Differences in Multimodality Intraoperative Neurophysiological Monitoring Changes Between Spinal Intramedullary Ependymoma and Hemangioblastoma

Kim, Dong‐Gun; Son, Yoori; Park, Young-Seop; Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib; Park, Kyung Seok

doi:10.1097/wnp.0000000000000247

Cited by 18 publications

(7 citation statements)

References 23 publications

(36 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present results partially correlate with those of former publications. [36][37][38][39][40][41][42][43] Although sensitivity and NPV were on a comparable level as our results in most studies, specificity and PPV differed widely. Some studies reported a specificity or PPV > 90%; ours differed markedly.…”

Section: Discussion Predictive Value Of Ionm During Resection Of Isctsupporting

confidence: 59%

Predictive Value of Transcranial Evoked Potential Monitoring for Intramedullary Spinal Cord Tumors

Ille

Wagner

Joerger

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

Background Intraoperative neurophysiologic monitoring (IONM) has increased patient safety and extent of resection in patients with eloquent brain tumors. Despite its comprehensive capability for the resection of intramedullary spinal cord tumors (ISCTs), the application during the resection of these tumors is controversial. Methods We retrospectively analyzed the resection of ISCTs in 83 consecutive cases. IONM was performed in all cases. Each patient's motor status and the McCormick scale was determined preoperatively, directly after surgery, at the day of discharge, and at long-term follow-up. Results IONM was feasible in 71 cases (85.5%). Gross total resection was performed in 75 cases (90.4%). Postoperatively, patients showed new transient deficits in 12 cases (14.5%) and new permanent deficits in 12 cases (14.5%). The mean McCormick variance between baseline and long-term follow-up was − 0.08 ± 0.54. IONM's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the patient's motor status at the day of discharge was 75.0%, 64.7%, 45.5%, and 86.8%. It was 88.9%, 59.7%, 24.2%, and 97.4% for the motor outcome at long-term follow-up. Patients experienced postoperative complications in 15 cases (18.1%). Conclusion IONM, as performed in the present study, shows a high sensitivity and NPV but low specificity and PPV, particularly for the patient's motor status at the long-term follow-up. As far as practicable by a retrospective study on IONM, our results confirm IONM's usefulness for its application during the resection of ISCTs. However, these results must be approved by a prospective study.

show abstract

Section: Discussion Predictive Value Of Ionm During Resection Of Isctsupporting

confidence: 59%

Predictive Value of Transcranial Evoked Potential Monitoring for Intramedullary Spinal Cord Tumors

Ille

Wagner

Joerger

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

show abstract

“…For postoperative neurologic deterioration, the alert criteria for intraoperative MEP changes vary from 50% to 75% in amplitude reduction [ 4 ]. Some studies included amplitude criterion in addition to the latency criterion for SEP monitoring [ 4 19 20 ]. The specific alarm criteria in our spine hospital are a more than 50% reduction in MEP amplitude, and a more than 10% of N20 or P37 latency prolongation for SEPs.…”

Section: Discussionmentioning

confidence: 99%

“…A follow-up study compared certain pathologic types of spinal cord tumors to identify which type easily affects the IONM alarm criteria [ 4 ]. Considering the signal pathways of MEPs and SEPs, the vulnerability to the tracts would differ by anatomical and pathologic types.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Neurophysiological Monitoring for Spinal Cord Tumor Surgery: Comparison of Motor and Somatosensory Evoked Potentials According to Tumor Types

