Multimodal intraoperative neurophysiological monitoring may better predict postoperative distal upper extremities’ complex-functional outcome than spinal and muscular motor evoked potentials alone in high-cervical intramedullary spinal cord tumor surgery

URN zum Zitieren dieses Dokuments:

urn:nbn:de:bvb:355-epub-594287 Copy

DOI zum Zitieren dieses Dokuments:

10.5283/epub.59428 Copy

Siller, Sebastian ; Duell, Sylvain ; Tonn, Joerg-Christian ; Szelenyi, Andrea

Lizenz: Creative Commons Namensnennung-NichtKommerziell-KeineBearbeitung 4.0 International PDF - Veröffentlichte Version (447kB)

Veröffentlichungsdatum dieses Volltextes: 28 Okt 2024 12:41

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Alternative Links zum Volltext:DOIVerlag

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Details

Dokumentenart:	Artikel
Open Access Art:	DEAL (Elsevier)
Titel eines Journals oder einer Zeitschrift:	Clinical Neurophysiology
Verlag:	Elsevier
Band:	168
Seitenbereich:	S. 52-60
Datum:	19 Oktober 2024
Institutionen:	Medizin > Lehrstuhl für Neurochirurgie
Sonstige Projekte:	European Association of Neurosurgical Societies (EANS) Research Fund 2020
Identifikationsnummer:	Wert Typ 10.1016/j.clinph.2024.10.007 DOI
Stichwörter / Keywords:	Intramedullary spinal cord tumor surgery Intraoperative neurophysiological monitoring, D wave, Motor evoked potentials, Somatosensory evoked potential, Free-running electromyography
Dewey-Dezimal-Klassifikation:	600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin
Status:	Veröffentlicht
Begutachtet:	Ja, diese Version wurde begutachtet
An der Universität Regensburg entstanden:	Zum Teil
Dokumenten-ID:	59428

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Zusammenfassung

Objective D-wave can safely monitor the corticospinal-tract (CST)-function regarding gross-motor outcome of lower extremities, but it is still unknown whether i)D-wave can also safely monitor the gross-motor outcome of distal upper extremities in those patients undergoing high-cervical intramedullary-spinal-cord-tumor (IMSCT)-resection (enabling epidural D-wave-placement below C5) and ...

Zusammenfassung

Objective
D-wave can safely monitor the corticospinal-tract (CST)-function regarding gross-motor outcome of lower extremities, but it is still unknown whether i)D-wave can also safely monitor the gross-motor outcome of distal upper extremities in those patients undergoing high-cervical intramedullary-spinal-cord-tumor (IMSCT)-resection (enabling epidural D-wave-placement below C5) and ii)multimodal IONM can also predict fine-motor/complex hand function.
Methods
We prospectively assessed 20 patients undergoing IMSCT-surgery above the C4/5-level with multimodal IONM (D-wave/mMEPs/EMG/SSEPs). Detailed gross-/fine-motor and complex hand function was assessed pre- and postoperatively and during long-term follow-up (mean:29.5 ± 18.8 months) and correlated with IONM-findings.
Results
D-wave monitoring was without intraoperative critical changes in all patients and none had any permanent postoperative gross-motor deficits. However, D-wave did not allow to predict the occurrence of mild permanent postoperative deficits affecting fine-motor function which was the case in 8% for distal upper extremities. The complex distal upper extremities’ function assessed by Nine-Hole-Peg-Test (reflecting the complex motor/sensory interaction for hand-usability) was permanently deteriorated in 15% postoperatively and only the combination of D-wave/mMEPs/EMG/SSEPs was able to provide a viable predictive power (specificity:79%/sensitivity:43%).
Conclusions
In high-cervical IMSCT-surgery, unimpaired D-wave reliably predicts preserved gross-motor function, but fails to sufficiently cover distal upper extremities’ fine-motor/complex function.
Significance
Our study underlines the importance of multimodal IONM for fine-motor/complex hand function.

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