Home Medicine Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation
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Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation

  • Xiaoyu Li , Hongqi Zhang EMAIL logo and Jian Ren
Published/Copyright: October 18, 2024
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Open Medicine
From the journal Open Medicine Volume 19 Issue 1

Abstract

Aim

The study aimed to evaluate the sensitivity and specificity of these monitoring parameters in predicting postoperative neurological dysfunction.

Methods

In this study, a total of 85 patients with spinal cavernous malformations (SCMs) treated at Xuanwu Hospital, Capital Medical University, from November 2012 to August 2017 were included. During the surgical procedures, all patients underwent monitoring of motor evoked potentials (MEP) and somatosensory evoked potentials (SEP). The criteria for warning included a reduction of ≥80% in MEP amplitude and ≥50% in SEP amplitude.

Results

Among 85 patients, 40 (47.1%) had SCMs located in the thoracic segment, 35 (41.2%) in the cervical segment, 6 (7.1%) in the cervical thoracic segment, and 4 (4.7%) in the lumbar segment. MEP recordings were obtained from 81 patients, and the preoperative McCormick score was 1.53 ± 0.69. The sensitivity of multimodal monitoring combined with the criteria of 80% reduction in MEP amplitude and SEP was 83.9%, with a specificity of 69%, a positive predictive value of 69%, and a negative predictive value of 90.4%.

Conclusion

This study emphasizes the crucial role of electrophysiological monitoring, particularly MEP and SEP, during the surgical resection of SCMs. The findings demonstrate that this approach is effective in predicting and preventing postoperative neurological dysfunction, thereby improving patient outcomes.

Keywords: motor evoked potentials; electrophysiological monitoring; spinal cavernous malformations; somatosensory evoked potentials; intraoperative neuromonitoring

1 Introduction

Spinal cavernous malformations (SCMs) are rare vascular lesions found within the spinal cord, primarily in the thoracic region. These SCMs represent approximately 5–12% of all spinal vascular disorders, as reported by various studies [1–3]. Due to the location of these lesions, patients may experience sensory and motor dysfunction in their lower extremities. Without timely surgical intervention, the onset of bleeding symptoms could lead to a further decline in the patient’s spinal cord function, potentially resulting in paralysis. Therefore, surgical resection is regarded as the optimal approach to prevent the incidence of bleeding. However, as the removal of intramedullary lesions may impact the sensory and motor conduction pathways, intraoperative neuromonitoring (IONM) becomes essential during the surgical procedure [4–6].

The first monitoring method used in spinal cord surgery was the somatosensory evoked potential (SEP), as reported by Engler et al. in 1978. However, SEP can only reflect the function of the spinal cord’s dorsal side, leading to potential false negatives. For instance, SEP may appear normal while patients experience motor dysfunction [7–9]. As motor function is crucial for patients’ postoperative function, the motor evoked potential (MEP) has been applied in spinal cord surgery since the 1990s [10]. In recent years, the combined application of SEP and MEP has become a routine method in spinal cord surgery. However, there is no consensus on the definition criteria for MEP, leading to reported false positives and negatives [11]. As surgical monitoring examinations deepen, studies have found that monitoring criteria may vary for different types of lesions [12].

The present study aimed to assess the results of IONM and postoperative functional changes in 85 patients with SCM. The sensitivity and specificity of different monitoring criteria were also analyzed for the combination of SEP and MEP, suggesting optimal criteria.

2 Methods

2.1 Patients’ data

This study included 85 patients with SCM who were admitted to our hospital from November 2012 to August 2017, including 43 men and 42 women, with an average age of 38.8 ± 13.2 (range, 13–73) years old. The lesion segmentation was determined according to the imaging results. All patients underwent neurological assessment before surgery, 3 h after surgery, at discharge, and 3–6 months after discharge. All surgeries were performed by an experienced surgeon.

  1. Ethical approval: The study was approved by the Ethics Committee of the Xuanwu Hospital (approval no. [2019] 044) and was conducted in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was waived by our Institutional Review Board because of the retrospective nature of our study.

2.2 IONM

The IONM was performed using the Nicolet System (Natus Neuro, Middleton, WI, USA). Neuromonitoring was conducted by the same surgical team throughout the procedure. Technicians were responsible for electrode placement, while a neurologist with over 10 years of monitoring experience confirmed baseline readings and interpreted intraoperative changes. The IONM data were then reviewed by two independent observers after surgery.

