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J Neurol Surg A Cent Eur Neurosurg 2021; 82(04): 325-332
DOI: 10.1055/s-0040-1710504
Original Article

Predictive Value of Transcranial Evoked Potential Monitoring for Intramedullary Spinal Cord Tumors

Sebastian Ille
1   Department of Neurosurgery, Technical University Munich Faculty of Medicine, München, Bayern, Germany
,
Arthur Wagner
1   Department of Neurosurgery, Technical University Munich Faculty of Medicine, München, Bayern, Germany
,
Ann Kathrin Joerger
1   Department of Neurosurgery, Technical University Munich Faculty of Medicine, München, Bayern, Germany
,
Maria Wostrack
1   Department of Neurosurgery, Technical University Munich Faculty of Medicine, München, Bayern, Germany
,
Bernhard Meyer
1   Department of Neurosurgery, Technical University Munich Faculty of Medicine, München, Bayern, Germany
,
Ehab Shiban
1   Department of Neurosurgery, Technical University Munich Faculty of Medicine, München, Bayern, Germany
2   Department of Neurosurgery, University of Augsburg, Augsburg, Bayern, Germany
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Abstract

Background Intraoperative neurophysiologic monitoring (IONM) has increased patient safety and extent of resection in patients with eloquent brain tumors. Despite its comprehensive capability for the resection of intramedullary spinal cord tumors (ISCTs), the application during the resection of these tumors is controversial.

Methods We retrospectively analyzed the resection of ISCTs in 83 consecutive cases. IONM was performed in all cases. Each patient's motor status and the McCormick scale was determined preoperatively, directly after surgery, at the day of discharge, and at long-term follow-up.

Results IONM was feasible in 71 cases (85.5%). Gross total resection was performed in 75 cases (90.4%). Postoperatively, patients showed new transient deficits in 12 cases (14.5%) and new permanent deficits in 12 cases (14.5%). The mean McCormick variance between baseline and long-term follow-up was − 0.08 ± 0.54. IONM's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the patient's motor status at the day of discharge was 75.0%, 64.7%, 45.5%, and 86.8%. It was 88.9%, 59.7%, 24.2%, and 97.4% for the motor outcome at long-term follow-up. Patients experienced postoperative complications in 15 cases (18.1%).

Conclusion IONM, as performed in the present study, shows a high sensitivity and NPV but low specificity and PPV, particularly for the patient's motor status at the long-term follow-up. As far as practicable by a retrospective study on IONM, our results confirm IONM's usefulness for its application during the resection of ISCTs. However, these results must be approved by a prospective study.

Keywords

intramedullary spinal cord tumor - intraoperative neuromonitoring - transcranial evoked potential monitoring

Financial Disclosures

Ehab Shiban received research grants and is a consultant for Nevro and Icotec. Bernhard Meyer received research grants and is a consultant for Brainlab AG. He received honoraria, consulting fees, and research grants from Medtronic, Icotec, and Relievant Medsystems; honoraria and research grants from Ulrich Medical; honoraria and consulting fees from Spineart Deutschland and DePuy Synthes; and royalties from Spineart Deutschland. The study was completely financed by institutional grants from the Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München.




Publication History

Received: 25 March 2019

Accepted: 22 October 2019

Article published online:
21 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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