The Neurosurgery Department, Rambam (Maimonides) Health Care Campus, Haifa, Israel.
The Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Neurosurg Rev. 2022 Apr;45(2):1481-1490. doi: 10.1007/s10143-021-01667-2. Epub 2021 Oct 11.
Resection of meningiomas adjacent to the central sulcus entails a high rate of morbidity. Explored for intra-axial lesion resection, intraoperative neuromonitoring intraoperative neuromonitoring (IONM) has been shown to decrease neurological deficits. The use of IONM is relatively uncommon and is not considered routine practice in the removal of extra-axial lesions. We sought to characterize IONM's impact on the surgical workflow in supratentorial meningiomas.
We retrospectively analyzed a prospectively collected database, searching cases in which IONM was used for resection of meningioma between 2017 and 2020. We classified the IONM effect on surgical workflow into 5 distinct categories of workflow changes (WFC).
Forty cases of meningiomas with IONM use were identified. In 1 case (class 1 WFC), the operation was stopped due to IONM input. In 5 cases (class 2 WFC), the tumor was incompletely resected due to input from the IONM. In 14 cases (35%), IONM leads to an alteration of the resection process (alteration of approach, class 3 WFC). In 4 cases (10%), anesthesia care was modified based on IONM input (class 4 WFC). In 16 cases, no changes were made (class 5 WFC). In all patients in whom a change was made (24 cases, WFC 1-4), only 8.3% suffered a temporary deficit, and there were no permanent deficits, whereas when no change was made, there were 18.75% temporary deficit and 6.25% permanent deficit.
IONM has an impact during resection of meningiomas in eloquent areas and may guide the surgical technique, approach to tumor resection, and extent of resection.
中央沟附近脑膜瘤的切除会导致很高的发病率。在轴内病变切除中探索术中神经监测（IONM）已被证明可以降低神经功能缺损。IONM 的使用相对较少，在轴外病变切除中不被认为是常规做法。我们试图描述 IONM 对幕上脑膜瘤手术流程的影响。
我们回顾性分析了一个前瞻性收集的数据库，搜索了 2017 年至 2020 年间使用 IONM 切除脑膜瘤的病例。我们将 IONM 对手术流程的影响分为 5 种不同的工作流程变化（WFC）类别。
确定了 40 例使用 IONM 的脑膜瘤病例。在 1 例（WFC 1 类）中，由于 IONM 的输入，手术停止。在 5 例（WFC 2 类）中，由于 IONM 的输入，肿瘤未完全切除。在 14 例（35%）中，IONM 导致切除过程发生改变（改变手术入路，WFC 3 类）。在 4 例（10%）中，根据 IONM 的输入修改了麻醉护理（WFC 4 类）。在 16 例中，没有发生变化（WFC 5 类）。在所有发生变化的患者（24 例，WFC 1-4 类）中，只有 8.3%出现暂时缺陷，没有永久性缺陷，而在没有发生变化的情况下，有 18.75%出现暂时缺陷和 6.25%出现永久性缺陷。
IONM 在语言区脑膜瘤切除过程中有一定影响，可以指导手术技术、肿瘤切除方法和切除范围。
