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Published in: Acta Neurochirurgica 12/2015

01-12-2015 | Experimental research - Spine

Multimodal intraoperative monitoring during intramedullary spinal cord tumor surgery

Authors: Seung-Hyun Jin, Chun Kee Chung, Chi Heon Kim, Young Doo Choi, Gilho Kwak, Bo Eun Kim

Published in: Acta Neurochirurgica | Issue 12/2015

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Abstract

Background

The aim of this work is to evaluate the utility of multimodal intraoperative monitoring (IOM) during intramedullary spinal cord tumor (IMSCT) surgery in our institution, and to investigate which IOM events are likely to be encountered during critical surgical phases.

Methods

Twenty-five patients who underwent IMSCT surgery with IOM were included in this study. Our multimodal IOM assessment included SSEP, mMEP, and fEMG monitoring. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity were assessed 24 h and 1 month after surgery. The IOM events during three main surgical phases were also investigated. For mMEP assessment, two warning criteria (>50 % decrease in mMEP amplitude and all-or-none mMEP amplitude presence) were employed.

Results

Long-term outcome prediction was better when the all-or-none criterion was applied than when the >50 % amplitude decrease criterion was applied. Based on the all-or-none criterion, the PPV, NPV, sensitivity, and specificity were 60, 100, 100, and 91 %. Frequent IOM events were observed during the three major main surgical phases. Seven (29 %) patients showed SSEP events during opening of the spinal cord. During tumor removal, 21 of 25 patients (84 %) had IOM events, and 13 of 18 (72 %) of the fEMG events occurred prior to the mMEP events.

Conclusions

Based on the association of fEMG events with upcoming mMEP events during tumor removal, we recommend inclusion of fEMG monitoring in IOM. Multimodal IOM provides useful electrophysiological information during IMSCT surgery, especially during the main surgical phases.
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Metadata
Title
Multimodal intraoperative monitoring during intramedullary spinal cord tumor surgery
Authors
Seung-Hyun Jin
Chun Kee Chung
Chi Heon Kim
Young Doo Choi
Gilho Kwak
Bo Eun Kim
Publication date
01-12-2015
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 12/2015
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-015-2598-y

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