Ann Rehabil Med.  2017 Aug;41(4):610-620. 10.5535/arm.2017.41.4.610.

Intraoperative Neurophysiological Monitoring for Spinal Cord Tumor Surgery: Comparison of Motor and Somatosensory Evoked Potentials According to Tumor Types

Affiliations
  • 1Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea. HANLEZZ@yuhs.ac

Abstract


OBJECTIVE
To identify which combination of motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) is most reliable for postoperative motor deterioration during spinal cord tumor surgery, according to anatomical and pathologic type.
METHODS
MEPs and SEPs were monitored in patients who underwent spinal cord tumor surgery between November 2012 and August 2016. Muscle strength was examined in all patients before surgery, within 48 hours postoperatively and 4 weeks later. We analyzed sensitivity, specificity, positive and negative predictive values of each significant change in SEPs and MEPs.
RESULTS
The overall sensitivity and specificity of SEPs or MEPs were 100% and 61.3%, respectively. The intraoperative MEP monitoring alone showed both higher sensitivity (67.9%) and specificity (83.2%) than SEP monitoring alone for postoperative motor deterioration. Two patients with persistent motor deterioration had significant changes only in SEPs. There are no significant differences in reliabilities between anatomical types, except with hemangioma, where SEPs were more specific than MEPs for postoperative motor deterioration. Both overall positive and negative predictive values of MEPs were higher than the predictive values of SEPs. However, the positive predictive value was higher by the dual monitoring of MEPs and SEPs, compared to MEPs alone.
CONCLUSION
For spinal cord tumor surgery, combined MEP and SEP monitoring showed the highest sensitivity for the postoperative motor deterioration. Although MEPs are more specific than SEPs in most types of spinal cord tumor surgery, SEPs should still be monitored, especially in hemangioma surgery.

Keyword

Spinal cord neoplasm; Intraoperative neurophysiological monitoring; Motor evoked potentials; Somatosensory evoked potentials; Postoperative complications

MeSH Terms

Evoked Potentials, Motor
Evoked Potentials, Somatosensory*
Hemangioma
Humans
Intraoperative Neurophysiological Monitoring*
Muscle Strength
Postoperative Complications
Sensitivity and Specificity
Spinal Cord Neoplasms*
Spinal Cord*
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