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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Dorsal column mapping in resection of intramedullary tumours – a prospective comparison of two methods and neurological follow-up

Dorsal column mapping bei intramedullären Tumoren – ein prospektiver Vergleichzweier Methodenund neurologische Verlaufsbeobachtung

Meeting Abstract

  • presenting/speaker Moritz Ueberschaer - Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgie, München, Deutschland
  • Andrea Szelényi - Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgie, München, Deutschland
  • Stefan Zausinger - Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgie, München, Deutschland
  • Jörg-Christian Tonn - Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgie, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV104

doi: 10.3205/20dgnc106, urn:nbn:de:0183-20dgnc1064

Veröffentlicht: 26. Juni 2020

© 2020 Ueberschaer et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: When performing surgery for intramedullary spinal cord tumours (imSCT) distortion of the regular anatomy makes visual identification of the dorsal columns (DC) and the midline for myelotomy challenging. For neurophysiological identification of the DC, dorsal column mapping (DCM) and spinal cord stimulation (SCS) are used. This study compares both methods in clinical use and describes their clinical impact.

Methods: In a single centre, prospective study patients with thoracic or cervical imSCT undergoing surgery from 04/2017 to 06/2019 were included. DMS was determined as follows:

1.
visual identification and marking of the anatomical midline by the surgeon
2.
recording of spinal SSEPs to follow tibial and/or median stimulation with an 8-channel DCM-electrode (AdTech Co., USA) and
3.
SCS by bipolar concentric probe (Inomed Co., Germany) and recording of cortical SEP phase reversal at C3/C4 .

Time of measurement, handling, interpretation and reliability of both methods were analysed. Standardized neurological examinations were performed preoperatively and one week postoperatively.

Results: 13 patients (8 f; median age 43 years (15-79)) with a median McCormick Score (McS) of 1 (0-3) were studied.

The DCM electrode detected the midline in 9/13 patients, with handling limitations in the remaining patients. SCS was applicable in all patients with reliable results in 9/13. If both recordings could be acquired (5/13), concordance was 100%. If standard SSEPs were poor, both methods were unstable. The SCS method was significantly less time-consuming (9min. vs. 17min.; p=0,001).

The anatomical midline indicated by the surgeon diverged by a mean of 0.5 mm (± 0.8mm) compared to the neurophysiologically identified midline. In 9/13 patients with distorted anatomy, DCM and SCS were helpful to confirm optimal region of myelotomy.

In the surgeon’s perception implementation of the SCS probe was felt safer and easier compared to the DCM electrode. After myelotomy based on anatomical and neurophysiological findings, no losses of SSEPs occurred with worsening >50% in 3 patient. 3 patients deteriorated to a McS of >1 (med. 2 (1-3)).

Conclusion: DCM and SCS are helpful to identify the correct region for myelotomy in imSCT with a favourable clinical outcome in this cohort. Regarding reliability and interpretation of measurements both methods were comparable while the SCS method evolved to be superior to the DCM electrode concerning applicability and time expenditure.