Utility of Intraoperative Monitoring in the Resection of Spinal Cord Tumors

Lakomkin, Nikita; Mistry, Akshitkumar M.; Zuckerman, Scott L.; Ladner, Travis R.; Kothari, Parth; Lee, Nathan John; Stannard, Blaine; Vasquez, Raul A.; Cheng, Joseph

doi:10.1097/brs.0000000000002300

Cited by 41 publications

(31 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To the best of our knowledge, the rate and determinants of D-wave recording in patients with IDEM tumors have not been specifically evaluated until now. 3,7,9,13,[15][16][17] Only Costa et al, 3 in their analysis of SSEP, MEP, and D-wave monitoring in 103 spinal cord procedures (23 ISCTs, 55 IDEM tumors, and 25 myelopathies), reported a 97.1% rate of D-wave monitorability. Indeed, caudal D-wave tracings were obtained in 97 patients and resulted in the most recordable intraoperative neurophysiological parameter in this study, even in compromised patients in whom baseline MEPs were absent.…”

Section: Monitorability Of D-wavesmentioning

confidence: 99%

“…The few studies that have assessed the utility of IONM during IDEM tumor surgery either did not report the use of Dwaves or reported D-waves only sporadically in a limited cohort of patients. 3,7,9,13,[15][16][17] The purposes of this study were to 1) investigate the rate of IONM ability, especially of D-waves, and evaluate the preoperative factors predicting the possibility of Dwave recording; 2) assess the accuracy of IONM (SSEPs, MEPs, and D-waves) in predicting new postoperative neurological deficits after IDEM tumor resection and statistically compare the accuracy of the 3 modalities by using receiver operating characteristic (ROC) curves; and 3) identify the subgroup of patients with IDEM tumors who are at the highest risk of evoked potential changes during surgery based on uni-and multivariate analyses and who can benefit most from the use of IONM.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Intraoperative neurophysiological monitoring for intradural extramedullary spinal tumors: predictive value and relevance of D-wave amplitude on surgical outcome during a 10-year experience

Ghadirpour¹,

Nasi

Iaccarino³

et al. 2019

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

OBJECTIVEThe purpose of this study was to evaluate the technical feasibility, accuracy, and relevance on surgical outcome of D-wave monitoring combined with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during resection of intradural extramedullary (IDEM) spinal tumors.METHODSClinical and intraoperative neurophysiological monitoring (IONM) data obtained in 108 consecutive patients who underwent surgery for IDEM tumors at the Institute for Scientific and Care Research “ASMN” of Reggio Emilia, Italy, were prospectively entered into a database and retrospectively analyzed. The IONM included SSEPs, MEPs, and—whenever possible—D-waves. All patients were evaluated using the modified McCormick Scale at admission and at 3, 6, and 12 months of follow-up .RESULTSA total of 108 patients were included in this study. A monitorable D-wave was achieved in 71 of the 77 patients harboring cervical and thoracic IDEM tumors (92.2%). Recording of D-waves in IDEM tumors was significantly associated only with a preoperative deeply compromised neurological status evaluated using the modified McCormick Scale (p = 0.04). Overall, significant IONM changes were registered in 14 (12.96%) of 108 patients and 9 of these patients (8.33%) had permanent loss of at least one of the 3 evoked potentials. In 7 patients (6.48%), the presence of an s18278 caudal D-wave was predictive of a favorable long-term motor outcome even when the MEPs and/or SSEPs were lost during IDEM tumor resection. However, in 2 cases (1.85%) the D-wave permanently decreased by approximately 50%, and surgery was definitively abandoned to prevent permanent paraplegia. Cumulatively, SSEP, MEP, and D-wave monitoring significantly predicted postoperative deficits (p = 0.0001; AUC = 0.905), with a sensitivity of 85.7% and a specificity of 97%. Comparing the area under the receiver operating characteristic curves of these tests, D-waves appeared to have a significantly greater predictive value than MEPs and especially SSEPs alone (0.992 vs 0.798 vs 0.653; p = 0.023 and p < 0.001, respectively). On multiple logistic regression, the independent risk factors associated with significant IONM changes in the entire population were age older than 65 years and an anterolateral location of the tumor (p < 0.0001).CONCLUSIONSD-wave monitoring was feasible in all patients without severe preoperative motor deficits. D-waves demonstrated a statistically significant higher ability to predict postoperative deficits compared with SSEPs and MEPs alone and allowed us to proceed with IDEM tumor resection, even in cases of SSEP and/or MEP loss. Patients older than 65 years and with anterolateral IDEM tumors can benefit most from the use of IONM.

