Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Spine (Phila Pa 1976). 2022 Jan 15;47(2):172-179. doi: 10.1097/BRS.0000000000004112.
Prospective multicenter study.
To examine transcranial motor-evoked potential (Tc-MEP) waveforms in intraoperative neurophysiological monitoring in surgery for intradural extramedullary (IDEM) tumors, focused on the characteristics for cervical, thoracic, and conus lesions.
IDEM tumors are normally curable after resection, but neurological deterioration may occur after surgery. Intraoperative neurophysiological monitoring using Tc-MEPs during surgery is important for timely detection of possible neurological injury.
The subjects were 233 patients with IDEM tumors treated surgically with Tc-MEP monitoring at 9 centers. The alarm threshold was ≥70% waveform deterioration from baseline. A case with a Tc-MEP alert that normalized and had no new motor deficits postoperatively was defined as a rescue case. A deterioration of manual muscle test score ≥1 compared to the preoperative value was defined as postoperative worsening of motor status.
The 233 patients (92 males, 39%) had a mean age of 58.1 ± 18.1 years, and 185 (79%), 46 (20%), and 2 (1%) had schwannoma, meningioma, and neurofibroma. These lesions had cervical (C1-7), thoracic (Th1-10), and conus (Th11-L2) locations in 82 (35%), 96 (41%), and 55 (24%) cases. There were no significant differences in preoperative motor deficit among the lesion levels. Thoracic lesions had a significantly higher rate of poor baseline waveform derivation (0% cervical, 6% thoracic, 0% conus, P < 0.05) and significantly more frequent intraoperative alarms (20%, 31%, 15%, P < 0.05). Use of Tc-MEPs for predicting neurological deficits after IDEM surgery had sensitivity of 87% and specificity of 89%; however, the positive predictive value was low.
Poor derivation of waveforms, appearance of alarms, and worse final waveforms were all significantly more frequent for thoracic lesions. Thus, amplification of the waveform amplitude, using multimodal monitoring, and more appropriate interventions after an alarm may be particularly important in surgery for thoracic IDEM tumors.Level of Evidence: 3.
前瞻性多中心研究。
在硬脊膜外（IDEM）肿瘤的术中神经生理监测中检查颅外运动诱发电位（Tc-MEP）波形，重点关注颈椎、胸椎和圆锥病变的特征。
IDEM 肿瘤通常在切除后可治愈，但术后可能会出现神经功能恶化。术中使用 Tc-MEPs 进行神经生理监测对于及时发现可能的神经损伤非常重要。
本研究共纳入 233 例接受 Tc-MEP 监测的 IDEM 肿瘤手术患者，这些患者来自 9 个中心。报警阈值为基线≥70%的波形恶化。术后 Tc-MEP 警报正常且无新的运动功能障碍的病例定义为抢救病例。与术前相比，徒手肌力测试评分恶化≥1 定义为术后运动状态恶化。
233 例患者（92 例男性，39%）的平均年龄为 58.1±18.1 岁，185 例（79%）、46 例（20%）和 2 例（1%）分别患有神经鞘瘤、脑膜瘤和神经纤维瘤。这些病变在 82 例（35%）、96 例（41%）和 55 例（24%）患者中分别位于颈椎（C1-7）、胸椎（Th1-10）和圆锥（Th11-L2）。病变水平之间术前运动功能障碍无显著差异。胸椎病变的基线波形获得不良率明显更高（颈椎 0%，胸椎 6%，圆锥 0%，P<0.05），术中报警更频繁（20%、31%、15%，P<0.05）。Tc-MEPs 用于预测 IDEM 手术后的神经功能缺损的敏感性为 87%，特异性为 89%；然而，阳性预测值较低。
胸椎病变的波形获得不良、报警出现和最终波形更差的发生率明显更高。因此，对于胸椎 IDEM 肿瘤的手术，放大波形幅度、使用多模态监测以及在报警后进行更适当的干预可能特别重要。
3 级。
