Dataset related to article "Intramedullary spinal cord tumors: the value of intraoperative neurophysiological monitoring in a series of 57 cases from two Italian centres."

BACKGROUND:

Intramedullary spinal cord tumors are rare lesions of the central nervous system. Anatomical, molecular and radiological features are well defined, but correct management is still matter of debate. Pertinent literature has reported conflicting opinions regarding the use of intraoperative electrophysiological monitoring (IONM) in the surgical treatment of this kind of lesions, recently. We report a retrospective study from two Italian centres, in order to highlight the usefulness of IONM in the management of intramedullary lesions.

METHODS:

We performed a retrospective review of patients with intramedullary spinal tumor who underwent surgical resection from February 2011 to February 2018 in two different institutions. Clinical and radiological data, lesion features, timing of symptom onset and IONM findings were record ed . The IONM includ ed somatosensory-evoked potentials(SSEP), motor-evoked potentials(MEP) and D-Wave whenever possible. We evaluated the outcome according to the Modified McCormick scale. We also evaluated the accuracy and relevance of surgical outcomes for each evoked potential(SSEP, MEP, D-Wave).

RESULTS:

A total of 57 patients were included. A gross total removal was achieved in 46 cases. Neurological follow-up was assessment at 3 days, and 3 and 6 months after surgery. Comparing the preoperative status and 6 months follow-up: the M-McCormick scale showed a neurological stability for 30 patients (52.63%), a worsening of neurological status for 7 patients (12.28%) and an improvement for 20 patients (35.08%). IONM presented high accuracy (sensibility of 100% and specificity of 95.65%) and significantly pred icted postoperative permanent motor d eficits(P<0.0001; AUC=0.978). D-Wave appeared to have significant greater predictive value than MEP and especially SSEP alone(0.967 vs 0.722 vs 0.542; P = 0.044 and P<0.001 respectively).

CONCLUSIONS:

The gold standard in the intramedullary lesion treatment is maximal safe resection with good neurological outcome, as shown in our patients. The use of IONM is helpful in intramedullary tumors resection in order to minimize postoperative neurological deficits and our analysis suggests that the use of D-Wave presents a statistically significant higher accuracy for predicting postoperative deficits than SSEP and MEP alone.

背景：
脊髓内肿瘤属于中枢神经系统罕见病变。其解剖学、分子生物学及影像学特征已明确，但临床诊疗的最优方案仍存在争议。近期相关文献针对术中神经电生理监测（intraoperative electrophysiological monitoring, IONM）在该类病变外科治疗中的应用价值，报道了相互矛盾的观点。本研究为来自两家意大利医疗中心的回顾性研究，旨在阐明IONM在脊髓内病变诊疗中的应用价值。

方法：
我们回顾性分析了2011年2月至2018年2月期间，在两家不同医疗机构接受手术切除的脊髓内肿瘤患者的临床资料。收集患者的临床与影像学数据、病变特征、症状发作时间及IONM监测结果。术中神经电生理监测涵盖体感诱发电位（somatosensory-evoked potentials, SSEP）、运动诱发电位（motor-evoked potentials, MEP）及D波（D-Wave），并尽可能完成上述检测项目。采用改良McCormick量表评估患者术后预后情况，同时分析各诱发电位（SSEP、MEP、D波）与手术预后的相关性及预测准确性。

结果：
本研究共纳入57例患者，其中46例实现肿瘤大体全切。分别于术后3天、3个月及6个月开展神经功能随访评估。对比术前与术后6个月的神经功能状态：根据改良McCormick量表评估结果，30例患者（52.63%）神经功能稳定，7例（12.28%）出现神经功能恶化，20例（35.08%）神经功能得到改善。IONM具有较高的预测准确性（灵敏度100%，特异度95.65%），可显著预测术后永久性运动功能缺损（P<0.0001；受试者工作特征曲线下面积AUC=0.978）。单独使用D波的预测价值显著高于MEP及单独使用SSEP（AUC分别为0.967、0.722、0.542；P值分别为0.044及<0.001）。

结论：
正如本研究队列所证实，脊髓内病变治疗的金标准为最大安全切除肿瘤，并获得良好的神经功能预后。术中应用IONM有助于脊髓内肿瘤的手术切除，可最大限度减少术后神经功能缺损；本研究分析还表明，单独使用D波预测术后缺损的准确性，在统计学上显著高于单独使用SSEP或MEP的方案。