Preservation of pelvic organ functions after surgical treatment of tumors in the caudal section of the spinal cord: role of intraoperative neurophysiological monitoring
- Authors: Malyshok D.Е.1, Bisaga G.N.1, Оrlov А.Y.1, Aleksandrov M.V.1,2
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Affiliations:
- Almazov National Medical Research Centre
- Kirov Military Medical Academy
- Issue: Vol 26, No 3 (2024)
- Pages: 381-390
- Section: Research paper
- Submitted: 21.12.2023
- Accepted: 06.06.2024
- Published: 06.09.2024
- URL: https://journals.eco-vector.com/1682-7392/article/view/624855
- DOI: https://doi.org/10.17816/brmma624855
- ID: 624855
Cite item
Abstract
The effectiveness of intraoperative neurophysiological monitoring of the segmental apparatus for the regulation of pelvic functions during surgical treatment of tumors in the caudal spinal cord was assessed. In this study, 99 patients with extramedullary and intramedullary spinal cord tumors at the Th11–S5 vertebral levels who received neurosurgical treatment were examined. Based on the extent of intraoperative neurophysiological monitoring, patients were divided into two groups: group 1 underwent standard monitoring of the pyramidal system, and group 2 underwent extended monitoring of pelvic organ functions, which was based on the recording of the bulbocavernosus reflex. Neurological examinations were conducted for all patients before surgery and in the early postoperative period (10–14 days). Twelve months after the surgery, a telephone survey of the complaints of pelvic organ dysfunction was conducted. The surgical outcomes of both groups were compared. Pelvic organ dysfunctions in the preoperative period were identified in 25%–30% of the patients in each group. In the examination 10–14 days after surgery, pelvic organ dysfunctions were found in 20 (48.8%) patients in group 1 and in 16 (27.6%) in group 2. At 12 months after surgery, the dysfunction rate increased from 56.1% (n = 23) in group 1 to 29.3% (n = 17) in group 2. Non-monitoring increased the risk of pelvic organ dysfunctions by 2.5 times in the early postoperative period (odds ratio, 2.50 (1.07–5.79)) and 3.08 times after 1 year (odds ratio, 3.08 (1.35–7.11)). Monitoring of pelvic functions reduced the risk of pelvic organ dysfunctions first identified in the early postoperative period by 5.2 times (odds ratio, 0.192 (0.04–0.80)). Thus, intraoperative continuous monitoring of the state of the segmental apparatus for regulating pelvic functions helps minimize the risk of postoperative development of pelvic disorders in patients with tumor lesions of the caudal parts of the spinal cord. Pelvic monitoring increases the functional permissibility of the operation, maintaining or improving the quality of life of the patients.
About the authors
Dar’ya Е. Malyshok
Almazov National Medical Research Centre
Email: dashadzhil@gmail.com
ORCID iD: 0000-0002-2322-6753
SPIN-code: 2204-4271
functional diagnostics doctor
Russian Federation, Saint PetersburgGennadiy N. Bisaga
Almazov National Medical Research Centre
Email: bisaga@yandex.ru
ORCID iD: 0000-0002-1848-8775
SPIN-code: 9121-7071
MD, Dr. Sci. (Med.), professor
Russian Federation, Saint PetersburgАndrei Yu. Оrlov
Almazov National Medical Research Centre
Email: orloff-andrei@mail.ru
ORCID iD: 0000-0001-6597-3733
SPIN-code: 4018-1328
MD, Dr. Sci. (Med.)
Russian Federation, Saint PetersburgMikhail V. Aleksandrov
Almazov National Medical Research Centre; Kirov Military Medical Academy
Author for correspondence.
