Analysis of multimodal intraoperative monitoring during intramedullary spinal ependymoma surgery
EANS Academy. Park J. 09/25/19; 275735; EP04133
Assoc. Prof. Jong-Hyeok Park
Assoc. Prof. Jong-Hyeok Park

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Abstract
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Background: To evaluate the validity of intraoperative somatosensory-evoked potential (SSEP) and motor-evoked potential (MEP) monitoring according to two different warning criteria for 6 months after intramedullary spinal ependymoma (IMSE) surgery.
Methods: A retrospective analysis was performed on patients who underwent IMSE surgery with intraoperative monitoring from January 2010 to June 2017. Twenty-six patients were included. We examined the sensitivity, specificity, positive predictable value (PPV), negative predictable value (NPV), and diagnostic odds ratio (DOR) of SSEP and MEP monitoring according to the following warning criteria: 50% decline and all-or-none. The postoperative motor deficit was evaluated using the Medical Research Council (MRC) scale. A significant motor deficit was defined as a decrease of ≥2 MRC grades. The postoperative motor deficit was recorded during the 6 months follow-up.
Results: The success rates of SSEP and MEP monitoring were 84.9% and 83.7%, respectively. There was one indeterminate case in SSEP and six in MEP. All-or-none criterion in SSEP and MEP monitoring showed higher specificity, PPV, and DOR than 50% decline criterion during 6 months. During the follow up, 37 of 38 extremities (97.4%) and 21 of 29 extremities (72.4%) were observed the improvement of sensory and motor deficit, respectively. Seven indeterminate cases also showed good clinical outcomes. However, most patients remained some degree of neurologic deficit.
Conclusions: Many false positive and false negative results of SSEP and MEP monitoring occurred immediately postoperative period. All-or-none criterion was more beneficial for IMSE surgery than 50% decline criterion. This trend was maintained until 6 months after surgery.
Background: To evaluate the validity of intraoperative somatosensory-evoked potential (SSEP) and motor-evoked potential (MEP) monitoring according to two different warning criteria for 6 months after intramedullary spinal ependymoma (IMSE) surgery.
Methods: A retrospective analysis was performed on patients who underwent IMSE surgery with intraoperative monitoring from January 2010 to June 2017. Twenty-six patients were included. We examined the sensitivity, specificity, positive predictable value (PPV), negative predictable value (NPV), and diagnostic odds ratio (DOR) of SSEP and MEP monitoring according to the following warning criteria: 50% decline and all-or-none. The postoperative motor deficit was evaluated using the Medical Research Council (MRC) scale. A significant motor deficit was defined as a decrease of ≥2 MRC grades. The postoperative motor deficit was recorded during the 6 months follow-up.
Results: The success rates of SSEP and MEP monitoring were 84.9% and 83.7%, respectively. There was one indeterminate case in SSEP and six in MEP. All-or-none criterion in SSEP and MEP monitoring showed higher specificity, PPV, and DOR than 50% decline criterion during 6 months. During the follow up, 37 of 38 extremities (97.4%) and 21 of 29 extremities (72.4%) were observed the improvement of sensory and motor deficit, respectively. Seven indeterminate cases also showed good clinical outcomes. However, most patients remained some degree of neurologic deficit.
Conclusions: Many false positive and false negative results of SSEP and MEP monitoring occurred immediately postoperative period. All-or-none criterion was more beneficial for IMSE surgery than 50% decline criterion. This trend was maintained until 6 months after surgery.
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