Intraoperative Neurophysiological Monitoring in Tethered Cord Syndrome Surgery: Predictive Values and Clinical Outcome.

Autor:	Squintani G; Neurology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Basaldella F; Neurology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Badari A; Neurology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Rasera A; Neurology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.; Neurology Unit, Ospedale Ca' Foncello, Treviso, Italy.; Neurology and Neurophysiology Unit, Azienda Ospedaliera Universitaria, Modena, Italy.; Neurosurgery Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; and.; Neurosurgery Unit, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy., Tramontano V; Neurology and Neurophysiology Unit, Azienda Ospedaliera Universitaria, Modena, Italy., Pinna G; Neurosurgery Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; and., Moscolo F; Neurosurgery Unit, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy., Soda C; Neurosurgery Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; and., Ricci U; Neurosurgery Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; and., Ravenna G; Neurosurgery Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; and., Sala F; Neurosurgery Unit, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
Jazyk:	angličtina
Zdroj:	Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society [J Clin Neurophysiol] 2024 Jun 25. Date of Electronic Publication: 2024 Jun 25.
DOI:	10.1097/WNP.0000000000001096
Abstrakt:	Introduction: "Tethered cord syndrome" (TCS) refers to a congenital abnormality associated with neurological signs and symptoms. The aim of surgery is to prevent or arrest their progression. This study reports a retrospective case series of tethered cord syndrome surgeries, supported by intraoperative neurophysiological monitoring. Methods: The case series comprises 50 surgeries for tethered cord syndrome in which multimodal intraoperative neurophysiological monitoring was performed using motor evoked potentials (transcranial motor evoked potentials [TcMEPs]), tibial nerve somatosensory evoked potentials (TNSEPs), and pudendal-anal reflex (PAR). The intraoperative neurophysiological monitoring results are reported and correlated with clinical outcomes. Results: Sensitivity, specificity, and negative predictive value were high for TcMEPs and TNSEPs, while PAR exhibited low sensitivity and positive predictive value but high specificity and negative predictive value. Fisher's exact test revealed a significant correlation between changes in TcMEPs, TNSEPs, and clinical outcome ( P < 0.000 and P = 0.049 respectively), but no correlation was detected between PAR and urinary/anal function ( P = 0.497). Conclusions: While TcMEPs and TNSEPs were found to be reliable intraoperative neurophysiological monitoring parameters during tethered cord syndrome surgery, PAR had low sensitivity and positive predictive value probably because the reflex is not directly related to bladder function and because its multisynaptic pathway may be sensitive to anesthetics. New onset muscle weakness and sensory deficits were related to postoperative changes in TcMEPs and TNSEPs, whereas changes in PAR did not predict bladder/urinary impairment. Urinary deficits may be predicted and prevented with other neurophysiological techniques, such as the bladder-anal reflex. Competing Interests: The authors have no funding or conflicts of interest to disclose. (Copyright © 2024 by the American Clinical Neurophysiology Society.)
Databáze:	MEDLINE
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