Department of Neurosurgery, Technical University Munich Faculty of Medicine, München, Bayern, Germany.
Department of Neurosurgery, University of Augsburg, Augsburg, Bayern, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2021 Jul;82(4):325-332. doi: 10.1055/s-0040-1710504. Epub 2021 Jan 21.
Intraoperative neurophysiologic monitoring (IONM) has increased patient safety and extent of resection in patients with eloquent brain tumors. Despite its comprehensive capability for the resection of intramedullary spinal cord tumors (ISCTs), the application during the resection of these tumors is controversial.
We retrospectively analyzed the resection of ISCTs in 83 consecutive cases. IONM was performed in all cases. Each patient's motor status and the McCormick scale was determined preoperatively, directly after surgery, at the day of discharge, and at long-term follow-up.
IONM was feasible in 71 cases (85.5%). Gross total resection was performed in 75 cases (90.4%). Postoperatively, patients showed new transient deficits in 12 cases (14.5%) and new permanent deficits in 12 cases (14.5%). The mean McCormick variance between baseline and long-term follow-up was - 0.08 ± 0.54. IONM's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the patient's motor status at the day of discharge was 75.0%, 64.7%, 45.5%, and 86.8%. It was 88.9%, 59.7%, 24.2%, and 97.4% for the motor outcome at long-term follow-up. Patients experienced postoperative complications in 15 cases (18.1%).
IONM, as performed in the present study, shows a high sensitivity and NPV but low specificity and PPV, particularly for the patient's motor status at the long-term follow-up. As far as practicable by a retrospective study on IONM, our results confirm IONM's usefulness for its application during the resection of ISCTs. However, these results must be approved by a prospective study.
术中神经生理监测（IONM）提高了语言相关脑肿瘤患者的手术安全性和肿瘤切除范围。尽管 IONM 具有全面切除脊髓内肿瘤（ISCT）的能力，但在这些肿瘤切除中的应用仍存在争议。
我们回顾性分析了 83 例连续 ISCT 切除病例。所有病例均行 IONM。每位患者的运动状态和 McCormick 分级在术前、术后即刻、出院时和长期随访时进行评估。
IONM 在 71 例（85.5%）中可行。75 例（90.4%）行全切除。术后 12 例（14.5%）出现新的短暂性神经功能缺损，12 例（14.5%）出现新的永久性神经功能缺损。基线与长期随访时 McCormick 分级的平均差值为-0.08±0.54。IONM 对出院时患者运动状态的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 75.0%、64.7%、45.5%和 86.8%。对长期随访时的运动结局的敏感性、特异性、PPV 和 NPV 分别为 88.9%、59.7%、24.2%和 97.4%。15 例（18.1%）患者术后出现并发症。
本研究中进行的 IONM 具有较高的敏感性和 NPV，但特异性和 PPV较低，特别是在长期随访时患者的运动状态。就 IONM 的回顾性研究而言，我们的结果证实了 IONM 在 ISCT 切除中的应用价值。然而，这些结果还需要前瞻性研究来证实。
