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.
脊髓肿瘤手术因存在神经功能恶化的固有风险而构成重大挑战。尽管已在众多医疗中心开展，但关于术前及术中神经生理学监测在检测和预防神经损伤方面的有效性仍存在持续争议。本研究首先系统综述了该领域常用的神经生理学技术。随后，我们报告了67例接受硬膜内肿瘤手术患者的队列研究结果。所有患者均接受术前及术中多模式体感诱发电位（SSEPs）和运动诱发电位（MEPs）监测，并于术后三个月进行临床评估。本研究旨在分析与神经功能预后相关的神经生理学、临床及影像学因素。单变量分析显示，术前及术中诱发电位改变、肿瘤大小以及室管膜瘤型组织学特征与神经功能恶化风险相关。多变量分析中，仅术前及术中神经生理学异常仍与神经功能恶化显著相关。值得注意的是，术中MEPs和SSEPs的短暂改变并未构成神经功能恶化风险。我们采用的机器学习模型展现出预测临床结局的可能性，准确率达到84%。
The Impact of Neurophysiological Monitoring during Intradural Spinal Tumor Surgery
肿瘤(癌症)患者之家