Artikel
Predictive value of transcranial evoked potential monitoring for intramedullary spinal cord tumours
Prädiktiver Wert von transkraniell evozierten Potentialen bei intramedullären Rückenmarkstumoren
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Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Intraoperative neurophysiological monitoring (IONM) has increased patient’s safety and extent of resection in patients with eloquent brain tumors. Despite its comprehensive capability for the resection of intramedullary spinal cord tumors (ISCT), the application during the resection of these tumors is controversially discussed.
Methods: We retrospectively analyzed the resection of ISCTs in 86 consecutive cases. IONM was performed in all cases. The patient’s motor status and the McCormick’s scale were determined preoperatively, directly after surgery, at the day of discharge and at long-term follow-up.
Results: IONM was feasible in 74 cases (86.1%). Gross total resection (GTR) was performed in 76 cases (88.4%). Postoperatively, patients showed new transient deficits in 12 cases (14.0%) and new permanent deficits in 13 cases (15.1%). The mean McCormick’s variance between baseline and long-term follow-up was -0.09±0.54. IONM’s sensitivity, specificity, positive predictive value and negative predictive value for the patient’s motor status at the day of discharge was 76.2%, 64.2%, 45.7%, 87.2%, and 90.0%. It was 59.4%, 25.7%, 97.4% for the motor outcome at long-term follow-up. Patients suffered from postoperative complications in 16 cases (18%).
Conclusion: IONM shows a high sensitivity and negative predictive but low specificity and positive predictive value particularly for the patient’s motor status at long-term follow up. Hence, our results confirm usefullness of IONM’s during the resection of ISCTs.