Multimodal intraoperative monitoring during intramedullary XXXX surgery.

@entity1 @entity2286 @entity5 @entity4097
BACKGROUND: The aim of this work is to evaluate the utility of multimodal intraoperative monitoring (IOM) during intramedullary @entity4097 (IMSCT) surgery in our institution, and to investigate which IOM events are likely to be encountered during critical surgical phases. METHODS: Twenty-five @entity1 who underwent IMSCT surgery with IOM were included in this study. Our multimodal IOM assessment included SSEP, mMEP, and fEMG monitoring. Positive predictive value ( @entity2286 ), negative predictive value (NPV), sensitivity, and specificity were assessed 24  h and 1  month after surgery. The IOM events during three main surgical phases were also investigated. For mMEP assessment, two warning criteria (>50  % decrease in mMEP amplitude and all-or-none mMEP amplitude presence) were employed. RESULTS: Long-term outcome prediction was better when the all-or-none criterion was applied than when the >50  % amplitude decrease criterion was applied. Based on the all-or-none criterion, the @entity2286 , NPV, sensitivity, and specificity were 60, 100, 100, and 91  %. Frequent IOM events were observed during the three major main surgical phases. Seven (29  %) @entity1 showed SSEP events during opening of the spinal cord. During @entity5 removal, 21 of 25 @entity1 (84  %) had IOM events, and 13 of 18 (72  %) of the fEMG events occurred prior to the mMEP events. CONCLUSIONS: Based on the association of fEMG events with upcoming mMEP events during @entity5 removal, we recommend inclusion of fEMG monitoring in IOM. Multimodal IOM provides useful electrophysiological information during IMSCT surgery, especially during the main surgical phases.
