PMID- 27157282
OWN - NLM
STAT- MEDLINE
DCOM- 20170901
LR  - 20220408
IS  - 1878-8769 (Electronic)
IS  - 1878-8750 (Linking)
VI  - 92
DP  - 2016 Aug
TI  - Influence of Tumor Location and Other Variables on Predictive Value of 
      Intraoperative myogenic Motor-Evoked Potentials in Spinal Cord Tumor Surgery.
PG  - 264-272
LID - S1878-8750(16)30246-7 [pii]
LID - 10.1016/j.wneu.2016.04.117 [doi]
AB  - OBJECTIVE: To study the influence of tumor location (cervical vs. thoracic; 
      extramedullary vs. intramedullary) on predictive value of intraoperative myogenic 
      motor-evoked potentials (iMEP) changes in patients undergoing surgery for spinal 
      cord tumors. METHODS: Three hundred patients retrospective data (91 
      intramedullary) and 209 (intradural extramedullary) with successful iMEP 
      recordings were analyzed. Responses to transcranial electrical stimulation were 
      recorded from the lower limb muscles. Preoperative clinical variables, iMEPs 
      changes, and postoperative neurologic deficits were noted. Associations between 
      categorical variables and outcome were analyzed with the Fisher exact test. 
      RESULTS: Of the 300 patients 28 (9.3%) had significant intraoperative worsening 
      of iMEPs. New postoperative deficits occurred in 23 of these 28 patients. 
      False-positive decreases in iMEPs were observed in 5 patients. There was a 
      significant association between changes in iMEP and postoperative new motor 
      deficits (P </= 0.0001). Multivariate analysis showed that patients with changes in 
      iMEP undergoing surgery for thoracic segment tumors, with longer duration of 
      symptoms (>12 months) and older age (>/=21.5 years) were more likely to suffer 
      postoperative neurological decline (odds ratio 4.1, P </= 0.001 and odds ratio 5.4 
      P </= 0.0001, respectively). The sensitivity of iMEPs was 100% and specificity 
      98.2%. The positive and negative predictive values were 82% and 100%; however, 
      the sensitivity and specificity is similar in thoracic intramedullary (TIM) (n = 
      53) and cervical intramedullary tumors (n = 38) (both were 100% and 97%). The 
      positive predictive value was significantly greater for TIM tumors (93% vs. 50%). 
      CONCLUSIONS: A strong association was observed between worsening of iMEPs and 
      postoperative new neurological deficits in patients with TIM tumor.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Velayutham, Parthiban
AU  - Velayutham P
AD  - Department of Neurological Sciences, Christian Medical College, Vellore, India.
FAU - Rajshekhar, Vedantam
AU  - Rajshekhar V
AD  - Department of Neurological Sciences, Christian Medical College, Vellore, India.
FAU - Chacko, Ari George
AU  - Chacko AG
AD  - Department of Neurological Sciences, Christian Medical College, Vellore, India.
FAU - Krothapalli Babu, Srinivasa
AU  - Krothapalli Babu S
AD  - Department of Neurological Sciences, Christian Medical College, Vellore, India. 
      Electronic address: srinivas@cmcvellore.ac.in.
LA  - eng
PT  - Journal Article
DEP - 20160506
PL  - United States
TA  - World Neurosurg
JT  - World neurosurgery
JID - 101528275
RN  - 0 (Neuromuscular Nondepolarizing Agents)
RN  - 2GQ1IRY63P (Atracurium)
RN  - 7E4PHP5N1D (Vecuronium Bromide)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Atracurium/therapeutic use
MH  - Child
MH  - Electromyography
MH  - Evoked Potentials, Motor/*physiology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Intraoperative/*methods
MH  - Neuromuscular Nondepolarizing Agents/therapeutic use
MH  - Neurosurgical Procedures/*methods
MH  - Odds Ratio
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
MH  - Severity of Illness Index
MH  - *Spinal Cord Neoplasms/pathology/physiopathology/surgery
MH  - Transcranial Direct Current Stimulation
MH  - Vecuronium Bromide/therapeutic use
MH  - Young Adult
OTO - NOTNLM
OT  - Intraoperative monitoring
OT  - Motor-evoked potentials
OT  - Postoperative outcome
OT  - Spinal cord tumors
EDAT- 2016/05/10 06:00
MHDA- 2017/09/02 06:00
CRDT- 2016/05/10 06:00
PHST- 2016/02/11 00:00 [received]
PHST- 2016/04/27 00:00 [revised]
PHST- 2016/04/27 00:00 [accepted]
PHST- 2016/05/10 06:00 [entrez]
PHST- 2016/05/10 06:00 [pubmed]
PHST- 2017/09/02 06:00 [medline]
AID - S1878-8750(16)30246-7 [pii]
AID - 10.1016/j.wneu.2016.04.117 [doi]
PST - ppublish
SO  - World Neurosurg. 2016 Aug;92:264-272. doi: 10.1016/j.wneu.2016.04.117. Epub 2016 
      May 6.