Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
Acta Neurochir (Wien). 2022 Oct;164(10):2595-2604. doi: 10.1007/s00701-022-05354-z. Epub 2022 Sep 6.
Microsurgical resection of spinal cord cavernous malformations can be assisted by intraoperative neurophysiological monitoring (IONM). While the clinical outcome after surgical resection has been discussed in several case series, the association of intraoperative IONM changes and detailed neurological outcome, however, has not been analyzed so far.
Seventeen patients with spinal cavernomas underwent surgery between 02/2004 and 06/2020. Detailed neurological and clinical outcome as well as IONM data including motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) monitoring were retrospectively analyzed. Intraoperative IONM changes were compared to outcome at 3-month and 1-year follow-up in order to identify surrogate parameters for an impending neurological deficit.
Compared to the preoperative state, McCormick score at 1-year follow-up remained unchanged in 12 and improved in five patients, none worsened, while detailed neurological examination revealed a new or worsened sensorimotor deficit in 4 patients. The permanent 80% amplitude reduction of MEP and 50% amplitude reduction of SSEP showed the best diagnostic accuracy with a sensitivity of 100% and 67% respectively and a specificity of 73% and 93% respectively. The relative risk for a new neurological deficit at 1-year follow-up, when reversible IONM-deterioration was registered compared to irreversible IONM deterioration, was 0.56 (0.23-1.37) for MEP deterioration and 0.4 (0.18-0.89) for SSEP deterioration.
Reversible IONM changes were associated with a better neurological outcome at follow-up compared to irreversible IONM deterioration during SCCM surgery. Our study favors the permanent 80% amplitude reduction criterion for MEP and 50% amplitude reduction criterion for SSEP for further prospective evaluation of IONM significance and the effectiveness of corrective maneuvers during SCCM surgeries.
术中神经生理监测（IONM）可辅助脊髓海绵状血管畸形的显微切除术。虽然已经有几项病例系列研究讨论了手术切除后的临床结果，但IONM 术中变化与详细神经预后之间的关系尚未得到分析。
2004 年 2 月至 2020 年 6 月期间，17 例脊髓海绵状血管畸形患者接受了手术治疗。回顾性分析了详细的神经和临床结果以及 IONM 数据，包括运动诱发电位（MEP）和体感诱发电位（SSEP）监测。将术中 IONM 变化与术后 3 个月和 1 年的随访结果进行比较，以确定即将出现神经功能缺损的替代参数。
与术前相比，1 年后 McCormick 评分保持不变的有 12 例，改善的有 5 例，无一例恶化，而详细的神经检查显示有 4 例出现新的或恶化的感觉运动功能障碍。MEP 永久 80%的振幅降低和 SSEP 永久 50%的振幅降低的诊断准确性最好，其灵敏度分别为 100%和 67%，特异性分别为 73%和 93%。与不可逆 IONM 恶化相比，当记录到可逆 IONM 恶化时，1 年后新的神经功能缺损的相对风险，对于 MEP 恶化是 0.56（0.23-1.37），对于 SSEP 恶化是 0.4（0.18-0.89）。
与 SCCM 手术期间不可逆的 IONM 恶化相比，可逆的 IONM 变化与随访时更好的神经预后相关。我们的研究倾向于永久性 MEP 振幅降低 80%和 SSEP 振幅降低 50%作为进一步评估 IONM 意义和 SCCM 手术中矫正措施有效性的标准。
