Intraoperative Motor Evoked Potential Monitoring Improves Outcome after Surgery for Intramedullary Spinal Cord Tumor: A Historical Control Study

Sala, Francesco; Palandri, Giorgio; Basso, Enrico; Lanteri, Paola; Deletis, Vedran; Faccioli, Franco; Bricolo, Albino

doi:10.1093/neurosurgery/57.2.422b

Cited by 8 publications

(12 citation statements)

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“…14 Many reports show that if the D wave is lost during the removal of an intramedullary spinal cord tumour, the patient will suffer from profound, persistent motor deficit. 11,14,19 Recently Eck et al 20 reported that the possibility of recording intraoperatively evoked m-MEPs in sublesional muscles of an SCI patient correlates with a good motor outcome: this finding is similar to our patient no. 14 of Table 2.…”

Section: Discussionsupporting

confidence: 89%

“…Indeed, m-MEPs are, at times, completely lost during surgery for intramedullary spinal cord tumours but, if the D-wave amplitude is either stable or decreased by o50%, the patient will present additional transient motor deficit postoperatively but motor strength recovery after surgery, with a delay of hours or days. 11,14,19 This phenomenon ('transient paraplegia') is probably due to the surgically induced temporary inactivation of non-corticospinal descending tracts and propriospinal system, while fast-conducting corticospinal fibers are mostly preserved. 14 The speculative mechanism of transient Figure 6 Intraoperative MEPs of patient 13 of Table 3.…”

Section: Discussionmentioning

confidence: 99%

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Neurophysiological assessment of the injured spinal cord: an intraoperative approach

et al. 2014

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Study design: Prospective, observational study. Objectives: To assess the spinal cord function intraoperatively in subjects during spine stabilization for spinal cord trauma, by recording muscular (m-MEPs) and epidural motor evoked potentials (e-MEPs, D wave) along with cortical and epidural somatosensory evoked potentials (e-SEPs) and predicting the outcome of spinal cord injury (SCI). Setting: Regional Trauma Center, Torino, Italy. Methods: Fifty-five patients were intraoperatively studied during posterior spine stabilization surgery for traumatic SCI. In all, 21 of these had complete SCI, 14 an incomplete SCI-6 of them with central cord syndrome and 1 with central cord plus Brown Sequard syndrome-and 20 patients were neurologically uncompromised. Results: The neurophysiologic profile of the complete SCI was the absence of both m-MEPs and e-MEPs caudally to the lesion site, associated with a lack of cortical and e-SEPs cranially to the lesion site. None of these patients recovered motor function in the follow-up. A clearly detectable caudal D wave was associated with motor recovery even in deeply paraparetic patients. In one neurologically incomplete patient a reversible deterioration of m-MEPs and e-MEPs was observed during the compression-distraction manoeuvre. Conclusion: Intraoperative neurophysiological evaluation of SCI patients can provide information about spinal cord function that is not retrievable by other clinical means and can correctly predict neurological outcome. Intraoperative testing during early stabilization of the spine of deeply paraparetic SCI patients provides additional information about their neurological profile.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Neurophysiological assessment of the injured spinal cord: an intraoperative approach

et al. 2014

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“…[7] for a comprehensive review). Although there is general agreement as to the methodology to elicit both e-MEPs and m-MEPs, controversies do persist as to the indications for IOM with both e-MEPs and m-MEPs [6,[10][11][12][13][14][15][16]. Numerous studies have proposed that a combined recording of epidural and muscle MEPs be carried out during IMSCT surgery [6,[10][11][12][13] to predict motor outcome in the presence of deterioration/disappearance of LLm-MEPs, however, not all agree [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies have proposed the combined use of D wave recordings and m-MEPs in intramedullary spinal cord surgery [6,[10][11][12][13], however, not all literature is in agreement [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Relevance of intraoperative D wave in spine and spinal cord surgeries

