Intraoperative neurophysiological monitoring for intradural extramedullary tumors: Why not?

摘要: Abstract Background While intraoperative neurophysiological monitoring (IOM) for intramedullary tumors has become a standard in neurosurgical practice, IOM intradural extramedullary (IDEMs) is still under debate. The aim of this study to evaluate the role during surgery IDEMs. Methods From March 2008 2013, 68 patients had microsurgery with IDEMs (31 schwannomas, 25 meningiomas, 6 ependymomas cauda/filum terminalis, 4 dermoid cysts and 2 other lesions). included somatosensory evoked potentials (SEPs), motor (MEPs), – selected cases D-waves. Also preoperative postoperative assessment was performed SEPs MEPs. All were evaluated at admission follow up (minimum months) Modified McCormick Scale (mMCs). Results Three different patterns observed surgery: no change (63 cases), transitory (3 cases) loss (2 cases). In first setting never stopped radical tumor removal achieved (no stop group). 3 change, temporarily halted but end completely removed (stop go more led an incomplete resection No presented worsening pre-operative clinical conditions (at 47 mMCs 1–2 21 3–5, while 62 are mMCS 3–5). Conclusions our series significant changes occurred 5 out (7.35%), it conceivable that modification surgical strategy induced by prevented or mitigated neurological injury these cases. Vice versa, 63 (92.65%) invariably predicted good outcome. Furthermore technique allowed safer placed difficult locations as cranio-vertebral junction antero/antero-lateral position (where rotation spinal cord can be monitored) even case adherent without clear cleavage plane.