背景:手术切除是大多数脊髓圆锥和马尾肿瘤(CMCET)病例的首选治疗方法。然而,全切除通常具有挑战性,如果强行尝试,极有可能导致各种并发症.术中神经生理监测(IONM)已成为CMCET切除的必要辅助工具。
目的:本研究旨在评估球海绵体反射(BCR)监测在CMCET手术中的应用价值。
方法:回顾性临床研究。
方法:回顾性分析了2020年9月至2022年6月在我院接受同一神经外科团队CMCET切除术的患者的病历。在所有手术中都进行了IONM。根据纳入标准和排除标准,最终,105名患者被纳入研究。
方法:术前评估排尿功能,一个月后,术后6个月使用神经源性膀胱症状评分(NBSS)。如果手术后一个月获得的BSS比手术前超过9分,可以认为患者出现了新发术后排尿功能障碍(PVDs).此外,如果在手术后6个月可以恢复BSS(比手术前高不到9点),它被定义为短期PVD。否则,它被定义为长期PVD。
方法:计算双侧BCR波形的幅度降低率(ARR),并比较患有PVDs的患者和没有PVDs的患者。随后应用受试者工作特征曲线分析来确定用于预测PVDs的最大和最小ARR的截止值。
结果:最大和最小ARR与短期和长期PVDs显着相关(所有比较p<0.001,曼-惠特尼U测试)。预测短期和长期PVD的最大ARR阈值分别为68.80%(AUC=0.996,p<0.001)和72.10%(AUC=0.996,p<0.001),分别。而最小ARR为50.20%(AUC=0.976,p<0.001)和53.70%AUC=0.999,p<0.001)。
结论:术中双侧BCR波形的振幅降低对PVDs具有较高的预测价值。
BACKGROUND: Surgical resection is the preferred treatment in most conus medullaris and cauda equina tumor (CMCET) cases. However, total resection is usually challenging to obtain and has a strong possibility of causing various complications if forcibly attempted. Intraoperative neurophysiological monitoring (IONM) has become a necessary adjunctive tool for CMCET resection.
OBJECTIVE: The current study aimed to evaluate the application value of bulbocavernosus reflex (BCR) monitoring in CMCET surgery.
METHODS: A retrospective clinical study.
METHODS: The medical records of patients who underwent CMCET resection by the same neurosurgical team at our hospital from September 2020 to June 2022 were retrospectively reviewed. IONM was conducted in all surgeries. According to inclusion criteria and exclusion criteria, ultimately, 105 patients were enrolled in the study.
METHODS: The voiding function was assessed before surgery, 1 month after, and 6 months after surgery using the Neurogenic Bladder Symptom Score (NBSS). If the NBSS obtained 1 month after surgery exceeds 9 points than that before surgery, it can be considered that the patient suffered new-onset postoperative voiding dysfunctions (PVDs). Moreover, if the NBSS could restored (less than 9 points higher than before the surgery) at 6 months after surgery, it was defined as a short-term PVD. Otherwise, it was defined as a long-term PVD.
METHODS: The amplitude reduction ratios (ARRs) of bilateral BCR waveforms were calculated and compared between patients with PVDs and those without. The receiver operating characteristic curve analysis was subsequently applied to determine the cut-off value of the maximal and minimal ARRs for predicting PVDs.
RESULTS: The maximal and minimal ARRs were significantly correlated with short-term and long-term PVDs (p<.001 for all comparisons, Mann-Whitney U test). The threshold values of maximal ARR for predicting short-term and long-term PVD were 68.80% (AUC=0.996, p<.001) and 72.10% (AUC=0.996, p<.001), respectively. While those of minimal ARR were 50.20% (AUC=0.976, p<.001) and 53.70% AUC=0.999, p<.001).
CONCLUSIONS: The amplitude reduction of intraoperative bilateral BCR waveforms showed high predictive value for PVDs.