STUDY DESIGN:Retrospective review of institutional data.
OBJECTIVE:The aim of this study was to assess the utility of somatosensory-evoked potentials (SSEP) and transcranial electric motor-evoked potentials (MEP) in the resection of spine tumors and evaluate the ability of both single and multi-modal monitoring to predict postoperative neurological deficits.
SUMMARY OF BACKGROUND DATA:Although the utility of intraoperative monitoring (IOM) is well established in scoliosis and degenerative surgery, studies in spine tumor patients have been limited.
METHODS:A series of consecutive patients who underwent resection with the use of IOM at a single institution between August 2009 and March 2013 was identified. Demographic, clinical, and neuromonitoring data were collected preoperatively, during surgery, at the moment of discharge, and at a 6-month follow-up visit. Three cohorts were established based on the anatomical location of the tumor: intramedullary, intradural extramedullary, and extradural. Additional groupings were formed based on spinal region. Patients with significant changes in SSEPs or MEPs during surgery were identified and the rate of neurological deficits was assessed.
RESULTS:A total of 52 patients were analyzed. A change in SSEPs or MEPs was detected in 11 (21.2%) cases whereas 14 patients (26.9%) developed permanent postoperative deficits. SSEPs predicted deficits in the resection of intramedullary tumors (P = 0.015) (area under cover, AUC = 0.83), and intradural extramedullary tumors (P = 0.048; AUC = 0.70). MEP monitoring did not predict postoperative deficits in the resection of intramedullary (P = 0.21; AUC = 0.69) or intradural extramedullary tumors (P = 0.31; AUC = 0.63). Neither SSEPs nor MEPs predicted deficits for extradural tumors.
CONCLUSION:The efficacy of IOM in spine tumor resection is dependent on tumor location relative to the spinal cord and dura. The accuracy of SSEPs and their ability to predict postoperative deficits was greatest for intramedullary lesions. For this series, MEP and multi-modal monitoring did not confer a benefit in predicting permanent neurological deficits.
LEVEL OF EVIDENCE:4.
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【Utility of Intraoperative Monitoring in the Resection of Spinal Cord Tumors: An Analysis by Tumor Location and Anatomical Region.].
【术中监测在脊髓肿瘤切除术中的效用：肿瘤位置和解剖区域的分析。】
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DOI：10.1097/BRS.0000000000002300文章类型：杂志文章
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研究设计：回顾性机构数据。
目的：本研究旨在评估体感诱发电位（SSEP）和经颅电动诱发电位（MEP）在脊柱肿瘤切除术中的作用，并评估单模式和多模式监测的预测能力术后神经功能缺损。
背景资料摘要：尽管在脊柱侧弯和退行性手术中已经确立了术中监测（IOM）的效用，但对脊柱肿瘤患者的研究仍然很有限。
方法：确定了一系列连续患者，这些患者在2009年8月至2013年3月期间在单个机构中使用IOM进行了切除。术前，手术期间，出院时和6个月的随访期间均收集了人口统计学，临床和神经监测数据。根据肿瘤的解剖位置建立了三个队列：髓内，硬膜内髓外和硬膜外。根据脊柱区域形成其他分组。确定手术期间SSEP或MEP有明显变化的患者，并评估神经功能缺损的发生率。
结果：共分析52例患者。在11例（21.2％）病例中发现SSEP或MEP发生了变化，而14例（26.9％）患者出现了永久性术后缺陷。 SSEPs预测髓内肿瘤切除的缺陷（P = 0.015）（隐蔽区域，AUC = 0.83）和硬膜内髓外肿瘤（P = 0.048； AUC = 0.70）。 MEP监测不能预测髓内（P = 0.21; AUC = 0.69）或硬膜内髓外肿瘤（P = 0.31; AUC = 0.63）切除术后的缺陷。 SSEP和MEP均未预测硬膜外肿瘤的缺陷。
结论：IOM在脊柱肿瘤切除术中的疗效取决于相对于脊髓和硬脑膜的肿瘤位置。对于髓内病变，SSEPs的准确性及其预测术后缺陷的能力最大。对于该系列，MEP和多模式监测在预测永久性神经功能缺损方面无益。
证据级别：4。
目的：本研究旨在评估体感诱发电位（SSEP）和经颅电动诱发电位（MEP）在脊柱肿瘤切除术中的作用，并评估单模式和多模式监测的预测能力术后神经功能缺损。
背景资料摘要：尽管在脊柱侧弯和退行性手术中已经确立了术中监测（IOM）的效用，但对脊柱肿瘤患者的研究仍然很有限。
方法：确定了一系列连续患者，这些患者在2009年8月至2013年3月期间在单个机构中使用IOM进行了切除。术前，手术期间，出院时和6个月的随访期间均收集了人口统计学，临床和神经监测数据。根据肿瘤的解剖位置建立了三个队列：髓内，硬膜内髓外和硬膜外。根据脊柱区域形成其他分组。确定手术期间SSEP或MEP有明显变化的患者，并评估神经功能缺损的发生率。
结果：共分析52例患者。在11例（21.2％）病例中发现SSEP或MEP发生了变化，而14例（26.9％）患者出现了永久性术后缺陷。 SSEPs预测髓内肿瘤切除的缺陷（P = 0.015）（隐蔽区域，AUC = 0.83）和硬膜内髓外肿瘤（P = 0.048； AUC = 0.70）。 MEP监测不能预测髓内（P = 0.21; AUC = 0.69）或硬膜内髓外肿瘤（P = 0.31; AUC = 0.63）切除术后的缺陷。 SSEP和MEP均未预测硬膜外肿瘤的缺陷。
结论：IOM在脊柱肿瘤切除术中的疗效取决于相对于脊髓和硬脑膜的肿瘤位置。对于髓内病变，SSEPs的准确性及其预测术后缺陷的能力最大。对于该系列，MEP和多模式监测在预测永久性神经功能缺损方面无益。
证据级别：4。