2.3 MEP

According to the lesion segmentation, the corresponding muscle was selected to record MEP. The abductor pollicis brevis was selected for the upper limb, and the abductor brevis, anterior tibialis, or quadriceps femoris were selected for the lower limb. A pair of needle electrodes were placed to record MEP. The stimulation point was located according to the 10–20 electroencephalogram (EEG) system, which is based on the relationship between the location of an electrode and the underlying area of the brain, specifically the cerebral cortex. C1 and C2 were selected to, respectively, place spiral electrodes to stimulate each other. Five trains were used for each stimulation, and the wave width was 300 μs. The intensity of stimulation was 150–400 V. Each stimulation was conducted after notifying the surgeon. Gauze or dental pads were placed between the teeth and the tongue in the patient’s mouth to prevent tongue biting injury as a result of masseter contraction during stimulation.

2.4 SEP

Two needle electrodes were placed in the median nerve of the upper limb for stimulation, and the stimulation parameter consisted of a wave width of 300 μs. Continuous stimulation was used, with stimulation frequency of 4.7 Hz and stimulation intensity of 10–20 mA. Two needle electrodes were placed in the posterior tibial nerve of the lower limbs for stimulation. The recording position still follows the 10–20 EEG system. The recording points of the lower limbs were 1–2 cm after the Cz and Fz for reference, and the recording points of the upper limbs were 1–2 cm after the C3 and C4, and Fz for reference.

2.5 Electromyography (EMG) recording

Free-running EMG was recorded using the same channels used for MEP for segmental and root recordings.

2.6 Anesthesia

Anesthesia induction was achieved by administering intravenous midazolam (1–2 mg), etomidate (0.15 mg/kg), sufentanil (0.3 μg/kg), rocuronium (0.6 mg/kg), or atracurium (0.15 mg/kg). After induction, muscle relaxants were no longer used. Remifentanil (0.2–0.4 μg/kg/min) and propofol (4-6 mg/kg/h) were injected for anesthesia maintenance.

The bispectral index was intraoperatively used to continuously monitor the depth of anesthesia, and the depth of anesthesia was kept stable during the removal of lesions.

2.7 Relationship between IONM and postoperative neurological function

True-positive: The IONM assessment was in line with the newly observed postoperative neurological deficit.

True-negative: No warning was found by the IONM, and there was no loss of neurological function after the surgery.

False-negative: No warning was found by the IONM; however, there was a new postoperative neurological deficit.

False-positive: Warning was detected by the IONM, while there was no new postoperative neurological deficit.

In the present study, the reduction of McCormick grade by 1 or more was indicative of a new neurological deficit.

2.8 Statistical analysis

Patients’ data were analyzed to determine the relationship between the monitoring capability of SEP and MEP and postoperative results, in which age, gender, and spinal cord injury level were considered. The Chi-square test was used to evaluate the null hypothesis, and there was no correlation between categorical variables and monitoring results. If the sample size was less than or equal to five, the Fisher’s exact test was utilized. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of different monitoring standards for prediction of postoperative neurological function were calculated. The statistical analysis was performed using SPSS 16.0 software (IBM, Armonk, NY, USA). A two-sided P < 0.05 was considered statistically significant.

3 Results

3.1 Location of SCM and the monitorability of MEP

Table 1 shows patients’ baseline demographic characteristics. Among 85 patients, there were 40 (47.1%), 35 (41.2%), 6 (7.1%), and 4 (4.7%) patients with SCM located in the thoracic segment, cervical segment, cervical thoracic segment, and lumbar segment, respectively. In 81 patients, MEP could be recorded, and the preoperative McCormick score was 1.53 ± 0.69. In four patients whose MEP could not be recorded, preoperative McCormick score was 4 in one patient, and it was 5 in the other three patients. The mean preoperative McCormick scores were 1.49 ± 0.64 and 2.30 ± 1.49 for SEP-measurable and non-measurable patients, respectively.

