Patel Mayur S, Botterbush Kathleen S, Lackland Tyler N, Prim Michael, Al-Hammadi Noor, Shorey Matthew, Mattei Tobias A, Mercier Philippe A
Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, 1008 South Spring Ave., Saint Louis, MO, 63110, USA.
Department of Neurosurgery, Banner-University Medical Center Phoenix, Phoenix, USA.
Childs Nerv Syst. 2025 Jan 31;41(1):96. doi: 10.1007/s00381-024-06738-5.
Posterior fossa decompression is currently an operative treatment of choice for Chiari Malformation I (CM1). However, there is controversy surrounding the possible benefits of employing intraoperative neuromonitoring (INM) for this type of procedure. In addition to presenting our single-center experience on the use of INM, we analyze the cost associated with INM in Chiari Malformation (CM) decompression surgery using the Healthcare Cost and Utilization Project (HCUP) database and discuss the legal implications of somatosensory evoked potentials (SSEP) monitoring during decompression for CM1.
We conducted a retrospective review of all patients undergoing CM1 decompression with SSEP neuromonitoring from 2011 to 2018. We collected patient characteristics, hospital charges, and surgical cost data from the HCUP database for patients undergoing CM decompression. Finally, we performed a review within the Thompson Reuters Westlaw Edge database for reported litigation involving INM for CM decompression.
None of the 110 patients submitted to surgery for CM1 at our institution had any significant SSEP changes intraoperatively or developed post-operative neurological deterioration. There were higher mean total hospital charges and surgical costs associated with INM ($31,272) for patients who received INM compared to patients who did not receive INM ($24,112). A careful review of the Westlaw database with multiple-word search strategies revealed no reported medical malpractice claims regarding the absence of SSEP neuromonitoring in a CM decompression procedure.
Using data collected at our institution and the HCUP national database, we showed that intraoperative neuromonitoring did not affect surgical planning and decision-making or post operative care, while adding unnecessary costs to CM decompression procedures. The absence of reported malpractice claims targeting the lack of neuromonitoring in CM cases suggests that SSEP neuromonitoring during CM may be unnecessary. We propose that neuromonitoring should not be used for routine CM decompression.
后颅窝减压术目前是治疗Ⅰ型 Chiari 畸形（CM1）的首选手术方法。然而，对于此类手术中使用术中神经监测（INM）的潜在益处存在争议。除了介绍我们单中心使用 INM 的经验外，我们还利用医疗成本与利用项目（HCUP）数据库分析了 Chiari 畸形（CM）减压手术中与 INM 相关的成本，并讨论了 CM1 减压过程中体感诱发电位（SSEP）监测的法律意义。
我们对 2011 年至 2018 年期间接受 CM1 减压并进行 SSEP 神经监测的所有患者进行了回顾性研究。我们从 HCUP 数据库中收集了接受 CM 减压患者的患者特征、医院收费和手术成本数据。最后，我们在汤森路透 Westlaw Edge 数据库中对报道的涉及 CM 减压 INM 的诉讼进行了审查。
在我们机构接受 CM1 手术的 110 例患者中，术中均未出现任何显著的 SSEP 变化，术后也未发生神经功能恶化。与未接受 INM 的患者（24,112 美元）相比，接受 INM 的患者的平均总医院收费和手术成本更高（31,272 美元）。通过多词搜索策略对 Westlaw 数据库进行仔细审查后发现，没有关于 CM 减压手术中未进行 SSEP 神经监测的医疗事故索赔报告。
利用我们机构收集的数据和 HCUP 国家数据库，我们表明术中神经监测不会影响手术规划、决策或术后护理，同时却给 CM 减压手术增加了不必要的成本。没有针对 CM 病例中缺乏神经监测的医疗事故索赔报告，这表明 CM 手术期间的 SSEP 神经监测可能是不必要的。我们建议神经监测不应常规用于 CM 减压。
Zotero 插件