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

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

doi:10.1227/01.neu.0000215948.97195.58

Cited by 382 publications

(259 citation statements)

References 75 publications

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“…In recent years, intraoperative spinal eMEP recording has proven very valuable in spinal cord tumor surgery because it allows monitoring of D waves and the intraoperative decrease in its amplitude (41,50). The major advantage of combined mMEP and eMEP monitoring is that it identifies impairment of the functional integrity of the motor pathways before a permanent deficit has occurred (38,40,41,70).…”

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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Section: Ionmmentioning

confidence: 99%

Operative Treatment of Anterior Thoracic Spinal Cord Herniation

Groen

Middel

Meilof

et al. 2009

Operative Neurosurgery

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“…Although MEPs are well established for the early detection of impending motor deficit during surgery of cranial procedures [10,11,14,17,19] and the spinal cord [1,5,15,16], for brainstem surgery a warning criterion has not yet become generally accepted.…”

Section: Introductionmentioning

confidence: 99%

Motor-evoked potentials (MEP) during brainstem surgery to preserve corticospinal function

Sarnthein

Bozinov²,

Melone

et al. 2011

Acta Neurochir

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Brainstem surgery bears a risk of damage to the corticospinal tract (CST). Motor-evoked potentials (MEPs) are used intraoperatively to monitor CST function in order to detect CST damage at a reversible stage and thus impede permanent neurological deficits. While the method of MEP is generally accepted, warning criteria in the context of brainstem surgery still have to be agreed on. Conclusions: Adjustment of surgical strategy contributed to good motor outcome in 33/39 patients. MEP monitoring may help significantly to prevent motor deficits during demanding neurosurgical procedures on the brainstem.

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“…LR between 1 and 2 and between 0.5-1 rarely alter pretest probability. 6 Despite traditional spinal IOM literature suggests that NIOM is effective in identifying patients at a high risk for sustaining new spinal cord injuries [7][8][9][10][11][12][13][14][15] as well as animal research has supported human experience, [16][17][18] there is a heterogeneity in IOM services and this should be reviewed to see what accounts for the difference in false-positive and false-negative cases in the literature.…”

Section: Resultsmentioning

confidence: 99%