Intraoperative neurophysiological monitoring for intradural extramedullary tumors: Why not?

Reza Ghadirpour, Davide Nasi, Corrado Iaccarino, David Giraldi, Rossella Sabadini, Luisa Motti, Francesco Sala, Franco Servadei

Research output: Contribution to journalArticle

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Abstract

Background While intraoperative neurophysiological monitoring (IOM) for intramedullary tumors has become a standard in neurosurgical practice, IOM for intradural extramedullary tumors (IDEMs) is still under debate. The aim of this study is to evaluate the role of IOM during surgery for IDEMs. Methods From March 2008 to March 2013, 68 patients had microsurgery with IOM for IDEMs (31 schwannomas, 25 meningiomas, 6 ependymomas of the cauda/filum terminalis, 4 dermoid cysts and 2 other lesions). The IOM included somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), and - in selected cases - D-waves. Also preoperative and postoperative neurophysiological assessment was performed with SEPs and MEPs. All patients were evaluated at admission and at follow up (minimum 6 months) with the Modified McCormick Scale (mMCs). Results Three different IOM patterns were observed during surgery: no change in evoked potentials (63 cases), transitory evoked potentials change (3 cases) and loss of evoked potentials (2 cases). In the first setting surgery was never stopped and a radical tumor removal was achieved (no stop surgery group). In 3 cases of transitory evoked potentials change, surgery was temporarily halted but the tumors were at the end completely removed (stop and go surgery group). In 2 more patients the loss of evoked potentials led to an incomplete resection (stop surgery group). No patients presented a worsening of the pre-operative clinical conditions (at admission 47 patients presented mMCs 1-2 and 21 patients mMCs 3-5, while at follow up 62 patients are mMCS 1-2 and 6 patients mMCs 3-5). Conclusions In our series significant IOM changes occurred in 5 out of 68 patients with IDEMs (7.35%), and it is conceivable that the modification of the surgical strategy - induced by IOM - prevented or mitigated neurological injury in these cases. Vice versa, in 63 patients (92.65%) IOM invariably predicted a good neurological outcome. Furthermore this technique allowed a safer tumor removal in IDEMs placed in difficult locations as cranio-vertebral junction or in antero/antero-lateral position (where rotation of spinal cord can be monitored) and even in case of tumor adherent to the spinal cord without a clear cleavage plane.

Original languageEnglish
Pages (from-to)140-149
Number of pages10
JournalClinical Neurology and Neurosurgery
Volume130
DOIs
Publication statusPublished - 2015
Externally publishedYes

Fingerprint

Intraoperative Neurophysiological Monitoring
Evoked Potentials
Neoplasms
Motor Evoked Potentials
Somatosensory Evoked Potentials
Spinal Cord
Ependymoma
Dermoid Cyst
Microsurgery
Patient Admission
Neurilemmoma
Meningioma

Keywords

  • D-waves
  • Intradural extramedullary tumors
  • Intraoperative neurophysiological monitoring
  • Motor evoked potentials
  • Somatosensory evoked potentials

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Ghadirpour, R., Nasi, D., Iaccarino, C., Giraldi, D., Sabadini, R., Motti, L., ... Servadei, F. (2015). Intraoperative neurophysiological monitoring for intradural extramedullary tumors: Why not? Clinical Neurology and Neurosurgery, 130, 140-149. https://doi.org/10.1016/j.clineuro.2015.01.007

Intraoperative neurophysiological monitoring for intradural extramedullary tumors : Why not? / Ghadirpour, Reza; Nasi, Davide; Iaccarino, Corrado; Giraldi, David; Sabadini, Rossella; Motti, Luisa; Sala, Francesco; Servadei, Franco.

In: Clinical Neurology and Neurosurgery, Vol. 130, 2015, p. 140-149.

