| Objective To assess the predictive value of multimodal intraoperative neurophysiologic monitoring(MIOM) during decompression for intramedullary spine tumors.Methods From January 2012 to December 2013, 34 cases of intramedullary spine tumors were treated with MIOM(somatosensory evoked potentials [SEP]. motor evoked potentials [MEP]and electromyography [EMG]). Pre- and postoperative neurologic status and intraoperative neurophysiologic data were collected.Results 34 patients were all used SEP and MEP monitoring. 8 cases of thoracic lumbar segment and conical parts lesions in patients with combined anal sphincter EMG monitoring at the same time. Electrophysiological monitoring data are satisfactory. Total excision of the tumor 28 cases(82.35%), subtotal resection 6 cases(17.65%). Preoperative Mc Cormick spinal cord function classification: â… level 14 cases, â…¡ level in 11 cases, â…¢ level 4 cases, â…£ level 4 cases, â…¤ level 1 case;After 2 weeks follow-up: â… level 14 cases, â…¡ level 15 cases, â…¢ level 3 cases, â…£level in 2 cases, â…¤ level 0 cases. 28 cases(82.4%) of the spinal cord function improved compared with preoperative or no change, 6 cases(17.6%)get worse. More than 6 months follow-up: â… level 16 cases, â…¡ level 13 cases, â…¢ level 3 cases,â…£ level in 2 cases, â…¤ level 0 cases. 30 cases(88.2%) of the spinal cord function improved compared with preoperative or no change, 4 cases(11.8%) get worse.21 patients reach the standard alarm, of temporal change in 14 cases and permanent change in 7 cases,SEPg get Negative predictive value of 90% and Positive predictive value of 25%.While MEPg get Negative predictive value of 100% and Positive predictive value of 100%.No patients get worse with EMG. Short-term follow-up in MIOM: sensitivity of 66.7%, specificity of 96.4%, false negative rate was 7.4%, the false positive rate is 42%; Long-term follow-up in MIOM: sensitivity of 100%, pecificity of 90.0%, false negative rate was 0, the false positive rate is 42%.Conclusions1. Intramedullary spinal cord tumor cancer surgery has a very high risk, the application of multimodal intraoperative neurophysiologic monitoring microsurgery resection of the tumor can be more comprehensive monitoring spinal cord function, effectively reduce the false negative cases caused by a single monitoring, to improve the safety of operation. multimodal intraoperative neurophysiologic monitoring of postoperative spinal cord function prediction effect, has a good clinical significance. MIOM in no more than a sex change to change or prompt intraoperatie neurologic integrity preserved, postoperative nerve function in patients with stable, long-term follow-up surgery prognosis is good, the long-term negative predictive value of 100%. Permanent change in MIOM prompt patients postoperative neurological damage, positive predictive value was 57.1%, high false positive. And MEP positive predictive value(80%)than SEP(25%), MEP in a single alarm is more prompt meaningful clinical outcomes than SEP, consider about MEP alarm threshold is relatively broad, and SEP vulnerable to external environment and the effect of nerve damage, and sensitive, so there are high false positive. EMG monitoring as a "real-time" feedback, the damage is extremely sensitive, intraoperative EMG can alarm in time to avoid nerve damage.2. MIOM can effectively protect the spinal cord function, but nerve monitoring requirement condition is harsh, like intraoperative anesthetic conditions, body temperature, blood pressure change might affect the monitoring quality,sometimes can cause false positive results, therefore, the police once produced must be careful analysis, exclusion of anesthesia, electrode loose or fall off and other technical reasons. Cross major cooperation is particularly important. |
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