1. Intraoperative neurophysiological mapping and monitoring in spinal tumor surgery: Sirens or indispensable tools?
- Author
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Adolfo Morelli, Raffaella Mallamace, Antonino Germanò, Angelo Quartarone, Carmen Terranova, Alfredo Conti, Gaetano Buda, Felice Esposito, Vincenzo Rizzo, Antonino Scibilia, Giovanni Raffa, SCIBILIA, ANTONINO, TERRANOVA, CARMEN, RIZZO, VINCENZO, RAFFA, giovanni, MORELLI, Adolfo, ESPOSITO, FELICE, MALLAMACE, RAFFAELLA MARIA, Buda, Gaetano, CONTI, Alfredo, QUARTARONE, Angelo, and GERMANO', Antonino Francesco
- Subjects
medicine.medical_specialty ,Intraoperative Neurophysiological Monitoring ,D wave ,Spinal tumor surgery ,Neurosurgical Procedures ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,Positive predicative value ,Evoked Potentials, Somatosensory ,D wave, Electromyography, Intraoperative monitoring, Motor evoked potential, Somatosensory evoked potential, Spinal tumor surgery, Surgery, Neurology (clinical) ,Medicine ,Humans ,Spinal Cord Neoplasms ,Motor evoked potential ,Intraoperative monitoring ,business.industry ,Electromyography ,Medicolegal aspects ,General Medicine ,Neurophysiology ,Evoked Potentials, Motor ,Spine ,Surgery ,Functional integrity ,Somatosensory evoked potential ,Spinal tumor ,030220 oncology & carcinogenesis ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Intraoperative neurophysiological monitoring - Abstract
Spinal tumor (ST) surgery carries the risk of new neurological deficits in the postoperative period. Intraoperative neurophysiological monitoring and mapping (IONM) represents an effective method of identifying and monitoring in real time the functional integrity of both the spinal cord (SC) and the nerve roots (NRs). Despite consensus favoring the use of IONM in ST surgery, in this era of evidence-based medicine, there is still a need to demonstrate the effective role of IONM in ST surgery in achieving an oncological cure, optimizing patient safety, and considering medicolegal aspects. Thus, neurosurgeons are asked to establish which techniques are considered indispensable. In the present study, the authors focused on the rationale for and the accuracy (sensitivity, specificity, and positive and negative predictive values) of IONM in ST surgery in light of more recent evidence in the literature, with specific emphasis on the role of IONM in reducing the incidence of postoperative neurological deficits. This review confirms the role of IONM as a useful tool in the workup for ST surgery. Individual monitoring and mapping techniques are clearly not sufficient to account for the complex function of the SC and NRs. Conversely, multimodal IONM is highly sensitive and specific for anticipating neurological injury during ST surgery and represents an important tool for preserving neuronal structures and achieving an optimal postoperative functional outcome.
- Published
- 2016