Resection of intramedullary spinal cord tumor under awake anesthesia: A novel approach to minimize postoperative motor deficits

作     者：Ahsan Ali Khan Lukui Chen Xiaoyuan Guo Hong Wang Guojian Wu Jun Kong Ning Yin 

作者机构：Department of Neurosurgery Zhongda Hospital Southeast University Department of Anaesthesia Zhongda Hospital Southeast University 

出 版 物：《Translational Neuroscience and Clinics》 (临床转化神经医学（英文版）)

年 卷 期：2017年第3卷第1期

页      面：28-34页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：Supported by the Nanjing Science and Technology Project(No.20130345) Jiangsu Science and Technology Project–Clinical Medicine Special Grant(No.BL2014076) 

主　　题：intramedullary spinal cord tumor awake neurophysiological monitoring 

摘      要：Objective: To observe advantages and disadvantages of the resection of intramedullary spinal cord tumor under awake anesthesia. Methods: Two patients with intramedullary spinal cord tumor underwent resection under awake anesthesia and followed up post-operatibely for any motor deficits. Results: Patients who underwent tumor resection under awake(AAA) anesthesia combined with intraoperative NPM had no motor deficits postoperatively. More accurate and nondelayed responses were observed in the awake cycle of anesthesia and helped guide surgery, thus avoiding injuries to the spinal cord. Conclusion: Intramedullary spinal cord tumors are not common, but only gross total resection(GTR) can provide complete remission of symptoms and progression-free survival. However, GTR sometimes results in motor function deficits postoperatively,particularly when the cervical cord is involved, and especially if surgery is done under general anesthesia with intraoperative neurophysiological monitoring(NPM) alone,because of delayed sensory evoked potential and motor evoked potential responses. We present two cases that underwent GTR of cervical intramedullary spinal cord tumors under an asleep-awake-asleep(AAA) cycle of anesthesia, combined with intraoperative NPM in which no post-operative motor deficits were observed on 6-months follow up.