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Correlation of Intraoperative Neurophysiological Parameters and Outcomes in Patients with Intramedullary Tumors
Leonardo Gilmone Ruschel1,2,3, Afonso Aragão1, Matheus Fernandes de Oliveira2,3,4
1Department of Neurosurgery, Neurological Institute of Curitiba, Curitiba, Paraná, Brazil.
Introduction:
Intramedullary spinal cord tumors (IMSCT) account for about 2%-4% of all central nervous system tumors. Surgical resection is the main treatment step, but might cause damage to functional tissues. Intraoperative neuromonitoring (IONM) is an adopted measure to decrease surgical complications. Below, we describe the results of IMSCT submitted to surgery under IONM at a tertiary institution.
Methods:
The sample consisted of consecutive patients with IMSCT admitted to the Neurological Institute of Curitiba from January 2007 to November 2016. A total of 47 patients were surgically treated. Twenty-three were male (48.9%) and 24 were female (51.1%). The mean age was 42.77 years. The mean follow-up time was 42.7 months.
Results:
Neurological status improved in 29 patients (62%), stable in 6 (13%), and worse in 12 (25%). Patients who presented with motor symptoms at initial diagnosis had a worse outcome compared to patients with sensory impairment and pain (P = 0.026). Patients with a change in electromyography had worse neurological outcomes compared to patients who did not show changes in monitoring (P = 0.017).
Discussion And Conclusion:
No prospective randomized high evidence study has been performed to date to compare clinical evolution after surgery with or without monitoring. In our sample, surgical resection was well succeeded mainly in oligosymptomatic patients with low preoperative McCormick classification and no worsening of IONM during surgery. We believe that microsurgical resection of IMSCT with simultaneous IONM is the gold standard treatment and achieved with good results.
Insights
Intramedullary spinal cord tumor (IMSCT) surgery using intraoperative neuromonitoring (IONM) showed good results, especially for patients with fewer symptoms. IONM is crucial for successful surgical outcomes in IMSCT treatment.
Area of Science:
- Neurosurgery
- Neurology
- Oncology
Background:
- Intramedullary spinal cord tumors (IMSCT) are rare, comprising 2-4% of CNS tumors.
- Surgical resection is primary treatment but risks neurological damage.
- Intraoperative neuromonitoring (IONM) is utilized to mitigate surgical complications.
Purpose of the Study:
- To evaluate the outcomes of IMSCT surgical resection with IONM.
- To identify factors influencing neurological outcomes after IMSCT surgery.
Main Methods:
- A retrospective analysis of 47 consecutive IMSCT patients undergoing surgery with IONM.
- Data collected included patient demographics, preoperative symptoms, and intraoperative monitoring.
- Mean follow-up was 42.7 months.
Main Results:
- Neurological status improved in 62% of patients, remained stable in 13%, and worsened in 25%.
- Motor symptoms at diagnosis correlated with worse outcomes (P=0.026).
- Changes in electromyography during surgery predicted poorer neurological outcomes (P=0.017).
Conclusions:
- Microsurgical resection of IMSCT with IONM is considered the gold standard.
- Successful outcomes were associated with oligosymptomatic patients and stable IONM.
- Further high-evidence studies are needed to compare outcomes with and without IONM.
