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 to cite this document:

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

DOI to cite this document:

10.5283/epub.59428 Copy

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

License: Creative Commons Attribution Non-commercial No Derivatives 4.0 PDF - Published Version (447kB)

Date of publication of this fulltext: 28 Oct 2024 12:41

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Details

Item type:	Article
Open Access Type:	DEAL (Elsevier)
Journal or Publication Title:	Clinical Neurophysiology
Publisher:	Elsevier
Volume:	168
Page Range:	pp. 52-60
Date:	19 October 2024
Institutions:	Medicine > Lehrstuhl für Neurochirurgie
Projects (Historical):	European Association of Neurosurgical Societies (EANS) Research Fund 2020
Identification Number:	Value Type 10.1016/j.clinph.2024.10.007 DOI
Keywords:	Intramedullary spinal cord tumor surgery Intraoperative neurophysiological monitoring, D wave, Motor evoked potentials, Somatosensory evoked potential, Free-running electromyography
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Partially
Item ID:	59428

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Abstract

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 ...

Abstract

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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Metadata last modified: 16 Jan 2025 15:00

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