Evaluation Of Introperative SEP+EMG Monitoring In Intraspinal Occupancy Surgery

Objective:To investigate the application of introperative somatosensory evoked potentials (SEP) and electromyography (EMG) monitoring in the resection of intraspinal occupancy and to evaluate the prognosis after the surgery.Methods:116patients, all suffered intraspinal occupancy, were reviewed from Dec,2009to Oct,2012nearly a3-year period of Tongji Hospital, affiliated to Huazhong University of Science and Technology.87patients with extramedullary intradural tumor and29patients with intramedullary tumor, in which including51cases of schwannoma (44.0%),23cases of meningioma (19.8%),14cases of astrocytoma (12.0%),11cases of ependymoma (9.5%),7cases of lipoma (6.0%),6cases of arachnoid cyst (5.2%),3cases of metastatic tumor (2.6%) and a cases of schistosome eggs (1.0%), were all performed tumor microsurgical resection. Patients were divided into two groups according to whether the use of electrophysiological monitoring.68patients were performed SEP+EMG monitoring by Xltek32-channel neurophysiological monitoring (Natus Medical, Inc., San Carlos, CA, USA.), and48patients were performed surgery without neurophysiological monitoring. Preoperative and postoperative clinical symptoms of two groups were analyzed according to JOA score principle by analysis of variance.Results:68-monitoring patients underwent surgical tumor resection with the assistance of neurophsiological monitoring. For technical reasons,2of them were executed SEP only and4(5.9%) of them were executed EMG only, others were performed SEP+EMG combined monitoring. Monitors of5patients reached alarm standards during tumor surgical resection and returned to baseline after suspension or adjustment of operations. Alarms didn’t occur in other patients.4patients of monitored patients exhibited mild neurological function deteriorate like worsened muscle strength and sensory disturbances.6(12.5%) of non-monitored patients exhibited neurological function deterioration. JOA score of2in6non-monitored patients is decreased by3points. According to JOA score principle, no difference is observed between two groups at preoperation (p=0.14, p>0.05) and the score of monitoring patients is obviously better than that of non-monitored patients (p=6.74E-06, p<0.01).Conclusion:SEP and EMG monitoring is very effective for the functional protection in spinal cord tumor patients undergoing surgery and it can ameliorate neurological function worsen by alerting the surgeons in time to adjust operations. Therefore, we advocate for spinal occupancy patients, especially intramedullary occupancy patients undergoing routine use of electrophysiological monitoring techniques, so that to maximize the removal of the tumor, protect the neurological function and improve the quality of life of patients.