Olmsted Zachary T, Ryu Brendan, Phayal Ganesh, Green Ross, Lo Sheng-Fu Larry, Sciubba Daniel M, Silverstein Justin W, D'Amico Randy S
Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, New York, USA.
Department of Neurology, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, New York, New York, USA.
World Neurosurg X. 2022 Sep 15;17:100139. doi: 10.1016/j.wnsx.2022.100139. eCollection 2023 Jan.
At present, surgical resection of primary intramedullary spinal cord tumors is the mainstay of treatment. However, given the dimensional constraints of the narrow spinal canal and dense organization of the ascending and descending tracts, intramedullary spinal cord tumor resection carries a significant risk of iatrogenic neurological injury. Intraoperative neurophysiological monitoring (IONM) and mapping techniques have been developed to evaluate the functional integrity of the essential neural pathways and optimize the surgical strategies. IONM can also inform on impending harm to at-risk structures and can correlate with postoperative functional recovery if damage has occurred. Direct waves (D-waves) will provide immediate feedback on the integrity of the lateral corticospinal tract. In the present review, we have provided an update on the utility of D-waves for spinal cord tumor resection. We have highlighted the neuroanatomical and neurophysiological insights from the use of D-wave monitoring, the technical considerations and limitations of the D-wave technique, and multimodal co-monitoring with motor-evoked potentials and somatosensory-evoked potentials. Together with motor-evoked potentials, D-waves can help to guide the extent of tumor resection and provide intraoperative warning signs and alarm criteria to direct the surgical strategy. D-waves can also serve as prognostic biomarkers for long-term recovery of postoperative motor function. We propose that the use of D-wave IONM can contribute key findings for clinical decision-making during spinal cord tumor resection.
目前，原发性脊髓髓内肿瘤的手术切除是主要治疗方法。然而，鉴于狭窄椎管的尺寸限制以及上下行神经束的密集排列，脊髓髓内肿瘤切除存在医源性神经损伤的重大风险。术中神经生理监测（IONM）和图谱技术已被开发出来，以评估重要神经通路的功能完整性并优化手术策略。IONM还可以提示对危险结构即将造成的损害，并且如果发生损伤，可与术后功能恢复情况相关联。直接波（D波）将对皮质脊髓侧束的完整性提供即时反馈。在本综述中，我们提供了关于D波在脊髓肿瘤切除中的应用的最新情况。我们强调了使用D波监测的神经解剖学和神经生理学见解、D波技术的技术考量和局限性，以及与运动诱发电位和体感诱发电位的多模式联合监测。与运动诱发电位一起，D波有助于指导肿瘤切除范围，并提供术中警示信号和警报标准以指导手术策略。D波还可作为术后运动功能长期恢复的预后生物标志物。我们提出，使用D波IONM可为脊髓肿瘤切除术中的临床决策提供关键发现。
