Sektionstage Herbst 2023 der Deutschen Gesellschaft für Neurochirurgie

Prof. Dr. med.

Prof. Dr.

Resektion intraduraler spinaler Tumoren – Tipps und Pitfalls

Übersichtsvortrag

Spinal Cord Mapping

Motor evoked intraoperative neuromonitoring of distal upper limbs&quot; fine-motor function in cervical intramedullary spinal cord tumor surgery: Is there a D-wave gap?

Abstract-Text Introduction: For cervical intramedullary spinal cord tumor (IMSCT) surgery, intraoperative assessment of motor pathways consists of spinal (D-wave) and muscle Motor Evoked Potentials (mMEP). It is well established that &gt; 50% amplitude preservation of D-wave predicts long-term lower limbs&quot; motor outcome and ambulation, in particular for MEP losses. Studies investigating the relation between D-wave and mMEP for the integrity of the corticospinal tract fibers at the lower cervical level are lacking. Such, we studied the relation between D-wave and hand-mMEP with long-term hand motor function. Material/Methods: We prospectively included 17 patients (m/f: 11/6, median age: 41 years) undergoing IMSCT surgery above the C4/5-level with successful intraoperative recording of hand-mMEP and epidurally D-wave (placed caudally to the surgical level but including at least the most rostrally located electrode covering the lower cervical segments), further median- and tibial nerve (m)SSEP, dorsal column mapping and hand-muscle EMG were implemented. The following permanent changes were judged to be significant: Loss or D-wave-amplitude decrement ≥50%, hmMEPs-amplitude decrement ≥80% or significant stimulation intensity increase. Distal upper/lower limbs&quot; detailed motor function was assessed pre- and 8-12 weeks postoperatively and at long-term follow-up (median 15 months) and correlated with IONM-findings. Results: Tumor histology consisted of ependymoma (53%), glioma (29%), cavernomas (12%) and hemangioblastomas (6%). Tumors were located above the C2/3-level in 47% and between the C3/4- and C4/5-level in 53% of the patients. Transient deterioration of hmMEPs resp. D-wave occured in one patient each (2/17, 12%); followed by transient new paresis only. In all other 15 patients, D-wave monitoring was stable/unremarkable. However, 5/15 (33%) patients postoperatively presented with a new motor deficit affecting only distal upper limbs&quot; muscle groups (corresponding to the spinal cord levels caudal to the level of D-wave recording) which were persistent during long-term follow-up, while the lower limbs&quot; motor function and gait were unaffected. In 4 of these 5 patients, critical and persisting hmMEPs findings were present (despite immediate intraoperative corrective actions) resulting in a sensitivity of 80% and a specifity of 100%. Discussion: In high-cervical IMSCT surgery, unimpaired D-wave findings reliably predicted preserved motor function of the lower limbs, however, did not sufficiently cover distal upper limbs&quot; motor function, thus, giving rise to false-negative findings. The underlying cause for this finding could be either a marginal alteration in D-wave amplitude related to the relatively small fraction of CST fibers innervating the hand muscles or an anterior horn injury that is not reflected in the D-wave. In conclusion, selective hmMEPs/mSSEPs-alterations have to be observed in this situation as those might predict distal upper limbs&quot; detailed motor outcome.

IONM bei spinalen und intramedullären Eingriffen

Spinale Tumoren

Abstractvortrag

PD Dr. med.

Prof. Dr. med

Motor deficits, ataxia and advanced age are associated with limited recovery after spinal meningioma resection

Abstract-Text Objective: Functional outcome after resection of spinal meningiomas is mostly considered satisfying. However, patients with non-resolving neurological symptoms, albeit mild, still show a reduced quality of life. We hence report on factors that determine full neurological recovery after surgical resection of spinal meningiomas in a larger patient cohort. Methods: We performed a single-center retrospective analysis of all patients undergoing surgery on spinal meningiomas between 2007 and 2019. Data collection included demographics, symptoms, clinical findings, histopathological diagnosis, surgical procedures, complications, and neurological outcome. Patients harboring a favorable outcome (Frankel grade E) were compared to patients with patients with non-resolving neurological symptoms (Frankel A to D) patients at final follow-up. Results: A total of 189 patients with a histologically diagnosed meningioma, including 44 males and 145 females with a median age 64 (range 55 to 74 years), were analyzed. Meningiomas were mostly found in the thoracic (n=127, 67%) followed by the cervical (n=49, 26%) spine. Upon admission, motor deficits or gait deficits (Frankel A-D) were present in 94 patients (50%). Gross total resection was achieved in 176 patients (93%), with a surgical complication rate of 5% (requiring revision). Histopathologically, all tumors were classified as WHO grade 1 meningiomas. After a mean follow-up of 860±470 days, 120 patients (63%) showed a fully preserved neurological function and 168 patients (89%) demonstrated a Frankel grade of D or E. Comparison of patients demonstrating full recovery (Frankel E) versus patients with nonresolving neurological deficits revealed an association of young age, the absence of ataxia and the absence of motor deficits with full neurological recovery at final follow-up. Conclusion: The data presented solidify the role of surgical resection in the treatment of spinal meningiomas, especially in young patients with mild neurological deficits. Furthermore, the presence of ataxia or motor deficits conferred a higher risk of non-resolving neurological deficits after spinal meningioma resection.

Dr. med.

Priv.-Doz. Dr. med.

Survival after neurosurgical therapy of spinal metastasis: Impact of synchronous versus metachronous metastatic disease

Abstract-Text Purpose Patients with spinal metastasis (SM) from solid tumors are often in an advanced stage of cancer. SM may to arise during a known oncological disease (metachronous SM) or be the primary manifestation of previously unknown cancer (synchronous SM). The time of diagnosis might decisively impact patient prognosis and further treatment stratification. In the present study, we analyzed the prognostic impact of synchronous versus (vs.) metachronous SM occurrence following resection of BM. Methods Between 2015 and 2020, 211 patients were surgically treated for SM at the authors' neuro-oncological center. Survival stratification calculated from the day of neurosurgical resection was performed for synchronous vs. metachronous SM diagnosis. Results Lung cancer was the most common tumor entity of primary site (23%) followed by prostate (21%) and breast cancer (11.3%). Synchronous SM occurrence was present in 97 patients (46%), metachronous SM occurrence was present in 114 patients (54%). The median overall survival for patients with synchronous SM diagnosis was 13.5 months compared to 13 months for patients with metachronous SM diagnosis (p=0.74). Conclusions The present study indicates that time of SM diagnosis (synchronous vs. metachronous) does not significantly impact patient survival following surgical therapy of SM. These results suggest that the indication for neurosurgical therapy should be made regardless of a synchronous or a metachronous time of SM occurrence.

Intensivmedizin mit Fokus Therapiezieländerung 

Seminarraum 5

Joint Session Neuroonkologie und Technik & Innovation – Spinale Tumore

Joint Session

Joint Session Neuroonkologie und Technik & Innovation – Spinale Tumore

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