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Spinal intradural extramedullary tumors: the value of intraoperative neurophysiologic monitoring on surgical outcome

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Abstract

Nerve sheath tumors and meningiomas account for most intradural extramedullary (IDEM) tumors. These tumors are benign and amenable to complete surgical resection. In recent years, these surgeries are performed with intraoperative neurophysiologic monitoring (IONM) in order to minimize neurological injury, but the evidence for the statistical efficacy of this utility is lacking. This paper evaluates IONM benefits in IDEM tumor resection. Data of patients treated surgically for spinal intradural tumors from 1998 to 2003 was previously collected and analyzed. We retrospectively evaluated patients’ charts operated in the years 2011 to 2013. Patients’ medical files were reviewed including radiological examinations and electrophysiological reports. The data was collected and evaluated. Forty-one cases of meningioma or nerve sheath tumor resection surgery were performed in the study period. The surgical results were compared to 70 cases of historical controls. Demographic data was similar in these two groups. Sensitivity, specificity, and positive and negative predicted values of IONM were 75, 100, 100, and 97%, respectively. New neurological deficit rate was evident in 10 and 14% for the study and control groups, respectively (not significant). While IONM predicts neurological deficits with high accuracy level, this study does not suggest that there is a significant global benefit of IONM in these cases. As reported by others, in this series, the rate of new neurological deficits in non-monitored cases is similar to the monitored cases series; hence, IONM role in preventing new neurological deficits has yet to be proven.

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Abbreviations

FN:

False negative

IDEM:

Intradural extramedullary

IONM:

Intraoperative neurophysiologic monitoring

MEP:

Motor-evoked potentials

SSEP:

Somato-sensory-evoked potentials

TIVA:

Total intravenous anesthesia

TN:

True negative

TP:

False

TP:

True positive

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Authors and Affiliations

  1. Spine Surgery Unit, Department of Neurosurgery, Sheba Medical Center affiliated to Sackler Medical School, Tel Aviv University, Te Aviv, Israel

    Ran Harel, David Schleifer & Nachshon Knoller

  2. Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel

    Ran Harel

  3. Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel

    Ran Harel, Moshe Attia & Zvi R. Cohen

  4. Department of Neurology, Barzilai Medical Center, Ashkelon, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel

    Shmuel Appel

Authors
  1. Ran Harel
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  2. David Schleifer
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  3. Shmuel Appel
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  4. Moshe Attia
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  5. Zvi R. Cohen
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  6. Nachshon Knoller
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Correspondence to Ran Harel.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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There has been no financial support for this work that could have influenced its outcome.

There are no known conflicts of interest associated with this publication.

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Harel, R., Schleifer, D., Appel, S. et al. Spinal intradural extramedullary tumors: the value of intraoperative neurophysiologic monitoring on surgical outcome. Neurosurg Rev 40, 613–619 (2017). https://doi.org/10.1007/s10143-017-0815-2

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  • DOI: https://doi.org/10.1007/s10143-017-0815-2

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