2012

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Purpose The combined recordings of epidural-(D wave) and muscle motor evoked potentials (m-MEPs) have been proposed in many studies in intramedullary spinal cord tumour (IMSCT) surgery, although not all agree. Furthermore, the usefulness of the intraoperative monitoring of motor systems using these methods in other types of spine surgery has not yet been clearly confirmed. The aim of this study is to test the impact of intraoperative D wave on the monitorability and motor outcome in spine surgery. Methods Intraoperative recording of posterior tibial nerve somatosensory potentials, lower limb m-MEPs (LLmMEPs) and epidurally recorded D wave caudally to the surgical level was attempted in a total of 103 spine and spinal cord surgeries (23 IMSCT, 55 extramedullary spinal cord tumours and 25 myelopathies). Results There was a 97.1 %, overall monitorability where at least 1 of the 3 modalities was applicable in 100 surgical procedures. Baseline LLm-MEPs were recorded bilaterally in 85 cases and unilaterally in 11. A caudal D wave was recorded in 97 cases. Transient, or persistent intraoperative modifications occurred in 14/23 IMSCT, 5/55 extramedullary spinal cord tumours and in 2/25 myelopathies. The presence of a persistent stable caudal D wave was predictive of a good motor outcome even when the LL-MEPs were absent and/or when lost during surgery.Conclusions Not only is intraoperative D wave recording to be considered mandatory in IMSCT surgery but it should also be attempted in other types of spine/spinal cord surgeries.

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“…The combined use of epidural D-wave recording and muscle MEPs (mMEPs) is probably the optimal way to assess motor pathways during spinal cord surgery. 19 Applying absence/presence criteria and the epidural D-wave recording could reduce the rate of falsepositive results.…”

Section: Corrective Measures When Meps Deterioratementioning

confidence: 99%

Combined motor- and somatosensory-evoked potential monitoring for spine and spinal cord surgery: correlation of clinical and neurophysiological data in 85 consecutive procedures

et al. 2009

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Study design: Prospective study. Objectives: The primary objective of neurophysiological monitoring during surgery is to prevent permanent neurological sequelae. To avoid neurological injury, we applied somatosensory-evoked potentials (SEPs) and/or motor-evoked potentials (MEPs). We evaluated whether the combination of SEP and MEP for spinal surgery may be beneficial. Setting: Asian Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Methods: Combined SEP/MEP monitoring was attempted in 100 consecutive procedures for spinal operations. Trains of transcranial electrical stimulation over the motor cortex were used to elicit MEPs from the muscles of the upper/lower limbs. The tibial and median nerves were stimulated to record SEP. Results: Combined SEP/MEP recording was successfully achieved in 85 of 100 operations. In 61 of 85 operations (71%), SEP and MEP were stable, and all patients remained neurologically intact after surgery. Significant MEP changes were recorded in 20 operations, either combined with (n ¼ 4) or without (n ¼ 16) SEP changes. In 7 of these 20 operations, MEP recovered to some extent after surgical intervention, and these patients showed no neurological changes. In the remaining 13 operations, MEP did not recover and the patients had a transient (n ¼ 4) or a permanent (n ¼ 3) motor deficit. Significant SEP changes with stable MEP were observed in four operations, all of which were not related to postoperative motor deficit. Conclusion: Combined SEP/MEP monitoring provided higher sensitivity and higher positive/negative predictive value than single-modality monitoring techniques. Detection of MEP changes and adjustment of surgical strategy may prevent irreversible pyramidal tract damage.

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Intraoperative Motor Evoked Potential Monitoring Improves Outcome after Surgery for Intramedullary Spinal Cord Tumor: A Historical Control Study

Cited by 8 publications

References 0 publications

Neurophysiological assessment of the injured spinal cord: an intraoperative approach

Neurophysiological assessment of the injured spinal cord: an intraoperative approach

Relevance of intraoperative D wave in spine and spinal cord surgeries

Combined motor- and somatosensory-evoked potential monitoring for spine and spinal cord surgery: correlation of clinical and neurophysiological data in 85 consecutive procedures

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