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The utility of intraoperative neurophysiological monitoring in surgical treatment for spinal arteriovenous malformations: A historical control study

OBJECTIVE: This study sought to investigate the utility of intraoperative neurophysiological monitoring (IONM) in the surgical treatment for spinal arteriovenous malformations (SAVMs). METHODS: We retrospectively reviewed the data of 39 patients who underwent surgical treatment for SAVMs. Twenty-eig...

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Autores principales: Kim, Sooyoung, Kim, Haelim, Kim, Jun-Soon, Hyun, Seung-Jae, Kim, Ki-Jeong, Park, Kyung Seok
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881687/
https://www.ncbi.nlm.nih.gov/pubmed/35243187
http://dx.doi.org/10.1016/j.cnp.2022.01.004
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author Kim, Sooyoung
Kim, Haelim
Kim, Jun-Soon
Hyun, Seung-Jae
Kim, Ki-Jeong
Park, Kyung Seok
author_facet Kim, Sooyoung
Kim, Haelim
Kim, Jun-Soon
Hyun, Seung-Jae
Kim, Ki-Jeong
Park, Kyung Seok
author_sort Kim, Sooyoung
collection PubMed
description OBJECTIVE: This study sought to investigate the utility of intraoperative neurophysiological monitoring (IONM) in the surgical treatment for spinal arteriovenous malformations (SAVMs). METHODS: We retrospectively reviewed the data of 39 patients who underwent surgical treatment for SAVMs. Twenty-eight patients who received multimodal IONM (transcranial electrical motor-evoked potentials [MEPs], somatosensory-evoked potentials, continuous electromyography, and bulbocavernosus reflex [BCR]) between 2011 and 2020 were compared to 11 historical controls between 2003 and 2011. The rates of postoperative neurological deficits (PNDs), neurophysiological warnings, and their characteristics were analyzed. RESULTS: PNDs were developed in 10.7% and 54.5% of patients in the IONM and historical control (non-IONM) groups, respectively (p = 0.008). Moreover, not applying IONM was the only significant risk factor for the development of PNDs in the logistic regression analysis (odds ratio 10.0, p = 0.007). In the IONM group, a total of three electrophysiological warnings were observed, and two of these were true positives; one patient complained of leg motor weakness after surgery with loss of the abductor halluces MEPs. The other patient experienced disappearance of the BCR during surgery and newly developed urinary retention. Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of IONM warnings for detecting PNDs were 66.7%, 96.0%, 66.7%, and 96.0%, respectively. CONCLUSIONS: The neurological outcome of the IONM group was significantly better than that of the historical control group in the surgical treatments for SAVMs. SIGNIFICANCE: Multimodal IONM could be a useful tool to detect neurological damage with relatively high accuracy in this type of surgery.
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spelling pubmed-88816872022-03-02 The utility of intraoperative neurophysiological monitoring in surgical treatment for spinal arteriovenous malformations: A historical control study Kim, Sooyoung Kim, Haelim Kim, Jun-Soon Hyun, Seung-Jae Kim, Ki-Jeong Park, Kyung Seok Clin Neurophysiol Pract Research Paper OBJECTIVE: This study sought to investigate the utility of intraoperative neurophysiological monitoring (IONM) in the surgical treatment for spinal arteriovenous malformations (SAVMs). METHODS: We retrospectively reviewed the data of 39 patients who underwent surgical treatment for SAVMs. Twenty-eight patients who received multimodal IONM (transcranial electrical motor-evoked potentials [MEPs], somatosensory-evoked potentials, continuous electromyography, and bulbocavernosus reflex [BCR]) between 2011 and 2020 were compared to 11 historical controls between 2003 and 2011. The rates of postoperative neurological deficits (PNDs), neurophysiological warnings, and their characteristics were analyzed. RESULTS: PNDs were developed in 10.7% and 54.5% of patients in the IONM and historical control (non-IONM) groups, respectively (p = 0.008). Moreover, not applying IONM was the only significant risk factor for the development of PNDs in the logistic regression analysis (odds ratio 10.0, p = 0.007). In the IONM group, a total of three electrophysiological warnings were observed, and two of these were true positives; one patient complained of leg motor weakness after surgery with loss of the abductor halluces MEPs. The other patient experienced disappearance of the BCR during surgery and newly developed urinary retention. Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of IONM warnings for detecting PNDs were 66.7%, 96.0%, 66.7%, and 96.0%, respectively. CONCLUSIONS: The neurological outcome of the IONM group was significantly better than that of the historical control group in the surgical treatments for SAVMs. SIGNIFICANCE: Multimodal IONM could be a useful tool to detect neurological damage with relatively high accuracy in this type of surgery. Elsevier 2022-02-03 /pmc/articles/PMC8881687/ /pubmed/35243187 http://dx.doi.org/10.1016/j.cnp.2022.01.004 Text en © 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Paper
Kim, Sooyoung
Kim, Haelim
Kim, Jun-Soon
Hyun, Seung-Jae
Kim, Ki-Jeong
Park, Kyung Seok
The utility of intraoperative neurophysiological monitoring in surgical treatment for spinal arteriovenous malformations: A historical control study
title The utility of intraoperative neurophysiological monitoring in surgical treatment for spinal arteriovenous malformations: A historical control study
title_full The utility of intraoperative neurophysiological monitoring in surgical treatment for spinal arteriovenous malformations: A historical control study
title_fullStr The utility of intraoperative neurophysiological monitoring in surgical treatment for spinal arteriovenous malformations: A historical control study
title_full_unstemmed The utility of intraoperative neurophysiological monitoring in surgical treatment for spinal arteriovenous malformations: A historical control study
title_short The utility of intraoperative neurophysiological monitoring in surgical treatment for spinal arteriovenous malformations: A historical control study
title_sort utility of intraoperative neurophysiological monitoring in surgical treatment for spinal arteriovenous malformations: a historical control study
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881687/
https://www.ncbi.nlm.nih.gov/pubmed/35243187
http://dx.doi.org/10.1016/j.cnp.2022.01.004
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