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The Impact of Neurophysiological Monitoring during Intradural Spinal Tumor Surgery.

Authors :
Ilhan, Furkan
Boulogne, Sébastien
Morgado, Alexis
Dauleac, Corentin
André-Obadia, Nathalie
Jung, Julien
Source :
Cancers. Jun2024, Vol. 16 Issue 12, p2192. 17p.
Publication Year :
2024

Abstract

Simple Summary: Spinal cord tumors represent a significant surgical challenge. Neurophysiological evaluation using motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) is used to assess the function of motor and somatosensory pathways before and during surgery. However, its role with respect to the detection of neurological damage is not fully known. This study assesses the prognostic value of alterations of pre- and per-operative MEPs and SSEPs in a cohort of 67 patients undergoing spinal cord tumor surgery. We show that pre- and intraoperative alterations to MEPs and SSEPs are strongly associated with a risk of neurological deterioration 3 months after surgery that is independent of initial clinical severity, tumor size, or histological subtype. Leveraging a classical machine learning approach, it is possible to predict neurological outcomes with an accuracy of 84%. Thus, this study demonstrates the pivotal role of pre- and intraoperative neurophysiological explorations in detecting and preventing neurological suffering during spinal tumor surgery. Surgery for spinal cord tumors poses a significant challenge due to the inherent risk of neurological deterioration. Despite being performed at numerous centers, there is an ongoing debate regarding the efficacy of pre- and intraoperative neurophysiological investigations in detecting and preventing neurological lesions. This study begins by providing a comprehensive review of the neurophysiological techniques commonly employed in this context. Subsequently, we present findings from a cohort of 67 patients who underwent surgery for intradural tumors. These patients underwent preoperative and intraoperative multimodal somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs), with clinical evaluation conducted three months postoperatively. The study aimed to evaluate the neurophysiological, clinical, and radiological factors associated with neurological outcomes. In univariate analysis, preoperative and intraoperative potential alterations, tumor size, and ependymoma-type histology were linked to the risk of worsening neurological condition. In multivariate analysis, only preoperative and intraoperative neurophysiological abnormalities remained significantly associated with such neurological deterioration. Interestingly, transient alterations in intraoperative MEPs and SSEPs did not pose a risk of neurological deterioration. The machine learning model we utilized demonstrated the possibility of predicting clinical outcome, achieving 84% accuracy. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
20726694
Volume :
16
Issue :
12
Database :
Academic Search Index
Journal :
Cancers
Publication Type :
Academic Journal
Accession number :
178155821
Full Text :
https://doi.org/10.3390/cancers16122192