The following established and validated questionnaires and examination protocols were used with focus on neurological function of the DC and quality of life (QoL): Clinical examinationĬlinical examination was performed preoperatively, on day seven after surgery and at least after 12 months. The study has been approved by the local ethics committee (735–16). Patients or patient caregivers had to give informed written consent. In this prospective single center study, all patients with imSCT undergoing tumor resection via midline myelotomy were included between April 2017 and October 2019. Recording of spinal somatosensory evoked potentials (spinal SSEP) Two methods for dorsal column mapping (DCM) have been described to reduce the occurrence of postoperative ataxia. ![]() Electrophysiological determination of the DCs may help the surgeon to identify the dorsal midline of the spinal cord for myelotomy. Thus, standardized IONM with continuous monitoring of somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) is deemed mandatory. Intraoperative neuromonitoring (IONM) has been shown to reduce the surgical risk for neurological impairment in imSCT. This can lead to surgical DC injury and might contribute to a relevant percentage of the reported rate of 43–55% postoperative ataxia. Edema, spinal cord rotation, or sheer volume effects may hamper the visual identification of the midline for myelotomy in imSCT. Additionally, the middle between the root entry zones and the dorsal median sulcal vein can indicate the midline. The dorsal median sulcus represents the midline being located between the right- and left-sided dorsal columns (DC) which consist of the medial lemniscus pathway (gracile and cuneate tract) conducting sensory afferents of fine touch, vibration, two-point discrimination, and proprioception (position). Ī midline myelotomy is considered as the safest and thus most frequent surgical approach for imSCT. Surgery is the first treatment for imSCT. At this point, most tumors have already grown to a significant size leading to a distortion of the regular anatomy of the spinal cord and its surface. Patients usually suffer from local pain or neurological deficits. Cervical and thoracic astrocytomas and ependymomas are most frequent, with young males predominating. Intramedullary spinal cord (imSCT) tumors are rare accounting for 5–10% of all spinal tumors. SCS evolved to be superior concerning applicability, cost-effectiveness, and time expenditure. ConclusionĭCM and SCS may help confirm and correct the AM for myelotomy in imSCT, leading to a favorable long-term neurological outcome in this cohort. Despite early postoperative worsening of DC function, long-term follow-up showed significant recovery and improvement in quality of life. After myelotomy, 3 patients experienced > 50% reduction in amplitude of SSEPs. In 92% of cases, the AM and neurophysiologic midlines were concordant. ![]() SCS was less time-consuming ( p = 0.001), cheaper, and easier to handle. If baseline SSEPs were poor, both methods were limited. If both recordings could be acquired (6/13), concordance was 100%. ![]() SCS was applicable in all patients with determination of the midline in 9/13. The DCM electrode detected the midline in 9/13 patients with handling limitations in the remaining patients. Standardized neurological examinations were performed preoperatively, 1 week postoperatively and after more than 12 months. Procedural and technical aspects were compared. SSEPs at the DC after stimulation of tibial/median nerve with an 8-channel DCM electrode and cortical SSEP phase reversal at C3/C4 after SCS using a bipolar concentric probe were recorded. Patients with surgically treated imSCT were prospectively included between 04/2017 and 06/2019. ![]() We compare application and feasibility of both methods. Dorsal column mapping (DCM) and spinal cord stimulation (SCS) can identify DC neurophysiologically. In surgery for intramedullary spinal cord tumors (imSCT), distortion of the anatomy challenges the visual identification of dorsal columns (DC) for midline myelotomy.
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