Tropeano Maria Pia, Rossini Zefferino, Franzini Andrea, Capo Gabriele, Olei Simone, De Robertis Mario, Milani Daniela, Fornari Maurizio, Pessina Federico
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy.
Neurosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
Cancers (Basel). 2023 Dec 25;16(1):111. doi: 10.3390/cancers16010111.
The study aimed at evaluating the efficacy and the ability of D-wave monitoring combined with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) to predict functional outcomes in intramedullary spinal cord tumor (IMSCT) surgery.
Between December 2011 and December 2020, all patients harboring IMSCT who underwent surgery at our institution were prospectively collected in a surgical spinal registry and retrospectively analyzed. Patient charts and surgical and histological reports were analyzed. The multimodal IONM included SSEPs, MEPs, and-whenever possible-D-waves. All patients were evaluated using the modified McCormick and Frankel grade at admission and 3, 6, and 12 months of follow-up.
Sixty-four patients were enrolled in the study. SSEP and MEP monitoring was performed in all patients. The D-wave was not recordable in seven patients (11%). Significant IONM changes (at least one evoked potential modality) were registered in 26 (41%) of the 64 patients. In five cases (8%) where the SSEPs and MEPs lost and the D-wave permanently dropped by about 50%, patients experienced a permanent deterioration of their neurological status. Multimodal IONM (SSEP, MEP, and D-wave neuromonitoring) significantly predicted postoperative deficits ( = 0.0001), with a sensitivity of 100.00% and a specificity of 95.65%. However, D-waves demonstrated significantly higher sensitivity (100%) than MEPs (62.5%) and SSEPs (71.42%) alone. These tests' specificities were 85.10%, 13.89%, and 17.39%, respectively. Comparing the area under ROC curves (AUCs) of these evoked potentials in 53 patients (where all three modalities of IONM were registered) using the pairwise -test, D-wave monitoring appeared to have higher accuracy and ability to predict postoperative deficits with strong statistical significance compared with MEP and SSEP alone (0.992 vs. 0.798 vs. 0.542; = 0.018 and < 0.001).
The use of multimodal IONM showed a statistically significant greater ability to predict postoperative deficits compared with SSEP, MEP, and D-wave monitoring alone. D-wave recording significantly increased the accuracy and clinical value of neurophysiological monitoring in IMSCT tumor resection.
本研究旨在评估D波监测联合体感诱发电位（SSEPs）和运动诱发电位（MEPs）预测髓内脊髓肿瘤（IMSCT）手术功能预后的疗效和能力。
2011年12月至2020年12月期间，在我院接受手术的所有患有IMSCT的患者均被前瞻性纳入手术脊柱登记册并进行回顾性分析。分析患者病历以及手术和组织学报告。多模式术中神经监测包括SSEPs、MEPs以及尽可能记录的D波。所有患者在入院时以及随访3、6和12个月时使用改良的麦考密克和弗兰克尔分级进行评估。
64例患者纳入本研究。所有患者均进行了SSEP和MEP监测。7例患者（11%）无法记录到D波。64例患者中有26例（41%）出现了显著的术中神经监测变化（至少一种诱发电位模式）。在5例（8%）患者中，SSEPs和MEPs消失且D波永久性下降约50%，这些患者的神经功能出现了永久性恶化。多模式术中神经监测（SSEP、MEP和D波神经监测）显著预测了术后神经功能缺损（P = 0.0001），敏感性为100.00%，特异性为95.65%。然而，单独D波的敏感性（100%）显著高于MEP（62.5%）和SSEP（71.42%）。这些检测的特异性分别为85.10%、13.89%和17.39%。使用成对检验比较53例患者（记录了所有三种术中神经监测模式）中这些诱发电位的ROC曲线下面积（AUCs），与单独的MEP和SSEP相比，D波监测在预测术后神经功能缺损方面似乎具有更高的准确性和能力，具有很强的统计学意义（0.992对0.798对0.542；P = 0.018和P < 0.001）。
与单独的SSEP、MEP和D波监测相比，使用多模式术中神经监测在预测术后神经功能缺损方面具有统计学上显著更强的能力。D波记录显著提高了IMSCT肿瘤切除术中神经生理监测的准确性和临床价值。
