Jiang Weichao, Yang Xiaocui, Lin Lihui, Wu Siqi, Hu Yahui, Su Zirui, Xiao Deyong, Guo Jianfeng, Wang Zhan-Xiang
Department of Neurosurgery and Department of Neuroscience, Fujian Key Laboratory of Brain Tumors Diagnosis and Precision Treatment, Xiamen Key Laboratory of Brain Center, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.
Acta Neurochir (Wien). 2025 Jan 27;167(1):26. doi: 10.1007/s00701-025-06433-7.
To investigate the technique for dorsal median sulcus (DMS) mapping and assess its application value in preserving dorsal columnn (DC) function during intramedullary space occupying surgery based on a single-center experience.
A retrospective analysis was conducted on 41 cases of intramedullary spinal cord tumor admitted to the Department of Neurosurgery at the First Affiliated Hospital of Xiamen University from March 2017 to August 2023. All included cases underwent intraoperative electrophysiological monitoring, and were divided into a study group (n = 18) and a control group (n = 23), based on whether DMS mapping technique was utilized. The general and clinical data, intraoperative electrophysiological monitoring data, and changes in patients' deep sensory function before and after surgery were collected. The postoperative neurological function protection of the two groups of patients with intramedullary spinal cord tumor was compared.
The present study introduces a technique for DMS mapping through the dorsal region stimulation. The amplitude and waveform of somatosensory evoked potentials (SEPs) recorded by the nerve stimulation probe consistently exhibited patterns relative to the dorsal column. This method demonstrated stable localization of the DMS during surgical procedures in all cases (18/18). Furthermore, compared to the double fork bipolar neurostimulator, the concentric bipolar neurostimulator induced SEPs with higher amplitudes in the dorsal column. There was no significant difference in tumor resection duration between the two groups, while postoperative hospitalization duration was shorter in the study group than in control group. During incision of dorsal column, SEP deterioration rate was 0/18 in study group and 4/23 in control group. During the procedure of tumor resection, the rate of deterioration in SEP was 5/18 in the study group and 9/23 in the control group. One week and three months post-surgery, the rate of decline in deep sensation in lower limbs was 4/18 and 3/18 respectively for the study group, while it was 8/23 and 9/23 for the control group.
The technique of DMS mapping is both stable and feasible, can assist the surgeon in accurately identifying the position of the posterior median sulci of the spinal cord and performing a precise dorsal columnotomy along the electrophysiological midline. This method holds great potential in enhancing the preservation of deep sensory function in patients' lower limbs post-surgery, thereby enabling them to benefit from the technique. Additionally, SEP Mapping of dorsal column aids in comprehending their function and facilitating rapid localization. Consequently, this approach introduces a novel neuroprotective measure for multimodal electrophysiological monitoring during intramedullary space occupying surgery.
基于单中心经验，探讨脊髓背正中沟（DMS）定位技术，并评估其在髓内占位手术中保留脊髓后索（DC）功能的应用价值。
回顾性分析2017年3月至2023年8月厦门大学附属第一医院神经外科收治的41例髓内脊髓肿瘤患者。所有纳入病例均接受术中电生理监测，并根据是否采用DMS定位技术分为研究组（n = 18）和对照组（n = 23）。收集患者的一般资料、临床资料、术中电生理监测数据以及手术前后患者深感觉功能的变化。比较两组髓内脊髓肿瘤患者术后神经功能的保护情况。
本研究介绍了一种通过背侧区域刺激进行DMS定位的技术。神经刺激探头记录的体感诱发电位（SEP）的波幅和波形始终呈现出与脊髓后索相关的模式。该方法在所有病例（18/18）的手术过程中均显示出DMS定位稳定。此外，与双叉双极神经刺激器相比，同心双极神经刺激器在脊髓后索诱发的SEP波幅更高。两组肿瘤切除时间无显著差异，而研究组术后住院时间短于对照组。在切开脊髓后索时，研究组SEP恶化率为0/18，对照组为4/23。在肿瘤切除过程中，研究组SEP恶化率为5/18，对照组为9/23。术后1周和3个月，研究组下肢深感觉下降率分别为4/18和3/18，而对照组分别为8/23和9/23。
DMS定位技术稳定可行，可协助术者准确识别脊髓后正中沟的位置，并沿电生理中线进行精确的脊髓后索切开术。该方法在提高患者术后下肢深感觉功能保留方面具有巨大潜力，从而使患者受益于该技术。此外，脊髓后索SEP定位有助于了解其功能并便于快速定位。因此，该方法为髓内占位手术中的多模态电生理监测引入了一种新的神经保护措施。
