Intraoperative Neurophysiological Monitoring for Spinal Cord Tumor Surgery: Comparison of Motor and Somatosensory Evoked Potentials According to Tumor Types.
10.5535/arm.2017.41.4.610
- Author:
Taeha PARK
1
;
Jinyoung PARK
;
Yoon Ghil PARK
;
Joowon LEE
Author Information
1. Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea. HANLEZZ@yuhs.ac
- Publication Type:Original Article
- Keywords:
Spinal cord neoplasm;
Intraoperative neurophysiological monitoring;
Motor evoked potentials;
Somatosensory evoked potentials;
Postoperative complications
- MeSH:
Evoked Potentials, Motor;
Evoked Potentials, Somatosensory*;
Hemangioma;
Humans;
Intraoperative Neurophysiological Monitoring*;
Muscle Strength;
Postoperative Complications;
Sensitivity and Specificity;
Spinal Cord Neoplasms*;
Spinal Cord*
- From:Annals of Rehabilitation Medicine
2017;41(4):610-620
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To identify which combination of motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) is most reliable for postoperative motor deterioration during spinal cord tumor surgery, according to anatomical and pathologic type. METHODS: MEPs and SEPs were monitored in patients who underwent spinal cord tumor surgery between November 2012 and August 2016. Muscle strength was examined in all patients before surgery, within 48 hours postoperatively and 4 weeks later. We analyzed sensitivity, specificity, positive and negative predictive values of each significant change in SEPs and MEPs. RESULTS: The overall sensitivity and specificity of SEPs or MEPs were 100% and 61.3%, respectively. The intraoperative MEP monitoring alone showed both higher sensitivity (67.9%) and specificity (83.2%) than SEP monitoring alone for postoperative motor deterioration. Two patients with persistent motor deterioration had significant changes only in SEPs. There are no significant differences in reliabilities between anatomical types, except with hemangioma, where SEPs were more specific than MEPs for postoperative motor deterioration. Both overall positive and negative predictive values of MEPs were higher than the predictive values of SEPs. However, the positive predictive value was higher by the dual monitoring of MEPs and SEPs, compared to MEPs alone. CONCLUSION: For spinal cord tumor surgery, combined MEP and SEP monitoring showed the highest sensitivity for the postoperative motor deterioration. Although MEPs are more specific than SEPs in most types of spinal cord tumor surgery, SEPs should still be monitored, especially in hemangioma surgery.