Research output: Contribution to journalArticle

Ghadirpour, R, Nasi, D, Iaccarino, C, Giraldi, D, Sabadini, R, Motti, L, Sala, F & Servadei, F 2015, 'Intraoperative neurophysiological monitoring for intradural extramedullary tumors: Why not?', Clinical Neurology and Neurosurgery, vol. 130, pp. 140-149. https://doi.org/10.1016/j.clineuro.2015.01.007
Ghadirpour, Reza ; Nasi, Davide ; Iaccarino, Corrado ; Giraldi, David ; Sabadini, Rossella ; Motti, Luisa ; Sala, Francesco ; Servadei, Franco. / Intraoperative neurophysiological monitoring for intradural extramedullary tumors : Why not?. In: Clinical Neurology and Neurosurgery. 2015 ; Vol. 130. pp. 140-149.
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abstract = "Background While intraoperative neurophysiological monitoring (IOM) for intramedullary tumors has become a standard in neurosurgical practice, IOM for intradural extramedullary tumors (IDEMs) is still under debate. The aim of this study is to evaluate the role of IOM during surgery for IDEMs. Methods From March 2008 to March 2013, 68 patients had microsurgery with IOM for IDEMs (31 schwannomas, 25 meningiomas, 6 ependymomas of the cauda/filum terminalis, 4 dermoid cysts and 2 other lesions). The IOM included somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), and - in selected cases - D-waves. Also preoperative and postoperative neurophysiological assessment was performed with SEPs and MEPs. All patients were evaluated at admission and at follow up (minimum 6 months) with the Modified McCormick Scale (mMCs). Results Three different IOM patterns were observed during surgery: no change in evoked potentials (63 cases), transitory evoked potentials change (3 cases) and loss of evoked potentials (2 cases). In the first setting surgery was never stopped and a radical tumor removal was achieved (no stop surgery group). In 3 cases of transitory evoked potentials change, surgery was temporarily halted but the tumors were at the end completely removed (stop and go surgery group). In 2 more patients the loss of evoked potentials led to an incomplete resection (stop surgery group). No patients presented a worsening of the pre-operative clinical conditions (at admission 47 patients presented mMCs 1-2 and 21 patients mMCs 3-5, while at follow up 62 patients are mMCS 1-2 and 6 patients mMCs 3-5). Conclusions In our series significant IOM changes occurred in 5 out of 68 patients with IDEMs (7.35{\%}), and it is conceivable that the modification of the surgical strategy - induced by IOM - prevented or mitigated neurological injury in these cases. Vice versa, in 63 patients (92.65{\%}) IOM invariably predicted a good neurological outcome. Furthermore this technique allowed a safer tumor removal in IDEMs placed in difficult locations as cranio-vertebral junction or in antero/antero-lateral position (where rotation of spinal cord can be monitored) and even in case of tumor adherent to the spinal cord without a clear cleavage plane.",
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T2 - Why not?

AU - Ghadirpour, Reza

AU - Nasi, Davide

AU - Iaccarino, Corrado

AU - Giraldi, David

AU - Sabadini, Rossella

AU - Motti, Luisa

AU - Sala, Francesco

AU - Servadei, Franco

PY - 2015

Y1 - 2015

N2 - Background While intraoperative neurophysiological monitoring (IOM) for intramedullary tumors has become a standard in neurosurgical practice, IOM for intradural extramedullary tumors (IDEMs) is still under debate. The aim of this study is to evaluate the role of IOM during surgery for IDEMs. Methods From March 2008 to March 2013, 68 patients had microsurgery with IOM for IDEMs (31 schwannomas, 25 meningiomas, 6 ependymomas of the cauda/filum terminalis, 4 dermoid cysts and 2 other lesions). The IOM included somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), and - in selected cases - D-waves. Also preoperative and postoperative neurophysiological assessment was performed with SEPs and MEPs. All patients were evaluated at admission and at follow up (minimum 6 months) with the Modified McCormick Scale (mMCs). Results Three different IOM patterns were observed during surgery: no change in evoked potentials (63 cases), transitory evoked potentials change (3 cases) and loss of evoked potentials (2 cases). In the first setting surgery was never stopped and a radical tumor removal was achieved (no stop surgery group). In 3 cases of transitory evoked potentials change, surgery was temporarily halted but the tumors were at the end completely removed (stop and go surgery group). In 2 more patients the loss of evoked potentials led to an incomplete resection (stop surgery group). No patients presented a worsening of the pre-operative clinical conditions (at admission 47 patients presented mMCs 1-2 and 21 patients mMCs 3-5, while at follow up 62 patients are mMCS 1-2 and 6 patients mMCs 3-5). Conclusions In our series significant IOM changes occurred in 5 out of 68 patients with IDEMs (7.35%), and it is conceivable that the modification of the surgical strategy - induced by IOM - prevented or mitigated neurological injury in these cases. Vice versa, in 63 patients (92.65%) IOM invariably predicted a good neurological outcome. Furthermore this technique allowed a safer tumor removal in IDEMs placed in difficult locations as cranio-vertebral junction or in antero/antero-lateral position (where rotation of spinal cord can be monitored) and even in case of tumor adherent to the spinal cord without a clear cleavage plane.

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KW - Motor evoked potentials

KW - Somatosensory evoked potentials

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