Awake neurological monitoring during surgery for spinal cord tumor

Abstract

Although the usefulness of awake surgery is recognized for brain tumor, there is no report on those for spinal cord tumor. The author retrospectively studied the feasibility and usefulness of awake surgery for spinal cord tumor performed at their hospital. Case 1) 65 y.o. woman with thoracic ependymoma. Cace 2) 66 y.o. woman with cauda-equina meningioma. Case 3) 33 y.o. man with cervico-thoracic subependymoma (in 2 operations). During these 4 operations, the neurological symptoms as pain, motor weakness, sensory disturbance, and decreased tolerable volume of bladder were recognized. In such cases, the surgeon paused manipulation, then tumor was totally removed in case 1 and 2, and partially removed in case 3 because of poor recovery. Adverse events were pain, and skin injuries of grade 2 and 3. As intraoperative neurophysiologic monitoring (IONM) for spinal cord tumor surgery, somatosensory evoked potentials and motor evoked potentials are commonly used. However, they have problems of time lag, or interference to surgical maneuver, which can be overcome by awake method. Actually, in our series, neurological deteriorations were detected promptly during surgical maneuver. Skin injury could be reduced with repetition. Awake surgery for spinal cord tumor was feasible and useful for intraoperative surgeon’s decision.