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Increased Intraoperative Motor Evoked Potentials and Motor Recovery after Spinal Cord Tumor Removal

척수 종양 제거 술 중 운동유발전위의 호전과 근력 호전의 관계

  • Pyo, Soeun (Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine) ;
  • Park, Yoon Ghil (Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine) ;
  • Park, Jinyoung (Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine) ;
  • Ko, Eu Jeong (Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine)
  • 표소은 (연세대학교 의과대학, 강남세브란스병원 재활의학과, 희귀난치성 신경근육병 재활연구소) ;
  • 박윤길 (연세대학교 의과대학, 강남세브란스병원 재활의학과, 희귀난치성 신경근육병 재활연구소) ;
  • 박진영 (연세대학교 의과대학, 강남세브란스병원 재활의학과, 희귀난치성 신경근육병 재활연구소) ;
  • 고유정 (연세대학교 의과대학, 강남세브란스병원 재활의학과, 희귀난치성 신경근육병 재활연구소)
  • Received : 2018.09.24
  • Accepted : 2018.10.22
  • Published : 2018.12.31

Abstract

Objective: To evaluate whether the increase of the amplitude of motor evoked potentials (MEPs) during surgery can imply favorable prognosis postoperatively in spinal cord tumor surgery. Method: MEPs were monitored in patients who underwent spinal cord tumor surgery between March 2016 and March 2018. Amplitude changes at the end of monitoring compared to the baselines in limb muscle were analyzed. Minimum and maximum changes were set to $MEP_{min}$ (%) and $MEP_{max}$ (%). Strengths of bilateral 10 key muscles which were documented a day before ($Motor_{pre}$), 48 h ($Motor_{48h}$) and 4 weeks ($Motor_{4wk}$) after the surgery were reviewed. Results: Difference of $Motor_{48h}$ from $Motor_{pre}$ ($Motor_{48h-pre}$) and $Motor_{4wk}$ from $Motor_{pre}$ ($Motor_{4wk-pre}$) positively correlated with $MEP_{min}$, suggesting that smaller the difference of MEPs amplitude, less recovery of muscle strength. There was a negative correlation between the amount of bleeding and $MEP_{min}$, indicating that the greater the amount of bleeding, the smaller the $MEP_{min}$, implying that MEPs amplitude is less likely to improve when the amount of bleeding is large. It also showed significant difference between patients with improved or no change of motor status and patients with motor deterioration after surgery according to anatomical tumor types. Conclusion: Improve of muscle strength was less when the increase of MEPs amplitude was small, and improvement of MEPs amplitude was less when the amount of bleeding was large. Correlation between changes of status of muscle strength after surgery and tumor types was observed. With amplitude increase in MEPs monitoring, restoration of muscle strength can be expected.

