PDF(Pubmed)
Abstract：
At present, surgical resection of primary intramedullary spinal cord tumors is the mainstay of treatment. However, given the dimensional constraints of the narrow spinal canal and dense organization of the ascending and descending tracts, intramedullary spinal cord tumor resection carries a significant risk of iatrogenic neurological injury. Intraoperative neurophysiological monitoring (IONM) and mapping techniques have been developed to evaluate the functional integrity of the essential neural pathways and optimize the surgical strategies. IONM can also inform on impending harm to at-risk structures and can correlate with postoperative functional recovery if damage has occurred. Direct waves (D-waves) will provide immediate feedback on the integrity of the lateral corticospinal tract. In the present review, we have provided an update on the utility of D-waves for spinal cord tumor resection. We have highlighted the neuroanatomical and neurophysiological insights from the use of D-wave monitoring, the technical considerations and limitations of the D-wave technique, and multimodal co-monitoring with motor-evoked potentials and somatosensory-evoked potentials. Together with motor-evoked potentials, D-waves can help to guide the extent of tumor resection and provide intraoperative warning signs and alarm criteria to direct the surgical strategy. D-waves can also serve as prognostic biomarkers for long-term recovery of postoperative motor function. We propose that the use of D-wave IONM can contribute key findings for clinical decision-making during spinal cord tumor resection.
摘要：
目前,原发性脊髓髓内肿瘤的手术切除是治疗的主要手段。然而,考虑到狭窄的椎管和上行和下行束的密集组织的尺寸限制，脊髓髓内肿瘤切除术具有医源性神经损伤的显著风险。已经开发了术中神经生理监测（IONM）和绘图技术来评估基本神经通路的功能完整性并优化手术策略。IONM还可以告知对危险结构的即将发生的损害，并且如果发生损害，则可以与术后功能恢复相关。直接波(D波)将提供关于外侧皮质脊髓束完整性的即时反馈。在本次审查中，我们提供了关于D波用于脊髓肿瘤切除术的最新信息.我们强调了使用D波监测的神经解剖学和神经生理学见解，D波技术的技术考虑和局限性，以及与运动诱发电位和体感诱发电位的多模态联合监测。连同运动诱发电位,D波可以帮助指导肿瘤切除的范围，并提供术中警告标志和警报标准，以指导手术策略。D波还可以作为术后运动功能长期恢复的预后生物标志物。我们建议使用D波IONM可以为脊髓肿瘤切除术期间的临床决策提供关键发现。
