = 0.63). Neither SSEPs nor MEPs predicted deficits for extradural tumors.

CONCLUSION

The efficacy of IOM in spine tumor resection is dependent on tumor location relative to the spinal cord and dura. The accuracy of SSEPs and their ability to predict postoperative deficits was greatest for intramedullary lesions. For this series, MEP and multi-modal monitoring did not confer a benefit in predicting permanent neurological deficits.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性机构数据研究。

目的

本研究旨在评估体感诱发电位（SSEP）和经颅电运动诱发电位（MEP）在脊柱肿瘤切除中的应用，并评估单一和多模态监测预测术后神经功能缺损的能力。

背景资料概要

尽管术中监测（IOM）在脊柱侧凸和退行性手术中的应用已得到充分证实，但在脊柱肿瘤患者中的研究仍有限。

方法

确定了 2009 年 8 月至 2013 年 3 月在一家机构接受 IOM 切除的一系列连续患者。收集了术前、术中、出院时和 6 个月随访时的人口统计学、临床和神经监测数据。根据肿瘤的解剖位置将患者分为三组：髓内、硬脊膜内髓外和硬脊膜外。根据脊柱区域形成了其他分组。识别术中 SSEP 或 MEP 发生变化的患者，并评估神经功能缺损的发生率。

结果

共分析了 52 例患者。11 例（21.2%）患者出现 SSEP 或 MEP 变化，14 例（26.9%）患者发生永久性术后神经功能缺损。SSEP 预测了髓内肿瘤（P=0.015）（覆盖面积，AUC=0.83）和硬脊膜内髓外肿瘤（P=0.048；AUC=0.70）切除中的缺陷。MEP 监测不能预测髓内（P=0.21；AUC=0.69）或硬脊膜外肿瘤（P=0.31；AUC=0.63）切除后的术后缺陷。SSEP 和 MEP 均不能预测硬脊膜外肿瘤的缺陷。