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Silverstein JW, D'Amico RS, Mehta SH, Gluski J, Ber R, Sciubba DM, Lo SFL. The diagnostic accuracy of neuromonitoring for detecting postoperative bowel and bladder dysfunction in spinal oncology surgery: a case series. J Neurooncol 2024:10.1007/s11060-024-04742-y. [PMID: 38884662 DOI: 10.1007/s11060-024-04742-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Postoperative bowel and bladder dysfunction (BBD) poses a significant risk following surgery of the sacral spinal segments and sacral nerve roots, particularly in neuro-oncology cases. The need for more reliable neuromonitoring techniques to enhance the safety of spine surgery is evident. METHODS We conducted a case series comprising 60 procedures involving 56 patients, spanning from September 2022 to January 2024. We assessed the diagnostic accuracy of sacral reflexes (bulbocavernosus and external urethral sphincter reflexes) and compared them with transcranial motor evoked potentials (TCMEP) incorporating anal sphincter (AS) and external urethral sphincter (EUS) recordings, as well as spontaneous electromyography (s-EMG) with AS and EUS recordings. RESULTS Sacral reflexes demonstrated a specificity of 100% in predicting postoperative BBD, with a sensitivity of 73.33%. While sensitivity slightly decreased to 64.71% at the 1-month follow-up, it remained consistently high overall. TCMEP with AS/EUS recordings did not identify any instances of postoperative BBD, whereas s-EMG with AS/EUS recordings showed a sensitivity of 14.29% and a specificity of 97.14%. CONCLUSION Sacral reflex monitoring emerges as a robust adjunct to routine neuromonitoring, offering surgeons valuable predictive insights to potentially mitigate the occurrence of postoperative BBD.
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Affiliation(s)
- Justin W Silverstein
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
- Department of Clinical Neurophysiology, Neuro Protective Solutions, New York, NY, USA.
| | - Randy S D'Amico
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Shyle H Mehta
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Jacob Gluski
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Roee Ber
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Daniel M Sciubba
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Sheng-Fu Larry Lo
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
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Liu K, Ma C, Li D, Li H, Dong X, Liu B, Yu Y, Fan Y, Song H. The role of intraoperative neurophysiological monitoring in intramedullary spinal cord tumor surgery. Chin Neurosurg J 2023; 9:33. [PMID: 38031178 PMCID: PMC10685460 DOI: 10.1186/s41016-023-00348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Intramedullary tumors are a class of central nervous system tumors with an incidence of 2 to 4%. As they are located very deep and frequently cause postoperative neurological complications, surgical resection is difficult. In recent years, many surgeons have performed electrophysiological monitoring to effectively reduce the occurrence of postoperative neurological complications. Modern electrophysiological monitoring technology has advanced considerably, leading to the development of many monitoring methods, such as SSEPs, MEPs, DCM, and EMG, to monitor intramedullary tumors. However, electrophysiological monitoring in tumor resection is still being studied. In this article, we discussed the different monitoring methods and their role in monitoring intramedullary tumors by reviewing previous studies. Intratumorally tumors need to be monitored for a summary of the condition of the patient. Only by using various monitoring methods flexibly and through clear communication between surgeons and neurophysiological experts can good decisions be made during surgery and positive surgical results be achieved.
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Affiliation(s)
- Kai Liu
- Department of Neurosurgery, Bethune First Hospital of Jilin University, Changchun, Jilin, China
| | - Chengyuan Ma
- Department of Neurosurgery, Bethune First Hospital of Jilin University, Changchun, Jilin, China
| | - Dapeng Li
- Department of Neurosurgery, Bethune First Hospital of Jilin University, Changchun, Jilin, China
| | - Haisong Li
- Department of Neurosurgery, Bethune First Hospital of Jilin University, Changchun, Jilin, China
| | - Xuechao Dong
- Department of Neurosurgery, Bethune First Hospital of Jilin University, Changchun, Jilin, China
| | - Bo Liu
- Department of Neurosurgery, Bethune First Hospital of Jilin University, Changchun, Jilin, China
| | - Ying Yu
- Department of Neurosurgery, Bethune First Hospital of Jilin University, Changchun, Jilin, China
| | - Yuxiang Fan
- Department of Neurosurgery, Bethune First Hospital of Jilin University, Changchun, Jilin, China
| | - Hongmei Song
- Department of Neurosurgery, Bethune First Hospital of Jilin University, Changchun, Jilin, China.
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Silverstein JW, Block J, Olmsted ZT, Green R, Pieters T, Babarevech K, Ballas-Williamson A, Skinner SA, Sciubba DM, Larry Lo SF. Intraoperative Monitoring of the External Urethral Sphincter Reflex: A Novel Adjunct to Bulbocavernosus Reflex Neuromonitoring for Protecting the Sacral Neural Pathways Responsible for Urination, Defecation and Sexual Function. J Clin Neurophysiol 2023:00004691-990000000-00113. [PMID: 37963332 DOI: 10.1097/wnp.0000000000001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
PURPOSE Intraoperative bulbocavernosus reflex neuromonitoring has been utilized to protect bowel, bladder, and sexual function, providing a continuous functional assessment of the somatic sacral nervous system during surgeries where it is at risk. Bulbocavernosus reflex data may also provide additional functional insight, including an evaluation for spinal shock, distinguishing upper versus lower motor neuron injury (conus vs. cauda syndromes) and prognosis for postoperative bowel and bladder function. Continuous intraoperative bulbocavernosus reflex monitoring has been utilized to provide the surgeon with an ongoing functional assessment of the anatomical elements involved in the S2-S4 mediated reflex arc including the conus, cauda equina and pudendal nerves. Intraoperative bulbocavernosus reflex monitoring typically includes the electrical activation of the dorsal nerves of the genitals to initiate the afferent component of the reflex, followed by recording the resulting muscle response using needle electromyography recordings from the external anal sphincter. METHODS Herein we describe a complementary and novel technique that includes recording electromyography responses from the external urethral sphincter to monitor the external urethral sphincter reflex. Specialized foley catheters embedded with recording electrodes have recently become commercially available that provide the ability to perform intraoperative external urethral sphincter muscle recordings. RESULTS We describe technical details and the potential utility of incorporating external urethral sphincter reflex recordings into existing sacral neuromonitoring paradigms to provide redundant yet complementary data streams. CONCLUSIONS We present two illustrative neurosurgical oncology cases to demonstrate the utility of the external urethral sphincter reflex technique in the setting of the necessary surgical sacrifice of sacral nerve roots.
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Affiliation(s)
- Justin W Silverstein
- Department of Neurology, North Shore University Hospital/ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, U.S.A
- Department of Clinical Neurophysiology, Neuro Protective Solutions, New York, New York, U.S.A
| | - Jon Block
- Department of Surgical Neurophysiology, ION Intraoperative Neurophysiology, Orinda, California, U.S.A
| | - Zachary T Olmsted
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, U.S.A.; and
| | - Ross Green
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, U.S.A.; and
| | - Thomas Pieters
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, U.S.A.; and
| | - Kristiana Babarevech
- Department of Clinical Neurophysiology, Neuro Protective Solutions, New York, New York, U.S.A
| | | | - Stanley A Skinner
- Department of Intraoperative Neurophysiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, U.S.A
| | - Daniel M Sciubba
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, U.S.A.; and
| | - Sheng-Fu Larry Lo
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, U.S.A.; and
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