Neuromonitoring for Proximal Fibular Osteochondroma Excision

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Oncology

Background:

• The peroneal nerve is vulnerable during proximal fibula tumor resection, with nerve injury rates ranging from 3% to 20%.
• Osteochondromas in the proximal fibula can pose risks to the peroneal nerve.
• This study focuses on the resection of symptomatic proximal fibular osteochondromas (PFO).

Purpose of the Study:

• To report institutional experience with PFO excision.
• To describe the technique and utility of intraoperative neuromonitoring during PFO excision.
• To evaluate the impact of neuromonitoring on postoperative neurological outcomes.

Main Methods:

• Retrospective review of 29 patients undergoing PFO excision from 1994 to 2018.
• Intraoperative neuromonitoring utilizing a multimodality protocol was employed from 2006 onwards.
• Analysis of neuromonitoring alerts and correlation with surgical interventions and patient outcomes.

Main Results:

• Neuromonitoring alerts occurred in 34.5% of procedures (10/29 patients).
• Alerts included EMG, motor-evoked potentials, somatosensory-evoked potentials, or combinations thereof.
• Interventions resolved all alerts; 6.9% experienced mild, transient sensory deficits, with no iatrogenic foot drop. Pre-existing deficits improved in some patients.

Conclusions:

• Intraoperative neuromonitoring during PFO excision yields a high rate of alerts, all manageable with corrective actions.
• Neuromonitoring appears to be a valuable tool in mitigating the risk of postoperative neurological deficits after fibular osteochondroma surgery.
• The study highlights the importance of vigilant monitoring to ensure patient safety during these procedures.