show abstract

Section: Monitorability Of D-wavesmentioning

confidence: 99%

mentioning

confidence: 99%

Intraoperative neurophysiological monitoring for intradural extramedullary spinal tumors: predictive value and relevance of D-wave amplitude on surgical outcome during a 10-year experience

Ghadirpour¹,

Nasi

Iaccarino³

et al. 2019

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

show abstract

“…In a review by Scibilia, et al on the use of intraoperative neuromonitoring in the specific scenario of spinal tumors, the authors came to the conclusion that neuromonitoring is a useful technology to aid in providing patients with adequate postoperative outcomes [ 20 ]. Other studies assessing the effect of neuromonitoring in spinal tumor surgery demonstrate that motor evoked potentials and multi-modal monitoring did not accurately provide predictive value for permanent functional deficits [ 21 ]. Significant changes occur most frequently in intramedullary lesions [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Neurophysiological Intraoperative Monitoring during Spinal Cord and Spine Surgery: A Critical Analysis of 121 Cases

Ibrahim

Mrowczynski

Zalatimo

et al. 2017

Cureus

View full text Add to dashboard Cite

Neuromonitoring has been utilized during spinal surgery to assess the function of the spinal cord in an effort to prevent intraoperative injury. Although its use is widespread, no clear benefit has been demonstrated. Our goal in this study was to interrogate the value of intraoperative neuromonitoring in decreasing the severity and rate of neurological injury during and after spinal surgery. Here we describe our experience of 121 patients who underwent spinal cord procedures with the combination of intraoperative neuromonitoring, to determine its ability to detect neurological changes and the specificity and sensitivity in this setting. The data for the 121 patients who underwent neurophysiological monitoring during various spinal procedures was collected retrospectively. The patients were classified into one of four groups according to the findings of intraoperative monitoring and the clinical outcomes on postoperative neurological exam. Intraoperative monitoring was evaluated for its specificity, sensitivity, and predictive value. In our cohort of 121 patients, the use of intraoperative neuromonitoring had a low sensitivity, which may produce an excessive number of false negatives. Based on these findings, neuromonitoring seems to have a poor positive predictive value and is thus an inappropriate test to prevent harm to patients.

show abstract

“…This might argue for using MEPs only during the cases with the highest risk (i.e., the highest prevalence) of postoperative neurologic deficit, which should lead to a higher PPV and thus greater utility for the surgeon. However, the existing literature has not shown a clear benefit to monitoring in cases such as spinal cord tumor resection [15][16][17].…”

Section: Intraoperative Mep Changesmentioning

confidence: 99%

The Significance of Motor Evoked Potential Changes and Utility of Multimodality Intraoperative Monitoring in Spinal Surgery: A Retrospective Analysis of Consecutive Cases at a Single Institution

Frazzetta¹,

Hofler²,

Adams³

et al. 2020

Cureus

View full text Add to dashboard Cite

Utility of Intraoperative Monitoring in the Resection of Spinal Cord Tumors

Abstract: 4.

Cited by 41 publications

References 24 publications

Intraoperative neurophysiological monitoring for intradural extramedullary spinal tumors: predictive value and relevance of D-wave amplitude on surgical outcome during a 10-year experience

Intraoperative neurophysiological monitoring for intradural extramedullary spinal tumors: predictive value and relevance of D-wave amplitude on surgical outcome during a 10-year experience

The Impact of Neurophysiological Intraoperative Monitoring during Spinal Cord and Spine Surgery: A Critical Analysis of 121 Cases

The Significance of Motor Evoked Potential Changes and Utility of Multimodality Intraoperative Monitoring in Spinal Surgery: A Retrospective Analysis of Consecutive Cases at a Single Institution

Contact Info

Product

Resources

About