Jesse Christopher Marvin, Alvarez Abut Pablo, Wermelinger Jonathan, Raabe Andreas, Schär Ralph T, Seidel Kathleen
Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Cancers (Basel). 2022 Aug 18;14(16):3989. doi: 10.3390/cancers14163989.
Data on intraoperative neurophysiological monitoring (IOM) during spinal meningioma (SM) surgery are scarce. The aim of this study was to assess the role of IOM and its impact on post-operative functional outcome. Eighty-six consecutive surgically treated SM patients were included. We assessed pre and post-operative Modified McCormick Scale (mMCS), radiological and histopathological data and IOM findings. Degree of cord compression was associated with preoperative mMCS and existence of motor or sensory deficits (p < 0.001). IOM was used in 51 (59.3%) patients (IOM-group). Median pre and post-operative mMCS was II and I, respectively (p < 0.001). Fifty-seven (66.3%) patients showed an improvement of at least one grade in the mMCS one year after surgery. In the IOM group, only one patient had worsened neurological status, and this was correctly predicted by alterations in evoked potentials. Analysis of both groups found no significantly better neurological outcome in the IOM group, but IOM led to changes in surgical strategy in complex cases. Resection of SM is safe and leads to improved neurological outcome in most cases. Both complication and tumor recurrence rates were low. We recommend the use of IOM in surgically challenging cases, such as completely ossified or large ventrolateral SM.
关于脊髓脑膜瘤（SM）手术中神经生理监测（IOM）的数据很少。本研究的目的是评估IOM的作用及其对术后功能结局的影响。纳入了86例连续接受手术治疗的SM患者。我们评估了术前和术后改良麦考密克量表（mMCS）、放射学和组织病理学数据以及IOM结果。脊髓受压程度与术前mMCS以及运动或感觉功能缺损的存在相关（p<0.001）。51例（59.3%）患者使用了IOM（IOM组）。术前和术后mMCS的中位数分别为II级和I级（p<0.001）。57例（66.3%）患者在术后1年时mMCS至少提高了一个等级。在IOM组中，只有1例患者神经状态恶化，诱发电位的改变正确地预测了这一情况。对两组的分析发现，IOM组的神经结局没有明显更好，但IOM在复杂病例中导致了手术策略的改变。大多数情况下，SM切除术是安全的，并且能改善神经结局。并发症和肿瘤复发率均较低。我们建议在手术难度较大的病例中使用IOM，例如完全骨化的或大型腹外侧SM。
