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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(02): 210-220
DOI: 10.1055/s-0044-1787052
Research Article

Diagnostic Accuracy of Somatosensory Evoked Potential and Transcranial Motor Evoked Potential in Detection of Neurological Injury in Intradural Extramedullary Spinal Cord Tumor Surgeries: A Short-Term Follow-Up Prospective Interventional Study Experience from Tertiary Care Center of India

Manish Kumar Mishra 
1   Department of Neurosurgery, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
,
Nityanand Pandey
1   Department of Neurosurgery, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
,
Hanjabam Barun Sharma
2   Department of Physiology, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
,
Ravi Shankar Prasad
1   Department of Neurosurgery, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
,
Anurag Sahu
1   Department of Neurosurgery, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
,
Ravi Shekhar Pradhan
1   Department of Neurosurgery, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
,
Vikrant Yadav
1   Department of Neurosurgery, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
› Author Affiliations Funding None.
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Abstract

Objective Intraoperative neuromonitoring (IONM) is an acknowledged tool for real-time neuraxis assessment during surgery. Somatosensory evoked potential (SSEP) and transcranial motor evoked potential (MEP) are commonest deployed modalities of IONM. Role of SSEP and MEP in intradural extramedullary spinal cord tumor (IDEMSCT) surgery is not well established. The aim of this study was to evaluate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and transcranial MEP, in detection of intraoperative neurological injury in IDEMSCT patients as well as their postoperative limb-specific neurological improvement assessment at fixed intervals till 30 days.

Materials and Methods Symptomatic patients with IDEMSCTs were selected according to the inclusion criteria of study protocol. On modified McCormick (mMC) scale, their sensory-motor deficit was assessed both preoperatively and postoperatively. Surgery was done under SSEP and MEP (transcranial) monitoring using appropriate anesthetic agents. Gross total/subtotal resection of tumor was achieved as per IONM warning alarms. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP were calculated considering postoperative neurological changes as “reference standard.” Patients were followed up at postoperative day (POD) 0, 1, 7, and 30 for convalescence.

Statistical Analysis With appropriate tests of significance, statistical analysis was carried out. Receiver-operating characteristic curve was used to find cutoff point of mMC for SSEP being recordable in patients with higher neurological deficit along with calculation of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP for prediction of intraoperative neurological injury.

Results Study included 32 patients. Baseline mean mMC value was 2.59. Under neuromonitoring, gross total resection of IDEMSCT was achieved in 87.5% patients. SSEP was recordable in subset of patients with mMC value less than or equal to 2 with diagnostic accuracy of 100%. MEP was recordable in all patients and it had 96.88% diagnostic accuracy. Statistically significant neurological improvement was noted at POD-7 and POD-30 follow-up.

Conclusion SSEP and MEP individually carry high diagnostic accuracy in detection of intraoperative neurological injuries in patients undergoing IDEMSCT surgery. MEP continues to monitor the neuraxis, even in those subsets of patients where SSEP fails to record.

Keywords

intradural extramedullary spinal cord tumor - intraoperative neurophysiological monitoring - IONM - modified McCormick scale - motor evoked potential - somatosensory evoked potential

Note

It has been presented in the “11th Annual Conference of the Neurological Surgeons Society of India” (04 March 2023), at Hyderabad (India) with title “Role of Intraoperative Neurophysiological Monitoring in Spinal Cord Tumor Surgeries: An Institutional Experience.


Authors' Contributions

M.K.M. helped in data collection, statistical analysis, and manuscript writing. N.P. contributed to research idea, manuscript writing, and supervision. H.B.S. helped in data collection and manuscript writing. R.S.P. and A.S. were involved in data collection and supervision. R.S.P. and V.Y. contributed to data collection.


Ethical Approval

Research protocol was approved by Institute's Ethics Committee and the ethical principles outlined by the Helsinki Declaration has been followed.




Publication History

Article published online:
05 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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