Intraoperative neuroelectrophysiological monitoring of spinal cavernous vascular malformations: sensitivity and specificity of monitoring and warning criteria

doi:10.3969/j.issn.1672-6731.2020.11.007

Abstract

Abstract:

Objective To analyze the sensitivity and specificity of neuroelectrophysiological monitoring and warning criterion in the spinal cord cavernous malformations surgery. Methods A total of 64 patients with spinal cord cavernous malformation underwent surgical treatment were collected from November 2012 to March 2016. All patients underwent intraoperative monitoring of motor-evoked potential (MEP) and somatosensory-evoked potential (SEP). Multimodal monitoring combined MEP amplitude decreased ≥ 80% with SEP was performed to predict the postoperative neurological function defect of patients. McCormick grade as "gold standard" was used to calculate sensitivity, specificity, positive predictive value and negative predictive value. Results The sensitivity, specificity, positive predictive value and negative predictive value were 75% (15/20), 78.57% (33/42), 62.50% (15/24) and 86.84% (33/38), respectively. Conclusions Intraoperative MEP combined with SEP monitoring can effectively predict the occurrence of new neurological deficits after operation. MEP amplitude reduction ≥ 80% can be used as the operation warning criterion.

Key words: Vascular malformations, spinal cord, Intraoperative neuroelectrophysiological monitoring, Evoked potentials

摘要：

目的分析脊髓海绵状血管畸形术中神经电生理监测预警标准的敏感性和特异性。方法选择2012年11月至2016年3月神经外科手术治疗的脊髓海绵状血管畸形患者共64例，术中采用运动诱发电位（MEP）联合体感诱发电位（SEP）对神经功能进行监测，并以运动诱发电位波幅降低≥ 80%作为预警标准预测术后神经功能缺损情况，以McCormick分级作为“金标准”，计算其灵敏度和特异度、阳性预测值和阴性预测值。结果运动诱发电位波幅降低≥ 80%联合体感诱发电位多模态监测的灵敏度为75%（15/20）、特异度78.57%（33/42），阳性预测值为62.50%（15/24）、阴性预测值86.84%（33/38）。结论脊髓海绵状血管畸形术中运动诱发电位联合体感诱发电位监测可有效预测术后新发神经功能缺损，运动诱发电位预警标准以波幅降低≥ 80%为宜。

关键词: 血管畸形, 脊髓, 术中神经电生理监测, 诱发电位

LI Xiao-yu, ZHANG Hong-qi, LING Feng, HU Peng, REN Jian. Intraoperative neuroelectrophysiological monitoring of spinal cavernous vascular malformations: sensitivity and specificity of monitoring and warning criteria[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(11): 970-974.

李晓宇, 张鸿祺, 凌锋, 胡鹏, 任健. 脊髓海绵状血管畸形术中神经电生理监测:预警标准敏感性和特异性分析[J]. 中国现代神经疾病杂志, 2020, 20(11): 970-974.

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