Intraoperative Neurophysiological Monitoring for Intradural Extramedullary Spinal Tumors Excision | ||||
| The Medical Journal of Cairo University | ||||
| Volume 93, Issue 06, June 2025, Page 717-728 PDF (240.71 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/mjcu.2025.444580 | ||||
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| Author | ||||
| DANIEL T. BOUBANE, M.D.1; AHMED S. ELKADY, M.D., Ph.D.2; AHMED A. MORSY, M.D., Ph.D.3 and NABIL A. ABDEL AZIZ NASEF, M.D., Ph.D.4 | ||||
| The Department of Neurosurgery, Faculty of Medicine, Alexandria University, Egypt; Department of Neurosurgery, Gamal Abdel Nasser University of Conakry, Republique of Guinea1, Department of Neurosurgery, Faculty of Medicine, Alexandria University2, Neurosurgery Department, Faculty of Medicine, Zagazig University3 and Neurosurgery Department, Faculty of Medicine Kafr El Sheikh University4 | ||||
| Abstract | ||||
| Background: Spinal neurosurgery often uses intraopera-tive neurophysiological monitoring (IONM), but its efficacy for IDEM spinal tumors is less established. Technological ad-vancements in imaging, neuromonitoring, and minimally in-vasive techniques are being used to improve functional results and minimize complications. A comprehensive clinical and radiological evaluation was performed. Somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) moni-toring were performed during surgery. Postoperative neurolog-ical outcome was evaluated immediately after surgery and at 6 months follow-up. Aim of Study: To evaluate the immediate and six-month outcomes of IDEM spinal tumor surgery using IONM in pa-tients with or without neurological deficits. Patients and Methods: This prospective study was carried out on 30 patients with IDEM spinal tumors who underwent surgery with IONM. Results: The study involved 30 IDEM tumor patients who underwent IONM surgery, with the majority being females (63.33%) and most having preoperative grade I Modified Mc-Cormick scale (MMS) scores (43.33%). The surgery involved total laminectomy in 20 patients (66.67%), total laminectomy with fixation in 6 (20%), and partial laminectomy in 4 (13.33%) patients. Histopathological findings revealed meningioma in 36.67% of patients, followed by schwannoma in 13.33%, neu-rofibroma in 23.33%, ependymomas in 16.67%, dermoid cysts in 6.67%, and hemangiopericytoma in 3.33%. In a study of 24 patients without deficit, 79.16% had stable IONM, while 20.83% experienced transient minor changes before recovery and continued surgery. In the deficit group, 66.67% experienced minor changes, followed by deterioration and surgery stops in 33.33% of patients. The study found a correlation between the MMS preoperatively, histopathological findings, and hospital stay for both groups with and without deficitafter a 6-months follow-up. Sensitivity decreased from 66.7% to 33.3% at 6 months, specificity from 92.6% to 91.7%, and Accuracy from 90.0% to 80.0% at 6 months. NPV worsene from 96.2% to 84.6%. Mc Nemar test (1 and 0.687), and Kappa tests 0.687 and 0.286, respectively. The rise in false negatives contributed to the decline in accuracy, indicating a need for improved test reliability. Conclusion: IONM techniques like SSEPs, MEPs, EMG, and D-waves are increasingly used in spinal procedures to pre-vent neurological complications. It accurately predicts immedi-ate neurological deficit after IDEM spinal tumor excision, but its predictive value for deficit 6 months post-surgery is lower. | ||||
| Keywords | ||||
| Intradural extramedullary; Neurophysiological; Monitoring; Somatosensory; Motor evoked potentials | ||||
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