Park

et al. 2017

Ann Rehabil Med

View full text Add to dashboard Cite

ObjectiveTo identify which combination of motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) is most reliable for postoperative motor deterioration during spinal cord tumor surgery, according to anatomical and pathologic type.MethodsMEPs and SEPs were monitored in patients who underwent spinal cord tumor surgery between November 2012 and August 2016. Muscle strength was examined in all patients before surgery, within 48 hours postoperatively and 4 weeks later. We analyzed sensitivity, specificity, positive and negative predictive values of each significant change in SEPs and MEPs.ResultsThe overall sensitivity and specificity of SEPs or MEPs were 100% and 61.3%, respectively. The intraoperative MEP monitoring alone showed both higher sensitivity (67.9%) and specificity (83.2%) than SEP monitoring alone for postoperative motor deterioration. Two patients with persistent motor deterioration had significant changes only in SEPs. There are no significant differences in reliabilities between anatomical types, except with hemangioma, where SEPs were more specific than MEPs for postoperative motor deterioration. Both overall positive and negative predictive values of MEPs were higher than the predictive values of SEPs. However, the positive predictive value was higher by the dual monitoring of MEPs and SEPs, compared to MEPs alone.ConclusionFor spinal cord tumor surgery, combined MEP and SEP monitoring showed the highest sensitivity for the postoperative motor deterioration. Although MEPs are more specific than SEPs in most types of spinal cord tumor surgery, SEPs should still be monitored, especially in hemangioma surgery.

show abstract

“…During resection of intramedullary, subdural and epidural tumors, MEP monitoring has become a true surgical technology ( 40 ). Recording and interpretation of MEPs is straightforward and fast.…”

Section: Discussionmentioning

confidence: 99%

“…Recording and interpretation of MEPs is straightforward and fast. During tumor separation procedures and during tumor resections, spinal cord and nerve roots may be damaged by vascular compromise, compression, traction or electric coagulation hemostasis ( 40 ). For detection of such potentially reversible damage, the function of the motor pathways must be assessed continuously with MEP monitoring.…”

Section: Discussionmentioning

confidence: 99%

Changes in transcranial electrical motor‑evoked potentials during the early and reversible stage of permanent spinal cord ischemia predict spinal cord injury in a rabbit animal model

et al. 2017

View full text Add to dashboard Cite

The present study examined changes in the transcranial electrical motor-evoked potentials (TceMEP) waveform to predict neurological deficits and histopathological changes during the early and reversible stage of different levels of permanent spinal cord ischemic injury in a rabbit animal model. A total of 24 New Zealand rabbits were randomly divided into four groups of 6 rabbits each. Group 1 underwent a ligation of the lumbar artery at three levels (L1-L3), group 2 underwent a ligation of the lumbar artery at four levels (L1-L4) and group 3 underwent a ligation of the lumbar artery at five levels (L1-L5). The sham group contained 6 rabbits and did not receive ligation. TceMEP was recorded within 5 min of ligation and, 2 days later, motor function was assessed and the spinal cords were removed for histological examination. Following spinal cord injury, the relationship between variations in the TceMEP waveform and motor function and pathological damage was analyzed. It was observed that the amplitude of TceMEP began to decrease within 1 min of lumbar artery ligation and that the amplitude stabilized within 5 min. These amplitude changes that occurred within 5 min of different levels of permanent spinal cord ischemic injury were positively related to changes in motor function following recovery from anesthesia and 2 days after ligation. The Pearson correlation coefficient was 0.980 and 0.923 for these two time points, respectively (P<0.001). In addition, the amplitude changes were positively related to pathological damage, with a Pearson correlation coefficient of 0.945 (P<0.001). The results of the present study suggested that amplitude changes in TceMEP are particularly sensitive to ischemia. Ischemia may be detected within 1 min and the amplitude changes begin to stabilize within 5 min following ligation of the lumbar artery. The use of intraoperative monitoring of TceMEP allows for the detection of spinal cord ischemic injury with no time delay, which may allow for protective measures to be taken to prevent the occurrence of irreversible spinal cord injury.

show abstract

Differences in Multimodality Intraoperative Neurophysiological Monitoring Changes Between Spinal Intramedullary Ependymoma and Hemangioblastoma

Cited by 18 publications

References 23 publications

Predictive Value of Transcranial Evoked Potential Monitoring for Intramedullary Spinal Cord Tumors

Predictive Value of Transcranial Evoked Potential Monitoring for Intramedullary Spinal Cord Tumors

Intraoperative Neurophysiological Monitoring for Spinal Cord Tumor Surgery: Comparison of Motor and Somatosensory Evoked Potentials According to Tumor Types

Changes in transcranial electrical motor‑evoked potentials during the early and reversible stage of permanent spinal cord ischemia predict spinal cord injury in a rabbit animal model

Contact Info

Product

Resources

About