Intraoperative Spinal Cord Monitoring for Intramedullary Surgery: An Essential Adjunct

Kothbauer, Karl F.; Deletis, Vedran; Epstein, Fred J.

doi:10.1159/000121199

Cited by 211 publications

(108 citation statements)

References 21 publications

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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%

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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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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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“…Radical resection can be safely pursued when the tumor shows clearly delineated margin. Further safety from intraoperative neurological injury is brought by the addition of neurophysiological monitoring into the surgical armamentarium [39,75]. More extensive resection was not associated with neurological decline after surgery [9,11,34,46] (Table 17), preoperative neurological function was the most important parameter for favorable functional outcome [6, 8, 9, 11, 13-15, 26, 41, 51, 52, 57, 62].…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors in intramedullary astrocytomas: a literature review

2009

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Astrocytomas affect a significant portion of patients with intramedullary tumors. These infiltratively growing tumors are treated by a variety of methods-biopsy and decompressive surgery, maximal safe resection, adjuvant oncological therapy. Also, numerous prognostic factors are reported in the literature. Better understanding of factors that influence prognosis may help in treatment planning with the goal of prolonging survival. We have thus undertaken an extensive literature review in order to define factors affecting prognosis. A total of 38 articles were studied. Only tumor grade was consistently reported as the major factor affecting prognosis. The influence of other clinical factors (age, gender, history length, functional status, tumor location or extent, syrinx or cyst presence) can be speculated upon, but cannot be assessed adequately from the available literature. For both low-and high-grade (HG) astrocytomas, maximal safe tumor resection should be the primary treatment objective but is often not feasible in contrast to other intramedullary and spinal neoplasms. Since the biological nature of spinal cord HG glioma is identical to that of the brain, the same treatment algorithm of maximal safe resection followed by concomitant radio-and chemotherapy would be sensible to implement.

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“…IONM is increasingly being used in operative treatment of spinal cord lesions (39)(40)(41). We monitored SSEPs and MEPs in all 3 patients.…”

Section: Ionmmentioning

confidence: 99%

Operative Treatment of Anterior Thoracic Spinal Cord Herniation

Groen

Middel

Meilof

et al. 2009

Operative Neurosurgery

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Anterior thoracic spinal cord herniation is a rare cause of progressive myelopathy. Much has been speculated about the best operative treatment. However, no evidence in favor of any of the promoted techniques is available to date. Therefore, we decided to analyze treatment procedures and treatment outcomes of anterior thoracic spinal cord herniation to identify those factors that determine postoperative outcome. METHODS: An individual patient data meta-analysis was conducted, focusing on age, gender, vertebral segment of herniation, preoperative neurological status, operative interval, operative findings, operative techniques, intraoperative neurophysiological monitoring, postoperative imaging, neurological outcome and follow-up. Three cases from our own institution were added to the material collected. Bivariate analysis tests and multivariate logistic regression tests were used so as to define which variables were associated with outcome after surgical treatment of anterior thoracic spinal cord herniation. RESULTS: Brown-Séquard syndrome and release of the herniated spinal cord appeared to be strong independent factors, associated with favorable postoperative outcome. Widening of the dura defect is associated with the highest prevalence of postoperative motor function improvement when compared with the application of an anterior dura patch (P Ͻ 0.036). CONCLUSION: Most patients with anterior thoracic spinal cord herniation require operative treatment because of progressive myelopathy. Patients with Brown-Séquard syndrome have a better prognosis with respect to postoperative motor function improvement. In this review, spinal cord release and subsequent widening of the dura defect were associated with the highest prevalence of motor function improvement. D-wave recording can be a very useful tool for the surgeon during operative treatment of this disorder.

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Intraoperative Spinal Cord Monitoring for Intramedullary Surgery: An Essential Adjunct

Cited by 211 publications

References 21 publications

Relevance of intraoperative D wave in spine and spinal cord surgeries

Relevance of intraoperative D wave in spine and spinal cord surgeries

Prognostic factors in intramedullary astrocytomas: a literature review

Operative Treatment of Anterior Thoracic Spinal Cord Herniation

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