Spinal cord tumor surgery--importance of continuous intraoperative neurophysiological monitoring after tumor resection.
METHODS
A retrospective clinical analysis of patients operated on for spinal tumors.


OBJECTIVE
To report on the importance of intraoperative neurophysiological monitoring (INM) throughout the entire surgical procedure.


BACKGROUND
Postoperative neurological deterioration, despite unaltered neurophysiological monitoring, has been reported. This might be related to timely restricted monitoring. Thus, the likelihood of alterations in INM from positioning to wound closure was analyzed.


METHODS
Two hundred three patients (age range, 54.9 ± 17.4 yr) undergoing intradural tumor removal were sampled in a prospective database and analyzed for the occurrence of alterations in intraoperative somatosensory- and motor-evoked potentials.


RESULTS
INM alterations were observed in 47 of 203 (23.2%) patients. These alterations were related to tumor resection in 29 (14.3%) cases, whereas these were unrelated to tumor removal in 18 patients: laminotomy in 5 (2.5%) patients, dura opening in 7 (3.5%) patients, dura closure in 5 (2.5%) patients, and laminoplasty in 1 (0.5%) patient caused INM changes.


CONCLUSIONS
This study demonstrates that monitoring beyond tumor resection is of essential importance in order to detect all critical phases of surgical procedure and to counteract accordingly.
Department of Neurosurgery, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany. marie-therese.forster@med.uni-frankfurt.de
Marie-Thérèse
MT
Forster
Gerhard
G
Marquardt
Volker
V
Seifert
Andrea
A
Szelényi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D007796:Laminectomy / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult