title: Intraoperative spinal cord monitoring using combined motor and sensory evoked potentials recorded from the spinal cord during surgery for intramedullary spinal cord tumor.
abstract: OBJECTIVE
  The risk of postoperative neurological impairment mandates the use of intraoperative spinal cord monitoring (IOM) during intramedullary spinal cord tumor (IMSCT) surgery. We have used spinal cord evoked potential after electrical stimulation of the cord(Sp-SCEP) to monitor the sensory tract, and SCEP after electrical stimulation to the brain (Br-SCEP) to monitor the motor tract. Both Sp-SCEP and Br-SCEP are stable under general anesthesia. We assessed the clinical utility of these multimodal spinal cord monitoring methods in a retrospective study of a cohort of patients undergoing IMSCT surgery.
  
  
  METHODS
  Thirteen patients with IMSCTs underwent tumor resection using Sp-SCEP and/or Br-SCEP.
  
  
  RESULTS
  Four patients underwent surgery using only Sp-SCEP monitoring, resulting in two false negatives. Nine patients underwent surgery monitored by Br-SCEP and Sp-SCEP. In three of the nine cases, Br-SCEP amplitude fell by 50% from control levels, despite there being no change in Sp-SCEP. In one of the nine cases, Sp-SCEP amplitude fell to 50% of control levels, but Br-SCEP amplitude was stable.
  
  
  CONCLUSIONS
  During IMSCT surgery, localized regions of the cord may be damaged. Multimodal monitoring should be used to monitor.Combining Sp-SCEP and Br-SCEP is a useful means of monitoring the sensory and motor tracts.
authors.affiliation: Department of Orthopedic Surgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama 640-8505, Japan. Electronic address: mando@gaia.eonet.ne.jp.
authors.forename: Muneharu
authors.initials: M
authors.lastname: Ando
authors.affiliation: Department of Orthopedic Surgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama 640-8505, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tamaki
authors.affiliation: Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
authors.forename: Munehito
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Orthopedic Surgery, Wakayama Medical University Kihoku Hospital, Wakayama, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Kawakami
authors.affiliation: Department of Orthopedic Surgery, Naga Hospital, Wakayama, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kubota
authors.affiliation: Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Nakagawa
authors.affiliation: Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iwasaki
authors.affiliation: Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Tsutsui
authors.affiliation: Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004558:Electric Stimulation; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000502:physiology*; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D055815:Young Adult
keywords: Intramedullary spinal cord tumor; Multimodal monitoring; Spinal cord evoked potential; Spinal cord monitoring