Multimodal intraoperative neurophysiological monitoring may better predict postoperative distal upper extremities' complex-functional outcome than spinal and muscular motor evoked potentials alone in high-cervical intramedullary spinal cord tumor surgery

Sebastian Siller; Sylvain Duell; Joerg-Christian Tonn; Andrea Szelenyi

doi:10.1016/j.clinph.2024.10.007

Multimodal intraoperative neurophysiological monitoring may better predict postoperative distal upper extremities' complex-functional outcome than spinal and muscular motor evoked potentials alone in high-cervical intramedullary spinal cord tumor surgery

Clin Neurophysiol. 2024 Oct 19:168:52-60. doi: 10.1016/j.clinph.2024.10.007. Online ahead of print.

Authors

Sebastian Siller¹, Sylvain Duell², Joerg-Christian Tonn², Andrea Szelenyi²

Affiliations

¹ Department of Neurosurgery, LMU Hospital, Ludwig-Maximilians-University Munich, Campus Großhadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. Electronic address: Sebastian.Siller@klinik.uni-regensburg.de.
² Department of Neurosurgery, LMU Hospital, Ludwig-Maximilians-University Munich, Campus Großhadern, Marchioninistrasse 15, 81377 Munich, Germany.

PMID: 39447422
DOI: 10.1016/j.clinph.2024.10.007

Abstract

Objective: D-wave can safely monitor the corticospinal-tract (CST)-function regarding gross-motor outcome of lower extremities, but it is still unknown whether i)D-wave can also safely monitor the gross-motor outcome of distal upper extremities in those patients undergoing high-cervical intramedullary-spinal-cord-tumor (IMSCT)-resection (enabling epidural D-wave-placement below C5) and ii)multimodal IONM can also predict fine-motor/complex hand function.

Methods: We prospectively assessed 20 patients undergoing IMSCT-surgery above the C4/5-level with multimodal IONM (D-wave/mMEPs/EMG/SSEPs). Detailed gross-/fine-motor and complex hand function was assessed pre- and postoperatively and during long-term follow-up (mean:29.5 ± 18.8 months) and correlated with IONM-findings.

Results: D-wave monitoring was without intraoperative critical changes in all patients and none had any permanent postoperative gross-motor deficits. However, D-wave did not allow to predict the occurrence of mild permanent postoperative deficits affecting fine-motor function which was the case in 8% for distal upper extremities. The complex distal upper extremities' function assessed by Nine-Hole-Peg-Test (reflecting the complex motor/sensory interaction for hand-usability) was permanently deteriorated in 15% postoperatively and only the combination of D-wave/mMEPs/EMG/SSEPs was able to provide a viable predictive power (specificity:79%/sensitivity:43%).

Conclusions: In high-cervical IMSCT-surgery, unimpaired D-wave reliably predicts preserved gross-motor function, but fails to sufficiently cover distal upper extremities' fine-motor/complex function.

Significance: Our study underlines the importance of multimodal IONM for fine-motor/complex hand function.

Keywords: D wave; Free-running electromyography; Intramedullary spinal cord tumor surgery; Intraoperative neurophysiological monitoring; Motor evoked potentials; Somatosensory evoked potential.