| ObjectiveTo investigate the application of combined cortical somatosensory evoked potential (CSEP) and transcranial electrical stimulation motor evoked potential (TES-MEP) monitoring during the spinal canal space-occupying lesion surgery.MethodsFifty two patients with spinal canal space-occupying lesions from July 2009 to January 2011 were included in this study.The patients were recorded for the CSEP at the same time recorded for the TES-MEP response on bilateral anterior tibial muscle and flexor hallucal brevis during the surgery. In addition, we also applied TES-MEP monitoring on the muscle of thenar or the muscle of hyporhenar when the patients underwent the cervical surgery. There were 46 cases with spinal canal tumors, and 6 cases with spinal canal hematomas. All patients were monitored using CSEP in conjunction with TES-MEP. Posterior approaches were used in all the procedures, and intravenous general anesthesia was applied for all the surgeries.ResultsThere are 9 cases with positive evoked potentials during surgeries. Six cases were caused by surgical manipulation. However, three cases with positive monitoring could not be explained clinically. CSEPs obviously improved intraoperatively in 4 cases. Two patients got improved CSEP and reappeared TES-MEPs simultaneously. One patient who had no intraoperative potential changes, got complete paraplegia 3 hours after surgery. MRI revealed a postoperative hematoma formation. The sensitivity, specificity and Youden index of CSEP were 67%, 95.6%, and 0.66; those of TES-MEP were 85.7%, 97.5%, and 0.81; those of combined monitoring were 100%, 97.6%, and 0.97.ConclusionHeight, weight and age have no effect on the resules of monitoring. TES-MEP monitoring can increase the safety of the spinal surgery by supplementing CSEP monitoring during spinal canal occupation surgery. Combined monitoring can predict neurological prognosis in some cases; and it can help the diagnosis of postoperative spinal cord injury. |
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