The Cutoff Amplitude of Transcranial Motor Evoked Potentials for Transient Postoperative Motor Deficits in Intramedullary Spinal Cord Tumor Surgery
The Cutoff Amplitude of Transcranial Motor Evoked Potentials for Transient Postoperative Motor Deficits in Intramedullary Spinal Cord Tumor Surgery
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DOI：
10.1097/brs.0000000000000421
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发表时间：
2014-08-15
期刊：
影响因子：
3
通讯作者：
Ishigro, Naoki
中科院分区：
文献类型：
--
作者：
Muramoto, Akio;Imagama, Shiro;Ishigro, Naoki
研究设计.术中经颅运动诱发电位（TcMEP）振幅和术后运动功能障碍（PMD）的回顾性临床研究。确定TcMEP的定量截止振幅，以预测脊髓髓内肿瘤（IMSCT）手术中的一过性PMD。“有无”标准是可靠的，并广泛使用的报警标准，以防止永久PMD IMSCT手术。然而，我们希望防止PMD，即使它是短暂的。应确定瞬态PMD的截止振幅。我们进行了一项回顾性研究，以确定预测IMSCT手术中一过性PMD的截止振幅。37名患者被纳入研究。我们检查了这些患者术中的电生理变化和围手术期的运动状态。进行受试者工作特性分析，以确定预测IMSCT手术中一过性PMD的截止振幅。比较颈、胸段病变的PMD发生率和TcMEP阈值。13例患者表现为一过性PMD。在37例280块可监测肌肉中，13例51块肌肉出现PMD。通过受试者工作特征分析，术中恶化点的相对和绝对截止振幅分别为基线振幅的12%残差和3.2 V。这些临界点的灵敏度/特异性分别为86%/74%和88%/78%。胸段病变PMD发生率明显高于颈段病变，截止振幅明显低于颈段病变。我们确定了预测IMSCT手术中一过性PMD的截止TcMEP振幅。颈部病变的截止振幅高于胸部病变。结果表明，需要在不同的脊柱水平设置不同的报警标准。
Study Design. Retrospective clinical study of intraoperative transcranial motor evoked potential (TcMEP) amplitudes and postoperative motor deficits (PMDs).Objective. To determine the quantifiable cutoff amplitude of TcMEP for predicting transient PMDs in intramedullary spinal cord tumor (IMSCT) surgery.Summary of Background Data. The "presence or absence" criterion is reliable and widely used the alarm criterion for preventing permanent PMDs in IMSCT surgery. However, we wanted to prevent PMDs even if it is transient. The cutoff amplitude for transient PMDs should be identified.Methods. We conducted a retrospective study to identify the cutoff amplitude for predicting transient PMDs in IMSCT surgery. Thirty-seven patients were included in the study. We examined intraoperative electrophysiological changes and perioperative motor status in these patients. Receiver operating characteristic analyses were performed to identify the cutoff amplitudes for predicting transient PMDs in IMSCT surgery. The incidence of PMDs and cutoff TcMEP amplitude in cervical and thoracic lesions were compared.Results. Thirteen cases demonstrated transient PMDs. Among 280 monitorable muscles in 37 cases, 51 muscles in 13 patients showed PMDs. Through receiver operating characteristic analysis, the relative and the absolute cutoff amplitudes at the intraoperative point of deterioration were identified to be 12% residual of baseline amplitude and 3.2 V, respectively. Sensitivity/specificity for those cutoff points are 86%/74% and 88%/78%, respectively. The incidence of PMD was significantly higher, and the cutoff amplitude was lower in the thoracic lesions than in the cervical lesions.Conclusion. We determined the cutoff TcMEP amplitude for predicting transient PMDs in IMSCT surgery. The cutoff amplitude for the cervical lesions was higher than that for the thoracic lesions. The results suggest the need for setting different alarm criteria in different level of spine.