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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Mapping the dorsal column and the corticospinal tract in intramedullary spinal cord tumour surgery

Mapping der Hinterstrangbahnen und Pyramidenbahn bei der Resektion von intramedullären Tumoren

Meeting Abstract

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  • presenting/speaker Kathleen Seidel - Inselspital, Neurochirurgie, Bern, Switzerland
  • Vedran v. Deletis - Albert Einstein College of Medicine, New York, United States; University Hospital Dubrava, Zagreb, Croatia
  • Francesco Sala - University Hospital, Institute of Neurosurgery, Vernona, Italy
  • Andreas Raabe - Inselspital, Neurochirurgie, Bern, Switzerland
  • Darko Chudy - University Hospital Dubrava, Zagreb, Croatia
  • Jürgen Beck - Inselspital, Neurochirurgie, Bern, Switzerland
  • Karl F. Kothbauer - Luzerner Kantonsspital, Klinik für Neurochirurgie, Luzern, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocBO-V11

doi: 10.3205/19dgnc035, urn:nbn:de:0183-19dgnc0351

Published: May 8, 2019

© 2019 Seidel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: During surgery of intramedullary spinal cord tumours, anatomical identification of the corticospinal tract (CST) and the dorsal column (DC) of the exposed spinal cord is difficult when anatomical landmarks are distorted by tumour growth. Neurophysiological identification is complicated by the fact that direct stimulation of the DC may result in muscle motor responses due to the centrally activated H-reflex. This study aims to provide a technique for intraoperative neurophysiological differentiation between CST and DC in the exposed spinal cord and the resection cavity.

Methods: Recordings were obtained from 32 consecutive patients undergoing spinal cord tumour surgery from 07/2015–03/2017. A double train stimulation paradigm with an intertrain interval of 60ms was devised with recording of responses from limb muscles.

Results: In non spastic patients (55% of cohort) an identical second response was noted following the first CST stimulation, but the second response was absent after DC stimulation. In patients with preexisting spasticity (45%), CST stimulation again resulted in two identical responses, whereas DC stimulation generated a second response that differed substantially from the first one. The recovery times of interneurons in the spinal cord grey matter for the CST were much shorter than those for the DC. Therefore, when a second stimulus train was applied 60ms after the first, the CST-fibre interneurons had already recovered ready to generate a second response, whereas the DC interneurons were still in the refractory period.

Conclusion: Mapping of the spinal cord using double-train stimulation allows neurophysiological distinction of CST from DC pathways during spinal cord tumour surgery in patients with and without preexisting spasticity.