The impact of intraoperative neurophysiological monitoring in spinal cord astrocytoma-surgery

Introduction: The advantages and the necessity of intraoperative neurophysiological monitoring (IOM) in the surgery of motor area infiltrative tumours is well known. The use of this technique for Rolandic meningioma is still debatable. The absence or the loss of the cleavage plan and an infiltrative border make the dissection exceedingly difficult and increase the risk of new postoperative motor disfunction. Materials and methods: We evaluated the impact of IOM, especially direct cortical stimulation on the degree of resection, new postoperative deficits, symptom remission and clinical-imagistic aspects at one-year follow up of 19 cases of Rolandic meningioma admitted in Third Department of Neurosurgery,” Prof. Dr N. Oblu” Emergency Clinical Hospital, Yassi, Romania, between January 2014 and July 2018. Results: More than half of the cases (57,88%) had epileptic manifestations as the main clinical symptom with the Jacksonian seizures being on the first place (31,57%), followed by progressive paresis (26,31%) and other nonspecific symptoms. Intraparenchymal preoperative oedema was observed in 36,84% of patients. The intensity of direct cortical stimulation was between 6-13 mA (median = 9mA; mode = 12mA). Simpson degree of resection was dominated by S3– 47,36% and S4 was obtained in 15,78% of cases. Postoperative the outcome was favourable for 73,68% patients with 5,26% motor aggravation and 10,52% new deficits. At one-year follow up no imagistic recurrence was observed and the permanent motor deficit was maintained in one of the three cases (5,26%). Conclusion: Even though meningiomas are extranevraxial lesions and those located on the convexity have a low risk of complication, the absence of a clear dissection plan between the tumour and the adjacent motor cortex is associated with a high risk for new postoperative neurological deficits. Therefore, it is important to perform cortical mapping for Rolandic meningioma, to determine the location of the primary motor area and to protect it from mechanical and vascular trauma, during tumour resection.

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Intraoperative neurophysiological monitoring during surgery for intramedullary spinal cord tumors

Intraoperative Monitoring of Neural Function - Handbook of Clinical Neurophysiology ◽

10.1016/s1567-4231(07)08045-8 ◽

2008 ◽

pp. 632-650 ◽

Cited By ~ 3

Author(s):

Francesco Sala ◽

Karl F. Kothbauer

Keyword(s):

Spinal Cord ◽

Intraoperative Neurophysiological Monitoring ◽

Neurophysiological Monitoring ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord

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Management of Extramedullary Intradural Spinal Tumors: The Impact of Clinical Status, Intraoperative Neurophysiological Monitoring and Surgical Approach on Outcomes in a 12-Year Double-Center Experience

Frontiers in Neurology ◽

10.3389/fneur.2020.598619 ◽

2020 ◽

Vol 11 ◽

Author(s):

Fabio Cofano ◽

Carlotta Giambra ◽

Paolo Costa ◽

Pietro Zeppa ◽

Andrea Bianconi ◽

...

Keyword(s):

Clinical Outcomes ◽

Surgical Approach ◽

Spinal Canal ◽

Clinical Status ◽

Extent Of Resection ◽

Intraoperative Neurophysiological Monitoring ◽

Neurophysiological Monitoring ◽

Surgical Access ◽

The Impact

Objective: Intradural Extramedullary (IDEM) tumors are usually treated with surgical excision. The aim of this study was to investigate the impact on clinical outcomes of pre-surgical clinical conditions, intraoperative neurophysiological monitoring (IONM), surgical access to the spinal canal, histology, degree of resection and intra/postoperative complications.Methods: This is a retrospective observational study analyzing data of patients suffering from IDEM tumors who underwent surgical treatment over a 12 year period in a double-center experience. Data were extracted from a prospectively maintained database and included: sex, age at diagnosis, clinical status according to the modified McCormick Scale (Grades I-V) at admission, discharge, and follow-up, tumor histology, type of surgical access to the spinal canal (bilateral laminectomy vs. monolateral laminectomy vs. laminoplasty), degree of surgical removal, use and type of IONM, occurrence and type of intraoperative complications, use of Ultrasonic Aspirator (CUSA), radiological follow-up.Results: A total number of 249 patients was included with a mean follow-up of 48.3 months. Gross total resection was achieved in 210 patients (84.3%) mostly in Schwannomas (45.2%) and Meningiomas (40.4%). IONM was performed in 162 procedures (65%) and D-wave was recorded in 64.2% of all cervical and thoracic locations (99 patients). The linear regression diagram for McCormick grades before and after surgery (follow-up) showed a correlation between preoperative and postoperative clinical status. A statistically significant correlation was found between absence of worsening of clinical condition at follow-up and use of IONM at follow-up (p = 0.01) but not at discharge. No associations were found between the choice of surgical approach and the extent of resection (p = 0.79), the presence of recurrence or residual tumor (p = 0.14) or CSF leakage (p = 0.25). The extent of resection was not associated with the use of IONM (p = 0.91) or CUSA (p = 0.19).Conclusion: A reliable prediction of clinical improvement could be made based on pre-operative clinical status. The use of IONM resulted in better clinical outcomes at follow-up (not at discharge), but no associations were found with the extent of resection. The use of minimally invasive approaches such as monolateral laminectomy showed to be effective and not associated with worse outcomes or increased complications.

