Functional Outcome in Spinal Meningioma Surgery and Use of Intraoperative Neurophysiological Monitoring

Abstract

Data on intraoperative neurophysiological monitoring (IOM) during spinal meningioma (SM) surgery are scarce. The aim of this study was to assess the role of IOM and its impact on post-operative functional outcome. Eighty-six consecutive surgically treated SM patients were included. We assessed pre and post-operative Modified McCormick Scale (mMCS), radiological and histopathological data and IOM findings. Degree of cord compression was associated with preoperative mMCS and existence of motor or sensory deficits (p < 0.001). IOM was used in 51 (59.3%) patients (IOM-group). Median pre and post-operative mMCS was II and I, respectively (p < 0.001). Fifty-seven (66.3%) patients showed an improvement of at least one grade in the mMCS one year after surgery. In the IOM group, only one patient had worsened neurological status, and this was correctly predicted by alterations in evoked potentials. Analysis of both groups found no significantly better neurological outcome in the IOM group, but IOM led to changes in surgical strategy in complex cases. Resection of SM is safe and leads to improved neurological outcome in most cases. Both complication and tumor recurrence rates were low. We recommend the use of IOM in surgically challenging cases, such as completely ossified or large ventrolateral SM.

Current Knowledge on Spinal Meningiomas—Surgical Treatment, Complications, and Outcomes: A Systematic Review and Meta-Analysis (Part 2)

“…No significant improvements were detected in patients operated with IONM. The authors recommended the use of IONM only in complex cases [ 42 ]. Nonetheless, randomized controlled trials are required to explore the true effect of this methodology on outcomes in spinal meningioma surgery.…”

“…Thromboembolic events were the main cause of the few severe complications (Ibanez type 3 or 4, 5.5% of all complications), highlighting the need for preventive measures in the postoperative management of risk patients. There was no evidence to suggest that IONM reduces the frequency of complications [ 40 , 41 , 42 ].…”

The Role of Prolonged Bed Rest in Postoperative Cerebrospinal Fluid Leakage After Surgery of Intradural Pathology—A Retrospective Cohort Study

“…All other CSFL occurred in the upper spinal levels above D-6 (N = 5/7, 71.4%). Previous studies also did not demonstrate a higher rate of CSFL in the lumbar spine, 1,2,4,5,18,39,42 questioning the hypothesis that elevated hydrostatic pressure in the lower spinal segment is a risk factor for CSFL.…”

Intraoperative Neurophysiologic Monitoring and Mapping During Surgery on Intramedullary Spinal Cord Tumors in Children and Adolescents

“…Intraoperative monitoring was conducted in a standard fashion by recording muscle MEPs and D-wave, as well as eliciting SEPs from all four extremities. 9,10 A commercially available system (Inomed Co, Emmendingen, Germany) equipped with a constant current stimulator was used.…”

“…These surgeries differ widely in their neurosurgical and neurophysiologic aspects, and hence, the value of IONM for IMSCT has been obscured. 10 To the best of our knowledge, the question of whether there is any evidence supporting IONM as a preventive tool in intramedullary tumor surgery has been addressed in only two studies, both of which reported level two evidence. Choi et al 35 compared 76 patients who underwent intramedullary tumor surgery without IONM (1998IONM ( -2006 and with IONM (2006IONM ( -2012.…”