Artikel
Predictive value of intraoperative neuromonitoring in brainstem cavernoma surgery
Das intraoperative Neuromonitoring und die Bedeutung für die chirurgische Behandlung von Hirnstammkavernomen
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Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Intraoperative neuromonitoring is an established tool for distinct neurosurgical procedures but the predictive value of motor or somatosensory evoked potentials (MEP/SSEP) in brainstem cavernoma (BSCM) surgery is still a matter of debate. This study aimed to evaluate the use of MEP and SSEP in surgically treated BSCM patients.
Methods: 62 consecutive patients (≥18 years-old) of a single institution that were surgically treated for BSCM were included. All patients received intraoperative MEP/SSEP monitoring and postoperative follow-up of >3 months. The study endpoints were new postoperative motor or somatosensory deficits and postoperative functional disability at discharge or follow-up. Diagnostic accuracy was determined by receiver operating characteristic (ROC) analyses with area under the curve (AUC) metrics.
Results: Intraoperative decrease of MEP/SSEP was associated with a new postoperative motor (discharge: OR=11.9, p=0.017; follow-up: OR=5.3, p=0.039) or somatosensory (discharge: OR=7.7, p=0.001; follow-up: OR=8.4, p=<0.001) deficit. Binary classification testing revealed sensitivity and specificity values for MEP (discharge: 31% and 93%; follow-up: 33% and 91%) or SSEP (discharge: 82% and 80%; follow-up: 85% and 79%) respectively. ROC analysis and AUC metrics exhibited acceptable performance of intraoperative neuromonitoring for MEP (AUC=0.75, p=0.02) and SSEP (AUC=0.72, p=0.004) values. Subsequent analysis identified an association between intraoperative MEP (OR=6, p=0.047) or SSEP (OR=4.09, p=0.009) decrease and increased postoperative functional disability.
Conclusion: Intraoperative neuromonitoring can reliably predict early postoperative motor or somatosensory deficits after brainstem cavernoma surgery.