Intramedullary spinal cord tumors: the value of intraoperative neurophysiological monitoring in a series of 57 cases from two Italian centers

Cannizzaro, Delia; Mancarella, Cristina; Nasi, Davide; Tropeano, Maria Pia; Anania, Carla Daniela; Cataletti, Giovanni; Milani, Daniela; Fava, Enrica; Ghadirpour, Reza; Costa, Francesco; Servadei, Franco; Fornari, Maurizio

doi:10.23736/s0390-5616.19.04758-1

Cited by 16 publications

(15 citation statements)

References 37 publications

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“…The use of intraoperative electrophysiological monitoring is helpful in intramedullary tumors resection in order to minimize postoperative neurological de cits. [33] Our results suggest that surgical resection of spinal cord gliomas, even in ltrative gliomas, does not worsen neurological outcome. Surgical resection has been shown to improve survival in spinal cord gliomas in several clinical studies; however, the EOR continues to be a subject of ongoing debate.…”

Section: Discussionmentioning

confidence: 52%

The H3 K27-altered, Extent of Resection and Survival in Pediatric High-grade Spinal Cord Gliomas

Zhang

Fan

et al. 2022

Preprint

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Purpose Pediatric high-grade spinal cord gliomas (pHGSG) are classified into two prognostically meaningful subtypes. The purpose of our study is to describe clinical characteristics and management of two pHGSG subtypes, especially focus on the effect of surgical resection in these two subtypes. Methods We described the clinical characteristics and management and analyzed the prognostic factors of 19 pHGSGs. Based on H3 K27-altered and isocitrate dehydrogenase (IDH) mutation status, pHGSGs were classified into H3 K27-altered and H3/IDH-wildtype pHGSG for assessing effect of surgical resection. Results Nineteen patients (11 males and 8 females) with a mean age of 12.7 ± 4.7 years were included in the analysis. The median survival time of all patients was 14 months. Thirteen pHGSG patients had H3 K27-altered tumors, and 6 had H3/IDH-wildtype tumors. All patients received therapeutic surgical resection, 10 (55.6%) patients underwent gross total resection (GTR) and 8 (33.3%) patients underwent subtotal resection (STR). pHGSG patients with H3 K27-altered underwent GTR (HR 0.311, 95% CI 0.075–1.289, p = 0.091) had tended to increase overall survival. For patients of H3/IDH-wildtype pHGSG, there was no survival advantage associated with GTR (p = 0.157). Conclusions The extent of surgical resection has the different effects on survival in H3 K27-altered and H3/IDH-wildtype pHGSGs. The patients with H3 K27-altered pHGSG have tended to benefit from a greater extent of surgical resection. Nevertheless the benefit was not evident in the patients with H3/IDH-wildtype pHGSG.

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Section: Discussionmentioning

confidence: 52%

The H3 K27-altered, Extent of Resection and Survival in Pediatric High-grade Spinal Cord Gliomas

Zhang

Fan

et al. 2022

Preprint

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“…D-wave was the potential directly recorded from the spinal cord by the epidural electrode induced by transcranial stimulation and had also developed as a more stable option for TcMEP. In surgery of 57 IMSCTs, mIONM with TcMEP, SEP, and D-wave was the significant predictive factor of postoperative motor dysfunction (area under the curve (AUC) 0.98) and D-wave was more significant than Tc-MEP or SEP ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Prediction of Post-operative Long-Term Outcome of the Motor Function by Multimodal Intraoperative Neuromonitoring With Transcranial Motor-Evoked Potential and Spinal Cord-Evoked Potential After Microsurgical Resection for Spinal Cord Tumors

