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2016, Volume 7, Number 2, Page(s) 111-120
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Intramedullary Spinal Cord Tumor Surgery: The Utility of Multimodal Intraoperative Neurophysiologic Monitoring
Terence Verla, Jared S. Fridley, Ibrahim Omeis
Department of Neurosurgery, Baylor College of Medicine, Houston, USA
Keywords: Intramedullary tumor, intraoperative monitoring, outcomes, spinal injury
Abstract
Intramedullary spinal cord tumors (IMSCT) account for about 2-4% of tumors of the central nervous system. Surgical resection continues to be the most effective treatment modality for the majority of intramedullary tumors with gross total resection leading to preserve neurologic function and improved survival. However, surgical treatment is often difficult and carries significant risk of postoperative neurologic complications.

Intraoperative neuromonitoring has been shown to be of clinical importance in the surgical resection of IMSCT. The main monitoring modalities include somatosensory-evoked potentials (SSEP), transcranial motorevoked potentials (TcMEP) via limb muscles or spinal epidural space (D waves) and dorsal column mapping. These monitoring modalities have been shown to inform surgeons intraoperatively and in many cases, have led to alterations in operative decision. Herein, we reviewed the literature on the utility of intraoperative neuromonitoring for intramedullary spinal tumor resection and its role in predicting post-operative neurologic deficits. Medline search was performed (2000-2015) and thirteen studies were reviewed. Data was extracted depicting the role of monitoring in outcomes of surgery. By utilizing intraoperative SSEP, TcMEP, D-waves and dorsal column mapping, spinal injury could be prevented in majority of cases, thereby improving postoperative neurologic functioning and outcome in patients undergoing surgery for IMSCT.

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