Analysis of the effect of intraoperative neuromonitoring during resection of benign nerve sheath tumors on gross-total resection and neurological complications
| Autor: | Wilson Z. Ray, Mark A. Mahan, Rajiv Midha, Courtney Pendleton, Zarina S. Ali, Thomas J. Wilson, Sara Saleh, Saud Alzahrani, Christopher F. Dibble, Eric L. Zager, Robert J. Spinner, Forrest Hamrick, Sravanthi Koduri, Lynda J.-S. Yang |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Weakness Multivariate analysis business.industry General Medicine Schwannoma medicine.disease Surgery Nerve sheath tumor 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Propensity score matching Cohort medicine Neurofibroma medicine.symptom business Peripheral Nerve Sheath 030217 neurology & neurosurgery |
| Zdroj: | Journal of Neurosurgery. 135:1231-1240 |
| ISSN: | 1933-0693 0022-3085 |
| DOI: | 10.3171/2020.8.jns202885 |
| Popis: | OBJECTIVEThe aim of this study was to examine the role of intraoperative neuromonitoring (IONM) during resection of benign peripheral nerve sheath tumors in achieving gross-total resection (GTR) and in reducing postoperative neurological complications.METHODSData from consecutive adult patients who underwent resection of a benign peripheral nerve sheath tumor at 7 participating institutions were combined. Propensity score matching was used to balance covariates. The primary outcomes of interest were the association between IONM and GTR and the association of IONM and the development of a permanent postoperative neurological complication. The secondary outcomes of interest were the association between IONM and GTR and the association between IONM and the development of a permanent postoperative neurological complication in the subgroup of patients with tumors involving a motor or mixed nerve. Univariate and multivariate logistic regression were then performed on the propensity score–matched samples to assess the ability of the independent variables to predict the outcomes of interest.RESULTSA total of 337 patients who underwent resection of benign nerve sheath tumors were included. In multivariate analysis, the use of IONM (OR 0.460, 95% CI 0.199–0.978; p = 0.047) was a significant negative predictor of GTR, whereas none of the variables, including IONM, were associated with the occurrence of a permanent postoperative neurological complication. Within the subgroup of motor/mixed nerve tumors, in the multivariate analysis, IONM (OR 0.263, 95% CI 0.096–0.723; p = 0.010) was a significant negative predictor of a GTR, whereas IONM (OR 3.800, 95% CI 1.925–7.502; p < 0.001) was a significant positive predictor of a permanent postoperative motor deficit.CONCLUSIONSOverall, 12% of the cohort had a permanent neurological complication, with new or worsened paresthesias most common, followed by pain and then weakness. The authors found that formal IONM was associated with a reduced likelihood of GTR and had no association with neurological complications. The authors believe that these data argue against IONM being considered standard of care but do not believe that these data should be used to universally argue against IONM during resection of benign nerve sheath tumors. |
| Databáze: | OpenAIRE |
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