title: Spinal intradural extramedullary tumors: the value of intraoperative neurophysiologic monitoring on surgical outcome.
abstract: Nerve sheath tumors and meningiomas account for most intradural extramedullary (IDEM) tumors. These tumors are benign and amenable to complete surgical resection. In recent years, these surgeries are performed with intraoperative neurophysiologic monitoring (IONM) in order to minimize neurological injury, but the evidence for the statistical efficacy of this utility is lacking. This paper evaluates IONM benefits in IDEM tumor resection. Data of patients treated surgically for spinal intradural tumors from 1998 to 2003 was previously collected and analyzed. We retrospectively evaluated patients' charts operated in the years 2011 to 2013. Patients' medical files were reviewed including radiological examinations and electrophysiological reports. The data was collected and evaluated. Forty-one cases of meningioma or nerve sheath tumor resection surgery were performed in the study period. The surgical results were compared to 70 cases of historical controls. Demographic data was similar in these two groups. Sensitivity, specificity, and positive and negative predicted values of IONM were 75, 100, 100, and 97%, respectively. New neurological deficit rate was evident in 10 and 14% for the study and control groups, respectively (not significant). While IONM predicts neurological deficits with high accuracy level, this study does not suggest that there is a significant global benefit of IONM in these cases. As reported by others, in this series, the rate of new neurological deficits in non-monitored cases is similar to the monitored cases series; hence, IONM role in preventing new neurological deficits has yet to be proven.
authors.affiliation: Spine Surgery Unit, Department of Neurosurgery, Sheba Medical Center affiliated to Sackler Medical School, Tel Aviv University, Te Aviv, Israel. Ran.Harel@sheba.health.gov.il.|Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel. Ran.Harel@sheba.health.gov.il.|Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel. Ran.Harel@sheba.health.gov.il.
authors.forename: Ran
authors.identifier: http://orcid.org/0000-0002-0165-7114
authors.initials: R
authors.lastname: Harel
authors.affiliation: Spine Surgery Unit, Department of Neurosurgery, Sheba Medical Center affiliated to Sackler Medical School, Tel Aviv University, Te Aviv, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Schleifer
authors.affiliation: Department of Neurology, Barzilai Medical Center, Ashkelon, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Appel
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Attia
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Zvi R
authors.initials: ZR
authors.lastname: Cohen
authors.affiliation: Spine Surgery Unit, Department of Neurosurgery, Sheba Medical Center affiliated to Sackler Medical School, Tel Aviv University, Te Aviv, Israel.
authors.forename: Nachshon
authors.initials: N
authors.lastname: Knoller
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D018317:Nerve Sheath Neoplasms / Q000601:surgery*; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Intradural tumor; Intraoperative neurophysiologic monitoring; Meningioma; Nerve sheath tumor; Spine tumor surgery