Intraoperative neurophysiological monitoring of the bulbocavernosus reflex during surgery for conus spinal lipoma: what are the warning criteria?
Intraoperative neurophysiological monitoring of the bulbocavernosus reflex during surgery for conus spinal lipoma: what are the warning criteria?
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DOI：
10.3171/2018.12.peds18535
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发表时间：
2019-05-01
影响因子：
1.9
通讯作者：
Morota, Nobuhito
中科院分区：
文献类型：
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作者：
Morota, Nobuhito
目的尽管在腰骶外科手术中球海绵体肌反射（BCR）的使用激增，但目前还没有广泛接受的BCR警告标准用于术中神经生理监测（IONM）。作者的目的是找到临床上可接受的警告标准，用于在IONM的BCR.METHODS记录的163例（中位年龄5个月），圆锥脊髓脂肪瘤谁接受了手术2002年8月至2016年5月的164个操作的BCR的IONM进行了回顾性分析。根据手术结束时的残余振幅对BCR的IONM结局进行分组：第1组，>= 50%;第2组，25%-50%（包括下限，但不包括上限）;第3组，<25%。BCR丢失的病例作为第3组的一个亚组进行单独评估。结果：149例（90.9%）手术中BCR可监测。第1组有118例手术（79.2%），第2组有18例手术（12.1%），第3组有13例手术（8.7%）。第2组2例（11.1%）和第3组6例（46.2%）手术导致泌尿系统并发症。在第3组亚组（丧失BCR）中，所有5例手术均导致泌尿系统并发症。BCR振幅降低的临界值位于第1组和第2组（区域1：临界值50%）、第2组和第3组（区域2：临界值25%）以及第3组及其亚组（区域3：临界值0，存在或丢失）之间。在1区，阳性预测值（PPV）为25.8%，阴性预测值（NPV）为100%。在2区，PPV为53.8%，NPV为98.5%。在3区，PPV为100%，NPV为97.9%。PPV在3区最高。结论BCR振幅的“丢失或保留”标准（3区：截断值为零）可作为术后排尿功能的预测指标。作为警告标准，可以使用75%（区域2）处的BCR幅度降低的截止值。这份关于BCR警告标准的初步临床报告可能有助于提高圆锥脂肪瘤手术的安全性。
OBJECTIVE Despite the surge in the intraoperative use of the bulbocavernosus reflex (BCR) during lumbosacral surgeries, there are as yet no widely accepted BCR warning criteria for use with intraoperative neurophysiological monitoring (IONM). The author's aim was to find clinically acceptable warning criteria for use in IONM of the BCR.METHODS Records of IONM of the BCR in 164 operations in 163 patients (median age 5 months) with a conus spinal lipoma who underwent surgery between August 2002 and May 2016 were retrospectively analyzed. The outcomes of IONM of the BCR were grouped by the residual amplitude at the end of surgery: group 1, >= 50%; group 2, 25%-50% (including the lower bound, but not the upper); and group 3, < 25%. Cases in which the BCR was lost were separately assessed as a subgroup of group 3. The postoperative urinary complication rate was used to verify the warning criteria zones.RESULTS The BCR could be monitored in 149 surgeries (90.9%). There were 118 surgeries (79.2%) in group 1, 18 (12.1%) in group 2, and 13 (8.7%) in group 3. Two surgeries (11.1%) in group 2 and 6 (46.2%) in group 3 resulted in urinary complications. In the group 3 subgroup (lost BCR), all 5 surgeries resulted in urinary complications. The cutoff value of the BCR amplitude reduction was placed between groups 1 and 2 (zone 1: cutoff 50%), groups 2 and 3 (zone 2: cutoff 25%), and group 3 and its subgroup (zone 3: cutoff zero, present or lost). In zone 1, the positive predictive value (PPV) was 25.8% and the negative predictive value (NPV) was 100%. In zone 2, the PPV was 53.8% and the NPV 98.5%. In zone 3, the PPV was 100% and the NPV 97.9%. The PPV was highest in zone 3. The NPV was highest in zone 1, but its PPV was low (25.8%).CONCLUSIONS The "lost or remained" criterion of BCR amplitude (zone 3: cutoff zero) can be used as a predictor of postoperative urinary function. As a warning criterion, the cutoff value of the BCR amplitude reduction at 75% (zone 2) may be used. This preliminary clinical report on the warning criteria for the BCR may contribute to improving the safety of surgery for conus spinal lipoma.