Kobayashi Kazuyoshi, Ando Kei, Nakashima Hiroaki, Machino Masaaki, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Yamaguchi Hidetoshi, Koshimizu Hiroyuki, Imagama Shiro
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan.
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan.
J Clin Neurosci. 2021 Feb;84:60-65. doi: 10.1016/j.jocn.2020.11.045. Epub 2020 Dec 28.
Most thoracic intradural extramedullary tumors (IDEMT) are benign lesions that are treated by gross total resection and spinal cord decompression. Intraoperative transcranial-motor evoked potential (Tc-MEP) monitoring is important for reducing postoperative neurological complications. The purpose of this study is to examine the characteristics of Tc-MEP waveforms in surgery for thoracic IDEMT resection based on location of the tumor relative to the spinal cord. The subjects were 56 patients who underwent surgery for thoracic IDEMT from 2010 to 2018. The waveform derivation rate for each lower muscle was examined at baseline and intraoperatively. 56 patients had a mean age of 61.7 years, and 21 (38%) were non-ambulatory before surgery. The tumors were schwannoma (n = 28, 50%), meningioma (n = 25, 45%), and neurofibroma (n = 3, 5%); and the lesions were dorsal (n = 29, 53%) and ventral (n = 27, 47%). There was a significantly higher rate of undetectable waveforms in all lower limb muscles in the ventral group compared to the dorsal group (15% vs. 3%, p < 0.05). In non-ambulatory cases, the derivation rate at baseline was significantly lower for ventral thoracic IDMETs (47% vs. 68%, p < 0.05). The abductor hallucis (AH) had the highest waveform derivation rate of all lower limb muscles in non-ambulatory cases with a ventral thoracic IDMET. Spinal cord compression by a ventral lesion may be increased, and this may be reflected in greater waveform deterioration. Of all lower limb muscles, the AH had the highest derivation rate, even in non-ambulatory cases with a ventral IDEMT, which suggests the efficacy of multichannel monitoring including the AH.
大多数胸段硬脊膜内髓外肿瘤（IDEMT）是良性病变，通过全切除和脊髓减压进行治疗。术中经颅运动诱发电位（Tc-MEP）监测对于减少术后神经并发症很重要。本研究的目的是根据肿瘤相对于脊髓的位置，研究胸段IDEMT切除手术中Tc-MEP波形的特征。研究对象为2010年至2018年接受胸段IDEMT手术的56例患者。在基线期和术中检查每块下肢肌肉的波形引出率。56例患者的平均年龄为61.7岁，21例（38%）术前不能行走。肿瘤类型为神经鞘瘤（n = 28，50%）、脑膜瘤（n = 25，45%）和神经纤维瘤（n = 3，5%）；病变位于背侧（n = 29，53%）和腹侧（n = 27，47%）。与背侧组相比，腹侧组所有下肢肌肉中波形无法引出的发生率显著更高（15%对3%，p < 0.05）。在不能行走的病例中，腹侧胸段IDMETs在基线期的引出率显著更低（47%对68%，p < 0.05）。在腹侧胸段IDMET不能行走的病例中，拇展肌（AH）在所有下肢肌肉中的波形引出率最高。腹侧病变对脊髓的压迫可能增加，这可能反映在波形恶化更严重。在所有下肢肌肉中，即使在腹侧IDEMT不能行走的病例中，AH的引出率也最高，这表明包括AH在内的多通道监测的有效性。
