title: Electrophysiological monitoring during preoperative angiography to guide decisions regarding permanent occlusion of major radicular arteries in patients undergoing total en bloc spondylectomy.
abstract: OBJECTIVE Preoperative embolization is performed before spine tumor surgery when significant intraoperative hemorrhage is anticipated. Occlusion of radicular and segmental arteries may result in spinal ischemia. The goal of this study was to check whether neurophysiological monitoring during preoperative angiography in patients scheduled for total en bloc spondylectomy (TES) of spine tumors improves the safety of vessel occlusion. METHODS This was a case series study of patients who underwent tumor embolization under somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring in preparation for TES in treating spine tumors. The angiography findings, the embolized vessels, and the results are presented. RESULTS Five patients whose ages ranged from 33 to 75 years and who had thoracic spine tumors are reported. Four patients suffered from primary tumor and 1 patient had a metastatic tumor. Radicular arteries at the tumor level, 1 level above, and 1 level below were permanently occluded when SSEPs and MEPs were preserved during temporary occlusion. No complications were encountered during or after the angiography procedure and embolization. CONCLUSIONS Temporary occlusion with electrophysiological monitoring during preoperative angiography may improve the safety of permanent radicular artery occlusion, including the artery of Adamkiewicz in patients undergoing TES for the treatment of spine tumors.
authors.affiliation: Department of Neurosurgery, The Spine Unit, Tel Aviv Medical Center;|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Khalil
authors.initials: K
authors.lastname: Salame
authors.affiliation: Department of Radiology, Tel Aviv Medical Center; and.
authors.forename: Shimon
authors.initials: S
authors.lastname: Maimon
authors.affiliation: Department of Neurosurgery, The Spine Unit, Tel Aviv Medical Center;|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gilad J
authors.initials: GJ
authors.lastname: Regev
authors.affiliation: Department of Radiology, Tel Aviv Medical Center; and.
authors.forename: Tali Jonas
authors.initials: TJ
authors.lastname: Kimchi
authors.affiliation: Department of Neurosurgery, The Spine Unit, Tel Aviv Medical Center;
authors.forename: Akiva
authors.initials: A
authors.lastname: Korn
authors.affiliation: Department of Neurosurgery, The Spine Unit, Tel Aviv Medical Center;
authors.forename: Laurence
authors.initials: L
authors.lastname: Mangel
authors.affiliation: Department of Neurosurgery, The Spine Unit, Tel Aviv Medical Center;|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Lidar
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; 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; D011300:Preoperative Care / Q000379:methods*; D020760:Spinal Cord Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: AKA = artery of Adamkiewicz; ASA, PSA = anterior, posterior spinal artery; EPM = electrophysiological monitoring; MEP = motor evoked potential; RMA = radiculomedullary artery; SSEP = somatosensory evoked potential; TES = total en bloc spondylectomy; electrophysiological monitoring; preoperative embolization; spine tumors; total en bloc spondylectomy