Table 1

Patients’ baseline characteristics

Age (years), average 38.8 ± 13.2
Gender, n (%)
Male 43 (50.6%)
Female 42 (49.4%)
Total 85
Lesions site, n (%)
Cervical 35 (41.2%)
Cervicothoracic 6 (7.1%)
Thoracic 40 (47.1%)
Lumbar 4 (4.7%)
Total
Modified McCormick grade at admission, n (%)
I 46 (54.1%)
II 28 (32.9%)
III 6 (7.1%)
IV 2 (2.4%)
V 3 (3.5%)
Total 85

3.2 Relationship between IONM findings and postoperative neurological function

3.2.1 MEP

Table 2 presents patients’ postoperative neurological function for occurrence of all single evoked potential warning changes. The two criteria of 80% amplitude reduction and amplitude disappearance were analyzed. Temporary changes and irreversible changes were analyzed, respectively. When 80% amplitude reduction was used as the MEP criterion, 27 (33.3%) patients exhibited MEP changes intraoperatively, of whom 7 (8.2%) and 20 (23.5%) patients were found with temporary changes and irreversible changes, respectively. These seven patients with temporary changes did not have postoperative dysfunction, while among 20 patients with irreversible MEP changes, 13 patients had postoperative dysfunction, of whom 4 patients had dysfunction immediately after surgery, 7 had dysfunction at discharge, and 2 had dysfunction at follow-up.

Table 2

Changes in IONM and postoperative outcomes

Clinical status Monitoring status
No change Temporary changes Permanent changes Total
SEP tcMEP (disappeared) tcMEP (>80% reduction) SEP tcMEP (disappeared) tcMEP (>80% reduction) SEP tcMEP (disappeared) tcMEP (>80% reduction) SEP tcMEP Any
52 n = 69 n = 54 n = 2 4 7 11 8 20 65 81 85
Stable 44 50 42 2 4 7 2 2 7 48 56 60
Deficit immediately after surgery 8 19 12 0 0 0 9 6 13 17 25 25
Deficit at hospital discharge 3 11 7 0 0 0 7 3 7 8 14 14
Deficit at long-term follow-up 0 6 4 0 0 0 6 0 2 4 6 6

When using the amplitude disappearance as the warning criterion of MEP, a total of 12 (14.8%) patients had intraoperative changes, of whom four patients had temporary changes and eight patients had irreversible changes. These four patients with temporary changes had no postoperative dysfunction, whereas six of eight patients with irreversible changes had postoperative dysfunction, of whom three patients had dysfunction at discharge. At follow-up, the dysfunction of these patients was recovered.

3.2.2 SEP

The warning criterion of SEP is when the amplitude is reduced by 50% or when the latency is prolonged by 10%. The results of intraoperative SEP changes and postoperative clinical function are summarized in Table 2. No patient with intraoperative SEP latency changes was found in this study; thus, patients with SEP changes were those with the reduced amplitude. Among 65 patients whose SEP could be recorded, there were two patients with temporary changes and 11 patients with irreversible changes. Of 11 patients, 6 patients had postoperative functional changes, 2 had dysfunction at discharge, and 3 had dysfunction at follow-up.

3.2.3 Multimodality IONM correlation analysis

The relationship between any changes in MEP and clinical outcomes is presented in Table 3 (>50% reduction of MEP) and Table 4 (disappearance of MEP).

Table 3

Relationship between any changes in evoked potential and clinical outcomes (>50% reduction in SEP or >80% reduction in tcMEP)

Clinical status Monitoring status (>80% reduction tcMEP)
No change Temporary changes Permanent changes Total
43 9 29 81
Stable 38 9 9 56
Deficit immediately after surgery 5 0 20 25
Deficit at hospital discharge 2 0 12 14
Deficit at long-term follow-up 0 0 6 6
Table 4

Relationship between any changes in evoked potential and clinical outcomes (>50% reduction in SEP or disappearance of tcMEP)

Clinical status Monitoring status (disappearance of MEP)
No change Temporary changes Permanent changes Total
57 5 19 81
Stable 47 5 4 56
Deficit immediately after surgery 10 0 15 25
Deficit at hospital discharge 3 0 10 13
Deficit at long-term follow-up 0 0 6 6

Table 3 shows the relationship between 80% amplitude reduction as the warning criterion of MEP and postoperative function, combined with multimodal SEP monitoring. Besides, six patients had temporary changes intraoperatively, and no patient had postoperative dysfunction. Moreover, 29 patients had irreversible changes of MEP, of whom 20 patients had postoperative dysfunction. Among 20 patients with postoperative dysfunction, 12 had dysfunction at discharge and 6 had dysfunction at follow-up.

Table 4 shows the relationship between the disappearance of wave amplitude as the warning criterion of MEP combined with multimodal SEP monitoring and postoperative function. It was revealed that five patients had temporary changes in intraoperative MEP, and no patient had postoperative dysfunction. Furthermore, 19 patients had irreversible changes in MEP, of whom 15 had postoperative dysfunction. Among 15 patients, 10 had dysfunction at discharge and 6 had functional impairment after discharge.

