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

Neurosurgery ◽  
2005 ◽  
Vol 57 (2) ◽  
pp. 422-423
Author(s):  
Francesco Sala ◽  
Giorgio Palandri ◽  
Elisabetta Basso ◽  
Paola Lanteri ◽  
Vedran Deletis ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Evoked Potential ◽  
Spinal Cord Tumor ◽  
Motor Evoked Potential ◽  
Historical Control ◽  
Intramedullary Spinal Cord ◽  
Intramedullary Spinal Cord Tumor ◽  
Evoked Potential Monitoring ◽  
Control Study ◽  
Potential Monitoring

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

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1129-1143 ◽  
Author(s):  
Francesco Sala ◽  
Giorgio Palandri ◽  
Elisabetta Basso ◽  
Paola Lanteri ◽  
Vedran Deletis ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Evoked Potential ◽  
Spinal Cord Tumor ◽  
Motor Evoked Potential ◽  
Historical Control Group ◽  
Historical Control ◽  
Control Group ◽  
Intramedullary Spinal Cord ◽  
Control Study

Abstract OBJECTIVE: The value of intraoperative neurophysiological monitoring (INM) during intramedullary spinal cord tumor surgery remains debated. This historical control study tests the hypothesis that INM monitoring improves neurological outcome. METHODS: In 50 patients operated on after September 2000, we monitored somatosensory evoked potentials and transcranially elicited epidural (D-wave) and muscle motor evoked potentials (INM group). The historical control group consisted of 50 patients selected from among 301 patients who underwent intramedullary spinal cord tumor surgery, previously operated on by the same team without INM. Matching by preoperative neurological status (McCormick scale), histological findings, tumor location, and extent of removal were blind to outcome. A more than 50% somatosensory evoked potential amplitude decrement influenced only myelotomy. Muscle motor evoked potential disappearance modified surgery, but more than 50% D-wave amplitude decrement was the major indication to stop surgery. The postoperative to preoperative McCormick grade variation at discharge and at a follow-up of at least 3 months was compared between the two groups (Student's t tests). RESULTS: Follow-up McCormick grade variation in the INM group (mean, +0.28) was significantly better (P = 0.0016) than that of the historical control group (mean, –0.16). At discharge, there was a trend (P = 0.1224) toward better McCormick grade variation in the INM group (mean, –0.26) than in the historical control group (mean, –0.5). CONCLUSION: The applied motor evoked potential methods seem to improve long-term motor outcome significantly. Early motor outcome is similar because of transient motor deficits in the INM group, which can be predicted at the end of surgery by the neurophysiological profile of patients.

scholarly journals Motor-evoked potential monitoring for intramedullary spinal cord tumor surgery: correlation of clinical and neurophysiological data in a series of 100 consecutive procedures

1998 ◽  
Vol 4 (5) ◽  
pp. E3 ◽  
Author(s):  
Karl F. Kothbauer ◽  
Vedran Deletis ◽  
Fred J. Epstein
Keyword(s):  
Spinal Cord ◽  
Evoked Potential ◽  
Spinal Cord Tumor ◽  
Motor Evoked Potential ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Intramedullary Tumors ◽  
Intramedullary Spinal Cord ◽  
Motor Pathways ◽  
Evoked Potential Monitoring

Resection of intramedullary spinal cord tumors carries a high risk for surgical damage to the motor pathways. This surgery is therefore optimal for testing the performance of intraoperative motor evoked potential (MEP) monitoring. This report attempts to provide evidence for the accurate representation of patients' pre- and postoperative motor status by combined epidural and muscle MEP monitoring during intramedullary surgery. The authors used transcranial electrical motor cortex stimulation to elicit MEPs, which were recorded from the spinal cord (with an epidural electrode) and from limb target muscles (thenar, anterior tibial) with needle electrodes. The amplitude of the epidural MEPs and the presence or absence of muscle MEPs were the parameters for MEP interpretation. A retrospective analysis was performed on data from the resection of 100 consecutive intramedullary tumors and MEP data were compared with the pre- and postoperative motor status. Intraoperative monitoring was feasible in all patients without severe preoperative motor deficits. Preoperatively paraplegic patients had no recordable MEPs. The sensitivity of muscle MEPs to detect postoperative motor deficits was 100% and its specificity was 91%. There was no instance in which a patient with stable MEPs developed a motor deficit postoperatively. Intraoperative MEPs adequately represented the motor status of patients undergoing surgery for intramedullary tumors. Because deterioration of the motor status was transient in all cases, it can be considered that impairment of the functional integrity of the motor pathways was detected before permanent deficits occurred.

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