Email: vmeda-nio@mil.ru
ORCID iD: 0000-0002-9935-3249
SPIN-code: 5452-8634
MD, Dr. Sci. (Med.), professor
Russian Federation, Saint Petersburg; Saint PetersburgReferences
- Samochernykh N, Sysoev K, Kim A, et al. C2 spinal nerve tumors in young adults: report of two cases and review of the literature. Child’s nervous system. Childs Nerv Syst. 2021;37(2):691–694. doi: 10.1007/s00381-020-04777-2
- Konovalov NA, Golanov AV, Shevelev IN, et al. The outcomes of treatment of cauda equina ependymomas in adults. Burdenko’s Journal of Neurosurgery. 2015;79(1):58–67. (In Russ.) EDN: TXLKPV doi: 10.17116/neiro201579158-67
- Wostrack M, Shiban E, Obermueller T, et al. Conus medullaris and cauda equina tumors: clinical presentation, prognosis, and outcome after surgical treatment: clinical article. J Neurosurg Spine. 2014;20(3):335–343. doi: 10.3171/2013.12.SPINE13668
- Deletis V, Vodusek D B. Intraoperative recording of the bulbocavernosus reflex. Neurosurgery. 1997;40(1):88–93. doi: 10.1097/00006123-199701000-00019
- Granata G, Padua L, Rossi F, et al. Electrophysiological study of the bulbocavernosus reflex: normative data. Funct Neurol. 2013;28(4):293. doi: 10.11138/FNeur/2013.28.4.293
- Sugiyama K, Harada N, Kondo K, et al. Relationship between preoperative neuroradiological findings and intraoperative bulbocavernosus reflex amplitude in patients with intradural extramedullary tumors. Neurol Med Chir (Tokyo). 2021;61(8): 484–491. doi: 10.2176/nmc.oa.2020-0425
- Malyshok DЕ, Bisaga GN, Оrlov АYu, et al. Effectiveness of intraoperative monitoring of the bulbocavernosus reflex for predicting postoperative pelvic disorders in the surgical treatment of distal spine tumors. Bulletin of the Russian Military Medical Academy. 2023;25(3):403–412. EDN: BGGFWY doi: 10.17816/brmma487910
- Shimada Y, Miyakoshi N, Kasukawa Y, et al. Clinical features of cauda equina tumors requiring surgical treatment. Tohoku J Exp Med. 2006;209(1):1–6. doi: 10.1620/tjem.209.1
- Han IH, Kuh SU, Chin DK, et al. Surgical treatment of primary spinal tumors in the conus medullaris. J Korean Neurosurg Soc. 2008;44(2):72–77. doi: 10.3340/jkns.2008.44.2.72
- Schwab JH, Healey JH, Rose P, et al. The surgical management of sacral chordomas. Spine (Phila Pa 1976). 2009;34(24):2700–2704. doi: 10.1097/BRS.0b013e3181bad11d
- Aleksandrov MV, Chikurov AA, Toporkova OA, et. al. Neurophysiological intraoperative monitoring in neurosurgery: a manual. 2nd edition, revised and supplemented; ed. by M.V. Aleksandrov. 2020. 159 р. (In Russ.)
- Fehlings MG, Brodke DS, Norvell DC, et al. The evidence for intraoperative neurophysiological monitoring in spine surgery: does it make a difference? Spine (Phila Pa 1976). 2010;35(9S):37–46. doi: 10.1097/BRS.0b013e3181d8338e
- Scibilia A, Terranova C, Rizzo V, et al. Intraoperative neurophysiological mapping and monitoring in spinal tumor surgery: sirens or indispensable tools? Neurosurg Focus. 2016;41(2):E18. doi: 10.3171/2016.5.FOCUS16141
- Kahraman S, Gocmen S, Gokmen MHA, et al. Intraoperative neurophysiologic monitoring for lumbar intradural schwannomas: does it affect clinical outcome? World Neurosurgery. 2019;124:e789–e792. doi: 10.1016/j.wneu.2019.01.054
- Scibilia A, Rizzo V, Terranova C, et al. The role of intraoperative neurophysiological monitoring in surgery of intradural extramedullary spinal cord tumors. Neuro-oncology. 2014;16(Supple2):ii46–ii48. doi: 10.1093/neuonc/nou174.184
- Skinner SA, Vodušek DB. Intraoperative recording of the bulbocavernosus reflex. J Clin Neurophysiol. 2014;31(4):313–322. doi: 10.1097/WNP.0000000000000054
- Verla T, Fridley JS, Khan AB, et al. Neuromonitoring for intramedullary spinal cord tumor surgery. World Neurosurg. 2016;95:108–116. doi: 10.1016/j.wneu.2016.07.066
- Sysoev K, Tadevosyan A, Samochernykh K, et al. Prognosis of surgical treatment of the tethered cord syndrome in children. Childs Nerv Syst. 2018;34(2):305–310. doi: 10.1007/s00381-017-3630-8
- Morota N. Intraoperative neurophysiological monitoring of the bulbocavernosus reflex during surgery for conus spinal lipoma: what are the warning criteria? J Neurosurg Pediatr. 20192(5):639–647. doi: 10.3171/2018.12.PEDS18535
- Choi J, Kim JS, Hyun SJ, et al. Efficacy of intraoperative bulbocavernosus reflex monitoring for the prediction of postoperative voiding function in adult patients with lumbosacral spinal tumor. J Clin Monit Comput. 2022;36(2):493–499. doi: 10.1007/s10877-021-00678-0
- McCormick PC, Post KD, Stein BM. Intradural extramedullary tumors in adults. Neurosurg Clin N Am. 1990;1(3):591–608.
- Klekamp J, Samii M. Surgery of Spinal Tumors. Heidelberg: Springer Berlin; 2007. 526 p.
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