3.2.4 Sensitivity and specificity analyses

The results of sensitivity and specificity analyses are presented in Table 5. According to the proposed criteria, patients’ prognosis was determined as true-positive, true-negative, false-positive, or false-negative.

Table 5

Sensitivity and specificity of both permanent IONM changes

>80% reduction in tcMEP Disappearance of tcMEP
True negative (n) 47 52
True positive (n) 20 15
False negative (n) 5 10
False positive (n) 9 4
Sensitivity (%) 80 60.0
Specificity (%) 83.9 92.9
Positive predicting result (%) 69.0 78.9
Negative predicting result (%) 90.4 83.9

According to the results summarized in Tables 2–4, patients with temporary changes in SEP or MEP did not have postoperative dysfunction. Therefore, temporary changes were not involved in the sensitivity and specificity analyses. Regarding the sensitivity of multimodal monitoring combined with 80% MEP amplitude reduction and SEP, the specificity was 83.9%, the PPV was 69%, and the NPV was 90.4%. Taking the disappearance of MEP amplitude as the warning criterion combined with the results of the SEP, the sensitivity, specificity, PPV, and NPV were 60.0, 92.9, 78.9, and 83.9%, respectively.

3.2.5 Case presentation

3.2.5.1 Case 1

A 22-year-old woman was admitted to our hospital with history of pain for 52 days, accompanied by dysuria and decreased lower limb muscle strength (3/5 of the left lower limb and 4/5 of the right lower limb). Magnetic resonance imaging (MRI) revealed that lesions extended from T10 to T11 vertebral bodies, and she was diagnosed with SCM (Figure 1). The patient’s McCormick score was 3. In addition, SEP and MEP of both lower limbs were monitored intraoperatively (Figure 2). During the surgery, MEP of abductor hallucis and quadriceps femoris decreased by more than 80%, and MEP of abductor pollicis brevis muscle disappeared (the baseline MEP of the right quadriceps femoris was not involved). After elimination of the technical failure, the surgery was suspended. After 30 min, the left MEP returned to more than 50% of the baseline, and the surgeon decided to continue the surgery. The surgeon attempted to minimize interference with the spinal cord as much as possible during the ongoing resection. However, at the end of the lesion resection, the MEP of the left abductor pollicis brevis and quadriceps femoris was reduced by more than 80% again. The patient’s SEP was stable throughout the surgery. We locally applied papaverine and increased the mean arterial pressure to over 90 mmHg to resist local ischemia. After the surgery, the right leg muscle strength was grade 2, the left leg muscle strength was grade 3, and McCormick score was 2. She was recovered to the preoperative level at 3 months after the surgery. The patient was defined as true-positive for the monitoring results.

Figure 1 Preoperative MRI (a) and (b), and intraoperative findings (c) showed an SCM at T10–T12 level. Postoperative MRI (d) and (e).
Figure 1

Preoperative MRI (a) and (b), and intraoperative findings (c) showed an SCM at T10–T12 level. Postoperative MRI (d) and (e).

Figure 2 A 22-year-old woman with a history of pain for 52 days, accompanied by dysuria and decreased lower limb muscle strength (3/5 of the left lower limb and 4/5 of the right lower limb). The patient’s McCormick score was grade 3. SEP (b) and MEP (a) of both lower limbs were monitored intraoperatively. Additional surgical findings and conditions are presented in Section 3.2.5.
Figure 2

A 22-year-old woman with a history of pain for 52 days, accompanied by dysuria and decreased lower limb muscle strength (3/5 of the left lower limb and 4/5 of the right lower limb). The patient’s McCormick score was grade 3. SEP (b) and MEP (a) of both lower limbs were monitored intraoperatively. Additional surgical findings and conditions are presented in Section 3.2.5.

3.2.5.2 Case 2

A 54-year-old woman was admitted for surgical treatment due to a cervical lesion discovered during a physical examination (Figure 3). Prior to surgery, the patient had numbness in both upper limbs, normal sensation in both lower limbs, and normal muscle strength in all limbs. During the surgery, the SEP and MEP in both upper and lower limbs were monitored. When the lesion was removed during surgery, the patient’s MEP in both upper and lower limbs decreased by more than 80%. The surgeon was reminded to pause the surgery and administer glucocorticoid and warm saline to rinse the surgical area. After the evoked potentials recovered by more than 50%, surgery continued, and the patient had no new postoperative functional impairment (Figure 4).

