Article
The predictive value of D-wave, hand-muscle MEPs and SSEPs for the distal upper limbs fine motor outcome after cervical intramedullary spinal cord tumour surgery
Der prädiktive Wert der D-Welle, der Handmuskel-MEPs und -SSEPs für das Outcome der Feinmotorik der distalen oberen Extremität nach spinalen intramedullären tumorchirurgischen Eingriffen
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Authors
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Sebastian Siller
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik, München, Deutschland
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Stefan Zausinger
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik, München, Deutschland
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Nora Muesken
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik, München, Deutschland
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Jörg-Christian Tonn
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik, München, Deutschland
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Andrea Szelényi
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik, München, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: D-wave and muscle MEP monitoring during cervical intramedullary spinal cord tumour surgery (cIMSCT) is considered to be the gold standard for assessing potential injury to the corticospinal tract and indicating permanent postoperative para-/tetraparesis, but its predictive value for the distal upper limbs’ fine-motor outcome in case of multimodal intraoperative neurophysiological monitoring (IONM) has not been addressed.
Methods: Intraoperative recording of epidural D-wave caudally to the surgical level, hand-muscle motor and median-nerve somatosensory-evoked potentials (hmMEPs/mSSEPs) was attempted in 11 patients (m/f: 6/5, median age: 41.4 years) undergoing cIMSCT surgeries. The following permanent IOM-alterations were considered significant: D-wave amplitude decrement ≥50%, hmMEPs amplitude decrement ≥80% and mSSEPs amplitude reduction ≥50% / latency increase ≥10%. Distal upper limb fine-motor function (manometrical hand-force measurement, Nine-Hole-Peg-Test) was assessed preoperatively and 6 weeks postoperative and correlated with IONM-findings.
Results: 73% of the tumours were located above C4-level. Gross-total resection was accomplished in 73%. In all cases, bilateral hmMEPs and mSSEPs were present, D-Wave recording failed in 1 patient with severe preoperative paraparesis. Transient deterioration of hmMEPs resp. D-wave occurred in one patient each; none of these patients had a new neurological deficit postoperatively. However, despite corrective actions, persisting critical hmMEPs findings were present in 3 patients and mSSEPs findings in 1 patient, while a persisting deterioration of D-wave parameters did not occur. Two of these 3 patients postoperatively presented with a paresis of distal upper limb fine motor function but intact gait.
Conclusion: In cIMSCT surgery, unimpaired D-wave findings reliably predicted preserved motor function of the lower limbs, however, failed to sufficiently cover distal upper limb motor function, thus giving rise to false-negative findings. In cIMSCT, selective hmMEPs and mSSEPs alteration have to be observed since they might predict distal upper limb fine motor outcome.