et al. 2022

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ObjectiveTo examine the effect of multimodal intraoperative neuromonitoring on the long-term outcome of motor function after microsurgical resection for spinal cord tumors.Materials and MethodsConsecutive fourteen patients with spinal tumors who were surgically treated at the University of Fukui Hospital between 2009 and 2020 [M:F = 10:4, ages ranging from 22 to 83 years (mean ± SD = 58 ± 21 years)] were included in this study. There were eight intra-axial tumors and six extra-axial tumors. There were four patients with hypertension, two patients with diabetes mellitus, and four patients with hyperlipidemia. Three patients were under antithrombotic medication, two were under steroid medication, four were current smokers, and four were current drinkers. Manual muscle test (MMT) of the upper and lower extremities of the patients was examined before surgery, 2 weeks after surgery, and at the final follow-up. The mean follow-up period was 38 ± 37 months. McCormick scores were examined before surgery and at the final follow-up. Microsurgical resection of the tumor was underwent through the posterior approach under transcranial motor-evoked potential (TcMEP) monitoring. The MEP of 46 extremities was recorded during the surgery. Gross total resection was achieved in 13 of 14 surgeries. Spinal cord-evoked potential (Sp-SCEP) monitoring was performed in eight of 14 patients.ResultsThe length of peritumoral edema was significantly longer in patients with deterioration of McCormick scores than in patients with preservation of McCormick scores (p = 0.0274). Sp-SCEP could not predict the deterioration. The ratio of MEP at the beginning of the surgery to that at the end of the surgery was the only significant negative factor that predicts deterioration of motor function of the extremity at the final follow-up (p = 0.0374, odds ratio [OR] 1.02E-05, 95% CI 9.13E+01–7.15E+18). A receiver operating characteristic (ROC) analysis revealed that the cutoff value of the ratio of MEP to predict the deterioration at the final follow-up was 0.23 (specificity 100%, specificity 88%, positive predictive value 100%, and negative predictive value 88%) to predict deterioration at the final follow-up.ConclusionsRatio MEP was the most significant negative factor to predict the deterioration of motor weakness at spinal tumor surgery. The setting of the cutoff value should be more strict as compared to the brain surgery and might be different depending on the institutions.

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“…Intramedullary tumors account for 2%-4% of central nervous system tumors and 10% of spinal tumors, with ependymomas and astrocytomas being the most frequent histological types. [1][2][3][4][5][6][7][8][9][10] These tumors are usually benign, slow growing and may extend to various segments of the spinal cord and have few specific symptoms because they usually evolve insidiously. [11][12][13][14][15][16] Even with the progress in surgical technique and intraoperative monitoring, postoperative prognostic factors are conflicting in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19][20][21][22][23][24][25][26][27][28] No prospective randomized high evidence study has been performed to date to compare clinical evolution after surgery with or without monitoring. [6,28] A recent meta-analysis failed to find a strong support for IONM use in spinal surgery. [23] On the other hand, there was a slight tendency to support IONM in IMSCT surgery.…”

Section: Discussionmentioning

confidence: 99%

“…They account for about 2%-4% of all central nervous system tumors and 20%-30% of all spinal cord tumors. [1][2][3][4][5][6][7][8][9][10] The most common type of IMSCT is ependymoma, followed by astrocytoma. [11][12][13][14][15][16][17][18][19][20][21][22] Pain manifested as back pain, radicular pain, or neuropathic pain has been reported to be the most common presenting symptom in patients with an IMSCT.…”

Section: Introductionmentioning

confidence: 99%

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Correlation of intraoperative neurophysiological parameters and outcomes in patients with intramedullary tumors

et al. 2021

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Introduction: Intramedullary spinal cord tumors (IMSCT) account for about 2%–4% of all central nervous system tumors. Surgical resection is the main treatment step, but might cause damage to functional tissues. Intraoperative neuromonitoring (IONM) is an adopted measure to decrease surgical complications. Below, we describe the results of IMSCT submitted to surgery under IONM at a tertiary institution. Methods: The sample consisted of consecutive patients with IMSCT admitted to the Neurological Institute of Curitiba from January 2007 to November 2016. A total of 47 patients were surgically treated. Twenty-three were male (48.9%) and 24 were female (51.1%). The mean age was 42.77 years. The mean follow-up time was 42.7 months. Results: Neurological status improved in 29 patients (62%), stable in 6 (13%), and worse in 12 (25%). Patients who presented with motor symptoms at initial diagnosis had a worse outcome compared to patients with sensory impairment and pain ( P = 0.026). Patients with a change in electromyography had worse neurological outcomes compared to patients who did not show changes in monitoring ( P = 0.017). Discussion and Conclusion: No prospective randomized high evidence study has been performed to date to compare clinical evolution after surgery with or without monitoring. In our sample, surgical resection was well succeeded mainly in oligosymptomatic patients with low preoperative McCormick classification and no worsening of IONM during surgery. We believe that microsurgical resection of IMSCT with simultaneous IONM is the gold standard treatment and achieved with good results.

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Intramedullary spinal cord tumors: the value of intraoperative neurophysiological monitoring in a series of 57 cases from two Italian centers

Cited by 16 publications

References 37 publications

The H3 K27-altered, Extent of Resection and Survival in Pediatric High-grade Spinal Cord Gliomas

The H3 K27-altered, Extent of Resection and Survival in Pediatric High-grade Spinal Cord Gliomas

Prediction of Post-operative Long-Term Outcome of the Motor Function by Multimodal Intraoperative Neuromonitoring With Transcranial Motor-Evoked Potential and Spinal Cord-Evoked Potential After Microsurgical Resection for Spinal Cord Tumors

Correlation of intraoperative neurophysiological parameters and outcomes in patients with intramedullary tumors

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