Figure 3 Preoperative MRI (a) and (b), and intraoperative findings (c) showed an SCM at C1–C2 level. Postoperative MRI (d) and (e).
Figure 3

Preoperative MRI (a) and (b), and intraoperative findings (c) showed an SCM at C1–C2 level. Postoperative MRI (d) and (e).

Figure 4 A 54-year-old woman was admitted for surgical treatment due to a cervical lesion discovered during a physical examination. Prior to surgery, the patient had numbness in both upper limbs, normal sensation in both lower limbs, and normal muscle strength in all limbs. During the surgery, the SEP (b) and (c) and MEP (a) in both upper and lower limbs were monitored. Additional surgical findings and conditions are presented in Section 3.2.5.
Figure 4

A 54-year-old woman was admitted for surgical treatment due to a cervical lesion discovered during a physical examination. Prior to surgery, the patient had numbness in both upper limbs, normal sensation in both lower limbs, and normal muscle strength in all limbs. During the surgery, the SEP (b) and (c) and MEP (a) in both upper and lower limbs were monitored. Additional surgical findings and conditions are presented in Section 3.2.5.

3.2.5.3 Case 3

A 26-year-old female patient presented with bilateral lower limb numbness and lower back pain for over 3 months. MRI revealed a spinal cord cavernous malformation at the L1 level (Figure 5). The patient presented with numbness in both lower limbs and a muscle strength grade of 5- in both lower limbs on preoperative examination. Intraoperatively, SEP of the tibial nerve in both lower limbs and MEP of the proximal and distal muscles of both lower limbs, as well as the anal sphincter, were monitored. During tumor resection, there was no significant decrease in sensory or MEPs (Figure 6). Postoperatively, the patient did not experience worsening sensory deficits or a decline in muscle strength.

Figure 5 Preoperative MRI (a) and (b), and intraoperative findings (c) showed an SCM at L1 level. Postoperative MRI (d) and (e).
Figure 5

Preoperative MRI (a) and (b), and intraoperative findings (c) showed an SCM at L1 level. Postoperative MRI (d) and (e).

Figure 6 A 26-year-old female patient presented with bilateral lower limb numbness and lower back pain for over 3 months. An MRI revealed a spinal cord cavernous malformation at the L1 level. Intraoperatively, SEP (b) of the tibial nerve in both lower limbs and MEP (a) of the proximal and distal muscles of both lower limbs, as well as the anal sphincter, were monitored. No significant decrease in sensory evoked potential or MEP was observed during tumor resection. Following the surgery, the patient did not experience worsening sensory deficits or a decline in muscle strength.
Figure 6

A 26-year-old female patient presented with bilateral lower limb numbness and lower back pain for over 3 months. An MRI revealed a spinal cord cavernous malformation at the L1 level. Intraoperatively, SEP (b) of the tibial nerve in both lower limbs and MEP (a) of the proximal and distal muscles of both lower limbs, as well as the anal sphincter, were monitored. No significant decrease in sensory evoked potential or MEP was observed during tumor resection. Following the surgery, the patient did not experience worsening sensory deficits or a decline in muscle strength.

  1. Informed consent: Informed consent was obtained from the patients.

4 Discussion

SCM is a relatively rare disease. Because of its special location and close relationship with the blood supply of the spinal cord, it is easy to cause damage to the spinal cord during resection, resulting in postoperative dysfunction. Therefore, IONM of MEP is essential [13]. To our knowledge, this is the largest study that performed electrophysiological monitoring on patients with SCM. The present study analyzed the results of IONM and patients’ neurological function after surgery of SCM, and it compared the changes of postoperative function with intraoperative 80% amplitude reduction and disappearance of MEP, which were utilized as the warning criteria. When 80% amplitude reduction was used as the warning criterion, combined with SEP, the sensitivity was 80%, the specificity was 83.9%, the PPV was 69%, and the NPV was 90.4%. Taking the disappearance of MEP amplitude as the warning criterion, combined with the multimodal monitoring results of SEP, the sensitivity was 60.0%, the specificity was 92.9%, the PPV was 78.9%, and the NPV was 83.9%.