References

  1. Lall RR, Lall RR, Hauptman JS, Munoz C, Cybulski GR, Koski T, et al: Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist. Neurosurg Focus 2012: 33: E10
  2. Magit DP, Hilibrand AS, Kirk J, Rechtine G, Albert TJ, Vaccaro AR, et al: Questionnaire study of neuromonitoring availability and usage for spine surgery. J Spinal Disord Tech 2007: 20: 282-289 https://doi.org/10.1097/01.bsd.0000211286.98895.ea
  3. Park J-H, Hyun S-J: Intraoperative neurophysiological monitoring in spinal surgery. World Journal of Clinical Cases 2015: 3: 765-773 https://doi.org/10.12998/wjcc.v3.i9.765
  4. Chang SH, Park YG, Kim DH, Yoon SY: Monitoring of Motor and Somatosensory Evoked Potentials During Spine Surgery: Intraoperative Changes and Postoperative Outcomes. Ann Rehabil Med 2016: 40: 470-480 https://doi.org/10.5535/arm.2016.40.3.470
  5. Macdonald DB, Al Zayed Z, Al Saddigi A: Four-limb muscle motor evoked potential and optimized somatosensory evoked potential monitoring with decussation assessment: results in 206 thoracolumbar spine surgeries. Eur Spine J 2007: 16 Suppl 2: S171-187 https://doi.org/10.1007/s00586-007-0426-7
  6. MacDonald DB, Al Zayed Z, Khoudeir I, Stigsby B: Monitoring scoliosis surgery with combined multiple pulse transcranial electric motor and cortical somatosensory-evoked potentials from the lower and upper extremities. Spine (Phila Pa 1976) 2003: 28: 194-203 https://doi.org/10.1097/00007632-200301150-00018
  7. Park T, Park J, Park YG, Lee J: Intraoperative Neurophysiological Monitoring for Spinal Cord Tumor Surgery: Comparison of Motor and Somatosensory Evoked Potentials According to Tumor Types. Ann Rehabil Med 2017: 41: 610-620 https://doi.org/10.5535/arm.2017.41.4.610
  8. MacDonald DB: Overview on Criteria for MEP Monitoring. J Clin Neurophysiol 2017: 34: 4-11 https://doi.org/10.1097/WNP.0000000000000302
  9. Pelosi L, Lamb J, Grevitt M, Mehdian SM, Webb JK, Blumhardt LD: Combined monitoring of motor and somatosensory evoked potentials in orthopaedic spinal surgery. Clin Neurophysiol 2002: 113: 1082-1091 https://doi.org/10.1016/S1388-2457(02)00027-5
  10. Weinzierl MR, Reinacher P, Gilsbach JM, Rohde V: Combined motor and somatosensory evoked potentials for intraoperative monitoring: intra- and postoperative data in a series of 69 operations. Neurosurg Rev 2007: 30: 109-116 https://doi.org/10.1007/s10143-006-0061-5
  11. Holdefer RN, MacDonald DB, Skinner SA: Somatosensory and motor evoked potentials as biomarkers for post-operative neurological status. Clin Neurophysiol 2015: 126: 857-865. https://doi.org/10.1016/j.clinph.2014.11.009
  12. Kobayashi K, Ando K, Kato F, Kanemura T, Sato K, Kamiya M, et al: Surgical outcomes of spinal cord and cauda equina ependymoma: Postoperative motor status and recurrence for each WHO grade in a multicenter study. J Orthop Sci 2018: 23: 614-621 https://doi.org/10.1016/j.jos.2018.03.004
  13. McGirt MJ, Chaichana KL, Atiba A, Attenello F, Yao KC, Jallo GI: Resection of intramedullary spinal cord tumors in children: assessment of long-term motor and sensory deficits. J Neurosurg Pediatr 2008: 1: 63-67 https://doi.org/10.3171/PED-08/01/063
  14. Liu JX, Zhou HZ, Yang SH, Shao ZW, Zheng QX, Yang C, et al: Clinical analysis of 73 cases of intraspinal nerve sheath tumor. J Huazhong Univ Sci Technolog Med Sci 2013: 33: 258-261. https://doi.org/10.1007/s11596-013-1107-x
  15. Ciappetta P, Domenicucci M, Raco A: Spinal meningiomas: prognosis and recovery factors in 22 cases with severe motor deficits. Acta Neurol Scand 1988: 77: 27-30
  16. Guerit J-M, Dion RA: State-of-the-art of neuromonitoring for prevention of immediate and delayed paraplegia in thoracic and thoracoabdominal aorta surgery. The Annals of Thoracic Surgery 2002: 74: S1867-S1869 https://doi.org/10.1016/S0003-4975(02)04130-9
  17. Astrup J, Siesjo BK, Symon L: Thresholds in cerebral ischemia - the ischemic penumbra. Stroke 1981: 12: 723-725 https://doi.org/10.1161/01.STR.12.6.723
  18. Macdonald DB, Skinner S, Shils J, Yingling C: Intraoperative motor evoked potential monitoring - a position statement by the American Society of Neurophysiological Monitoring. Clin Neurophysiol 2013: 124: 2291-2316 https://doi.org/10.1016/j.clinph.2013.07.025