METHODS: Between January 2013 and August 2018, 87 patients with IDEM tumors who underwent tumor removal surgery via MIS-keyhole approach under multimodal IONM were retrospectively reviewed. The neurological status was assessed using a modified McCormick grading scale pre- and postoperatively. Multimodal IONM consisted of motor evoked potentials (MEP), somatosensory evoked potentials (SEP), and electromyography (EMG). Both short-term and long-term clinical evaluations as well as patients\' medical files were retrospectively analyzed.
RESULTS: Surgeries were performed for resection of SS in 49 patients and SM in 38 patients. Tumor locations were cervical in 16.1%, thoracic in 48.3%, thoracolumbar in 4.6%, lumbar 31%. Critical IONM changes were detected in 9 operations (10.3%) in which there were 2 SEPs, 5 MEPs, and 2 EMG events. Three IONM changes (2 MEPs, 1 EMG) were turned out to be transient change in nature since they were resolved in a short time when immediate corrective actions were initiated. Six patients with permanent IONM changes (2SEPs, 3MEPs, 1EMG event), all deficits had resolved during hospitalization or on short -term follow-up evaluation. Sensitivity, specificity, and positive and negative predicted values of IONM were 100, 96, 67, and 100%, respectively. Gross total resection rate was 100%, and a stable or improved McCormick grade exhibited in all patients. No tumor recurrence and no spinal instability were found in the long-term follow-up evaluation (mean 5.2 ± 2.9 years postoperatively). Overall, 94% of patients were either satisfied or very satisfied with their operation, and 93% patients reported excellent or good general clinical outcome according to Odom\'s criteria.
CONCLUSIONS: MIS-keyhole surgery with multimodal IONM for IDEM tumors enables a high level of satisfaction and a satisfying long-term clinical and surgical outcome.
方法:回顾性分析了2013年1月至2018年8月在多模式IONM下,经MIS-锁孔入路行肿瘤切除手术的87例IDEM肿瘤患者。术前和术后使用改良的McCormick分级量表评估神经状态。多模态IONM由运动诱发电位(MEP)组成,体感诱发电位(SEP),和肌电图(EMG)。回顾性分析了短期和长期临床评估以及患者的医疗档案。
结果:手术切除SS49例,SM38例。肿瘤部位为宫颈16.1%,胸廓占48.3%,胸腰椎占4.6%,腰椎31%。在有2个SEP的9个手术(10.3%)中检测到严重的IONM变化,5个欧洲议会议员,和2个EMG事件。三个IONM更改(2个MEP,1EMG)被证明是自然界中的瞬时变化,因为它们在立即采取纠正措施的短时间内得到解决。6例永久性IONM改变的患者(2SEPs,3MEPs,1EMG事件),所有缺陷均在住院期间或短期随访评估中得到解决.灵敏度,特异性,IONM的正预测值和负预测值分别为100%、96%、67%和100%,分别。总切除率为100%,所有患者均表现出稳定或改善的麦考密克等级。在长期随访评估中(平均术后5.2±2.9年),未发现肿瘤复发和脊柱不稳定。总的来说,94%的患者对他们的手术满意或非常满意,根据Odom的标准,93%的患者报告了优异或良好的一般临床结果。
结论:MIS-锁孔手术联合多模式IONM治疗IDEM肿瘤可获得较高的满意度和令人满意的长期临床和手术结果。