Artikel
Spinal cord tumor surgery – importance of continuous intraoperative neurophysiological monitoring during wound closure
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Autoren
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M.T. Forster
- Klinik für Neurochirurgie, Johann-Wolfgang-Goethe Universität, Frankfurt am Main
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G. Marquardt
- Klinik für Neurochirurgie, Johann-Wolfgang-Goethe Universität, Frankfurt am Main
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V. Seifert
- Klinik für Neurochirurgie, Johann-Wolfgang-Goethe Universität, Frankfurt am Main
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A. Szelényi
- Klinik für Neurochirurgie, Johann-Wolfgang-Goethe Universität, Frankfurt am Main
| Veröffentlicht: | 28. April 2011 |
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Gliederung
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Objective: During the last decades, intraoperative neurophysiological monitoring (INM) has become a reliable method to assess the integrity of the corticospinal tract (CST) and dorsal columns during spinal surgery. Whereas changes in INM related to positioning and tumor removal are well known, changes during wound closure have only been described anecdotally. We therefore analyzed our prospective data base with regard to alterations of INM during wound closure following laminotomy.
Methods: 15 patients with spinal cord tumors were treated with a laminotomy. In all these cases, somatosensory (SSEPs) and motor (MEPs) evoked potentials have been monitored. In addition direct (D) waves from the spinal cord were recorded in 6 patients. Monitoring was performed during positioning of the patient, laminotomy, dura opening, tumor resection, dura closure and reinsertion of the laminae. According to the stages of the surgical procedures, alterations of recorded potentials were analyzed.
Results: Five patients had unchanged potentials until the end of the operative procedure. Alterations of INM were observed during tumor resection in six patients, dura closure in three, and during reinsertion of the laminae following laminotomy in one, respectively. Surgical strategy was modified according to the surgical step when INM alterations were observed. Hence, a halt of tumor resection was the chosen treatment in six patients, whereas duraplasty was carried out in four patients. In one patient reinsertion of the laminae led to dramatic changes in INM recordings and was followed by immediate removal of the reinserted laminae. Nevertheless she suffered from postoperative tetraparesis from which she recovered only slowly.
Conclusions: INM enables the neurosurgeon to identify critical steps in the surgical procedure and to adapt his course of action. For an optimal avoidance of postoperative neurological deficits, intraoperative monitoring should be maintained from the positioning the patient until skin closure.
