Objective: The study aimed at evaluating the efficacy and the ability of D-wave monitoring combined with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) to predict functional outcomes in intramedullary spinal cord tumor (IMSCT) surgery. Methods: Between December 2011 and December 2020, all patients harboring IMSCT who underwent surgery at our institution were prospectively collected in a surgical spinal registry and retrospectively analyzed. Patient charts and surgical and histological reports were analyzed. The multimodal IONM included SSEPs, MEPs, and—whenever possible—D-waves. All patients were evaluated using the modified McCormick and Frankel grade at admission and 3, 6, and 12 months of follow-up. Results: Sixty-four patients were enrolled in the study. SSEP and MEP monitoring was performed in all patients. The D-wave was not recordable in seven patients (11%). Significant IONM changes (at least one evoked potential modality) were registered in 26 (41%) of the 64 patients. In five cases (8%) where the SSEPs and MEPs lost and the D-wave permanently dropped by about 50%, patients experienced a permanent deterioration of their neurological status. Multimodal IONM (SSEP, MEP, and D-wave neuromonitoring) significantly predicted postoperative deficits (p= 0.0001), with a sensitivity of 100.00% and a specificity of 95.65%. However, D-waves demonstrated significantly higher sensitivity (100%) than MEPs (62.5%) and SSEPs (71.42%) alone. These tests’ specificities were 85.10%, 13.89%, and 17.39%, respectively. Comparing the area under ROC curves (AUCs) of these evoked potentials in 53 patients (where all three modalities of IONM were registered) using the pairwiset-test, D-wave monitoring appeared to have higher accuracy and ability to predict postoperative deficits with strong statistical significance compared with MEP and SSEP alone (0.992 vs. 0.798 vs. 0.542;p= 0.018 andp< 0.001). Conclusion: The use of multimodal IONM showed a statistically significant greater ability to predict postoperative deficits compared with SSEP, MEP, and D-wave monitoring alone. D-wave recording significantly increased the accuracy and clinical value of neurophysiological monitoring in IMSCT tumor resection.
目的：本研究旨在评估D波监测联合体感诱发电位（SSEPs）和运动诱发电位（MEPs）在预测髓内脊髓肿瘤（IMSCT）手术功能预后方面的效能与能力。方法：前瞻性收集2011年12月至2020年12月期间在本机构接受手术的所有IMSCT患者数据，建立脊柱手术登记库并进行回顾性分析。对患者病历、手术记录及病理报告进行系统分析。术中多模式神经电生理监测（IONM）包括SSEPs、MEPs及条件允许时的D波监测。所有患者在入院时及术后3、6、12个月随访时均采用改良McCormick分级和Frankel分级进行评估。结果：共纳入64例患者。所有患者均接受SSEP和MEP监测，其中7例（11%）未能记录到D波。64例患者中有26例（41%）出现显著的IONM变化（至少一种诱发电位模式）。在5例（8%）SSEPs和MEPs消失且D波永久性下降约50%的病例中，患者均出现神经功能状态的永久性恶化。多模式IONM（SSEP、MEP及D波监测）对术后神经功能缺损的预测具有统计学显著性（p=0.0001），敏感度为100.00%，特异度为95.65%。然而，D波监测的敏感度（100%）显著高于单独的MEPs（62.5%）和SSEPs（71.42%），三者特异度分别为85.10%、13.89%和17.39%。在53例同时记录三种IONM模式的患者中，通过配对t检验比较受试者工作特征曲线下面积（AUCs），D波监测显示出更高的准确性和术后神经功能缺损预测能力，与单独使用MEP或SSEP相比具有强统计学显著性（0.992 vs. 0.798 vs. 0.542；p=0.018且p<0.001）。结论：与单独使用SSEP、MEP或D波监测相比，多模式IONM在预测术后神经功能缺损方面具有统计学上显著更强的能力。D波记录显著提高了IMSCT肿瘤切除术中神经电生理监测的准确性和临床价值。
肿瘤(癌症)患者之家