Intraoperative Neurophysiological Monitoring in Surgical Treatment of Spinal Dural Arteriovenous Fistulas: Technique and Results

Reza Ghadirpour; Davide Nasi; Corrado Iaccarino; Antonio Romano; Luisa Motti; Marco Farneti; Rosario Pascarella; Franco Servadei

doi:10.4103/ajns.AJNS_209_16

Intraoperative Neurophysiological Monitoring in Surgical Treatment of Spinal Dural Arteriovenous Fistulas: Technique and Results

Asian J Neurosurg. 2018 Jul-Sep;13(3):595-606. doi: 10.4103/ajns.AJNS_209_16.

Authors

Reza Ghadirpour^{1

2}, Davide Nasi^{1

2}, Corrado Iaccarino^{1

2}, Antonio Romano^{1

2}, Luisa Motti³, Marco Farneti⁴, Rosario Pascarella⁵, Franco Servadei^{1

2}

Affiliations

¹ Department of Neurosurgery-Neurotraumatology, A.O.U. Parma, Parma, Italy.
² Parma Department of Neurosurgery-Neurotraumatology, Arcispedale Santa Maria Nuova, Italy.
³ Department of Neurophysiology, IRCCS "Arcispedale Santa Maria Nuova," Reggio Emilia, Italy.
⁴ Department of Neurosurgery, "S. Anna" University Hospital, Ferrara, Italy.
⁵ Department of Neuroradiology, IRCCS "Arcispedale Santa Maria Nuova," Reggio Emilia, Italy.

Abstract

Objective and background: Data on intraoperative neurophysiological monitoring (IOM) during surgery of spinal dural arteriovenous fistulas (SDAVFs) are lacking. The purpose of this study was to evaluate the role of IOM during microsurgery for SDAVFs.

Materials and methods: From March 2007 to March 2013, 12 patients had microsurgery with IOM for SDAVFs. The IOM included somatosensory-evoked potentials, motor-evoked potentials (MEPs), and - in selected cases - D-Waves. All patients were evaluated at admission and at follow-up (6, 12, and 24 months) with Aminoff-Logue Disability Scale for Gait-Aminoff-Logue Disability Scale (G-ALS) and Micturition-Aminoff-Logue Disability Scale (M-ALS).

Statistical analysis used: Logistic regression was used for detecting the clinical risk factors influencing neurological functions after the treatment.

Results: During surgery, we registered the absence of significant modifications of evoked potentials in nine cases (75%), while improvement of MEPs occurred in three cases (25%). No false-negative case was registered, and IOM predicted the absence of new postoperative neurological deficit in all patients. At 24-month follow-up, nine patients improved their overall neurological status, while three patients remained stable. At univariate analysis, Aminoff-Logue Disability Scales for Gait and Micturition (G + M-ALS) score at 24-month follow-up was directly associated with the duration of symptom before the surgery (P = 0.024), preoperative G-ALS (P = 0.02), M-ALS (P = 0.022), and G + M-ALS scores (P = 0.045), and improvement of IOM after occlusion of the fistula (P = 0.025).

Conclusions: In our series, no significant worsening of evoked potentials occurred and subsequently the surgical strategy was not changed by IOM. However, no false-negative case was registered, and IOM predicted the absence of new postoperative neurological deficit in all patients. Patients with improvement of IOM parameters after occlusion of the fistula had greater chances of postsurgical improvement at the univariate analysis.

Keywords: D-Waves; intraoperative neurophysiological monitoring; motor-evoked potential; somatosensory-evoked potentials; spinal dural arteriovenous fistulas; surgery.