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Intraoperative neurophysiological monitoring in patients undergoing tethered cord surgery after fetal myelomeningocele repair

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.1.peds11336 ◽

2014 ◽

Vol 13 (4) ◽

pp. 355-361 ◽

Cited By ~ 8

Author(s):

Eric M. Jackson ◽

Daniel M. Schwartz ◽

Anthony K. Sestokas ◽

Deborah M. Zarnow ◽

N. Scott Adzick ◽

...

Keyword(s):

Spinal Cord ◽

Motor Evoked Potential ◽

Tethered Cord ◽

Neurological Status ◽

Intraoperative Neurophysiological Monitoring ◽

Neurophysiological Monitoring ◽

Neural Function ◽

Lower Extremity Function ◽

Fetal Repair ◽

Myelomeningocele Repair

Object Fetal myelomeningocele closure has been shown to be advantageous in a number of areas. In this study, the authors report on neural function in patients who had previously undergone fetal myelomeningocele repair and returned to the authors' institution for further surgery that included intraoperative neurophysiological monitoring. Methods The authors retrospectively reviewed data obtained in 6 cases involving patients who underwent fetal myelomeningocele repair and later returned to their institution for spinal cord untethering. (In 4 of the 6 cases, the patients also underwent removal of a dermoid cyst [3 cases] or removal of an epidermoid cyst [1 case] during the untethering procedure.) Records and imaging studies were reviewed to identify the anatomical level of the myelomeningocele as well as the functional status of each patient. Stimulated electromyography (EMG) and transcranial motor evoked potential (tcMEP) recordings obtained during surgery were reviewed to assess the functional integrity of the nerve roots and spinal cord. Results During reexploration, all patients had reproducible signals at or below their anatomical level on stimulated EMG and tcMEP recordings. Corresponding to these findings, prior to tethering, all patients had antigravity muscle function below their anatomical level. Conclusions All 6 patients had lower-extremity function and neurophysiological monitoring recording signals at or below their anatomical level. These cases provide direct evidence of spinal cord and nerve root conductivity and functionality below the anatomical level of the myelomeningocele, further supporting that neurological status improves with fetal repair.

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Spinal Cord Tumor Surgery—Importance of Continuous Intraoperative Neurophysiological Monitoring After Tumor Resection

Spine ◽

10.1097/brs.0b013e31824c76a8 ◽

2012 ◽

Vol 37 (16) ◽

pp. E1001-E1008 ◽

Cited By ~ 20

Author(s):

Marie-Thérèse Forster ◽

Gerhard Marquardt ◽

Volker Seifert ◽

Andrea Szelényi

Keyword(s):

Spinal Cord ◽

Spinal Cord Tumor ◽

Tumor Resection ◽

Intraoperative Neurophysiological Monitoring ◽

Neurophysiological Monitoring ◽

Tumor Surgery

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Ntra-Operative Neurophysiological Monitoring During the Removal of Intramedullary Tumors (literary review)

Journal of New Medical Technologies ◽

10.12737/9087 ◽

2015 ◽

Vol 22 (1) ◽

pp. 93-101

Author(s):

Федин ◽

P. Fedin ◽

Шахпаронова ◽

N. Shakhparonova ◽

Гуща ◽

...

Keyword(s):

Spinal Cord ◽

Complete Information ◽

Neurophysiological Monitoring ◽

Intramedullary Tumors ◽

Physiological Factors ◽

Factors Affecting ◽

Maximum Security ◽

Whole Process ◽

The Impact

Progress in the field of neurosurgery and the possibility of total removal of the majority of intramedullary tumors leads to the question about maximum security functions of the spinal cord. The invention and implementation of intra-operative neuro-physiological monitoring (IOM) provides real-time to assess the impact of surgical procedures on the pathways of the spinal cord. Effective and informed monitoring includes an assessment of motor and sensitive ways to complete information about the functions of the spinal cord. Identifying predictors of favorable functional outcome and algorithm development monitoring allows the authors to modify neurosurgical tactics and improve the patient´s quality of life after surgery. This article describes all the methods IOM and physiological factors affecting the monitoring of responses. The authors review data on the effects of different anesthetics on the ability of neurons to conduct impulses and the most favorable combinations of drugs. It is proved that the IOM is effective as predictors of high risk of postoperative complications (4 studies class I and 7 studies of class II). It is important to consider the factors such as experience neurophysiologist and his ability to interpret data, as well as experience of the surgeon in using these data, the actions of the anesthesiologist - the whole process of interaction affects the final outcome of the operation.

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