Siller, Sebastian and Duell, Sylvain and Tonn, Joerg-Christian and Szelenyi, Andrea (2024) 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. CLINICAL NEUROPHYSIOLOGY, 168. pp. 52-60. ISSN 1388-2457, 1872-8952
Full text not available from this repository. (Request a copy)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 multi- modal IONM (D-wave/mMEPs/EMG/SSEPs). Detailed gross-/fine-motor and complex hand function was assessed preand 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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | SCOLIOSIS SURGERY; ADULT NORMS; PEG TEST; STIMULATION; Intramedullary spinal cord tumor surgery; Intraoperative neurophysiological monitoring; D wave; Motor evoked potentials; Somatosensory evoked potential; Free-running electromyography |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurochirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 14 Jan 2026 06:16 |
| Last Modified: | 14 Jan 2026 06:16 |
| URI: | https://pred.uni-regensburg.de/id/eprint/64174 |
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