The routine use of both MEP and SEP in multimodal monitoring during spinal cord surgery has been promoted. However, the warning criterion of MEP has been frequently applied in various studies [14,15]. The most conventional monitoring criteria include 50% amplitude reduction, 80% amplitude reduction, amplitude disappearance, and reversible and irreversible changes. With the deepening of monitoring experience, the monitoring criteria need to be extensively discussed. Monitoring results may vary for lesions located in different segments, or even for lesions with distinct properties within the same segment. Consequently, the criteria for monitoring alerts may also differ [16]. Our research group has previously compared the monitoring results of spinal arteriovenous malformation and SCM [17], and found that there were significant differences between them. Therefore, it is essential to summarize the monitoring results of a specific surgery. In the present study, for surgery of SCM, it was found from the monitoring results of the MEP that temporary changes in MEP could not cause postoperative dysfunction. However, a 50% amplitude reduction was used as the criterion, which exhibited no difference from the 80% amplitude reduction. The disappearance of this warning criterion was associated with high specificity, while it produced more false negative results, and false negative results are the most important problem in monitoring. Therefore, in clinical practice, the disappearance of MEP is a more suitable standard for suspending surgery, whereas reductions of 50 and 80%, and SEP reductions over 50%, are more appropriate as standards for alerting the surgeons. Following these standards, it is advisable to proceed with surgery as gently as possible and provide warm saline and steroids in the surgical area. In the case of surgery for spinal cord cavernous vascular malformation, different degrees of IONM warnings have significance for the surgeon, but the treatments should correspond accordingly.

In the present study, all patients with temporary changes did not have postoperative disorders, including two patients with SEP amplitude reduction and seven patients with MEP amplitude reduction of more than 80% (the amplitude disappeared in four patients). This indicates that if warning criteria appear intraoperatively, and corresponding treatment measures are taken such that the induced potential amplitude can be restored, patients may generally not experience postoperative dysfunction. Therefore, these results also underscore the importance of timely intervention when warning signs in MEP are observed.

The MEP may serve as a nonlinear and unstable indicator. After reaching the appropriate threshold of stimulation, the amplitude of the MEP does not increase due to the enhancement of stimulation, and even if the recorded muscle strength is normal, the amplitude of the MEP may not be completely consistent. Therefore, during intraoperative monitoring, it is crucial to not only use staged warning criteria, but also to understand that the trend of variations is more significant than a single variation. This is because frequent warnings due to individual variations of MEP may impact the normal course of the surgery. In addition to investigating the correlation between MEP warning criteria and postoperative neurological function, it is also necessary to identify which types of surgeries are more likely to result in changes to MEP [18].

Few surgeons may consider an individual reduction of SEP as a criterion to halt surgery. Therefore, in the current spinal cord surgeries, SEP can be primarily used as a reference in conjunction with MEP. Moreover, a remarkable number of patients with spinal cord lesions have preoperative sensory impairment, resulting in an unsatisfactory preoperative rate of SEP. In this study, SEP was feasibly recorded preoperatively in 65 patients, with an elicitation rate of 76.5%, while the elicitation rate of MEP was 95.3%. Among 11 patients with irreversible SEP changes, 9 patients experienced postoperative dysfunction, including 7 patients with only SEP changes who had postoperative sensory dysfunction. However, the long-term recovery effect on patients with sensory impairment was suboptimal, with the majority of patients with long-term dysfunction primarily experienced numbness. Therefore, changes in SEP are of significant importance.

The false negative rate in this study was higher than previously reported rate [19,20], which could be related to strict definition of neurological dysfunction in the present study. Patients whose McCormick score was reduced by 1 were included in the dysfunction category. False negative reports of SEP combined with MEP were very limited and controversial in the recent decade. According to the 80% MEP reduction criterion, combined with the multimodal monitoring of SEP, five patients with false negative results were found. Among five patients, the McCormick scores of four patients were only reduced by 1 point. Postoperative dysfunction was mainly the reduction of muscle strength by 1 point or the emergence of new postoperative sensory dysfunction. Only one patient whose McCormick score was reduced by 2 points had a 50% amplitude reduction of MEP; however, this did not meet the warning criteria used in this study. Among five patients, one lesion was located in the cervical segment, and the other four lesions were located in T10–T12 (close to the conus medullaris), indicating that there may be a blinded spot of neuromonitoring during the lesion resection. Among nine patients with false positive results, lesions in six patients were located in the cervical segment or cervical thoracic segment, demonstrating that the cervical spinal cord was swiftly recovered.

There were some limitations in this study. First, because the incidence rate of SCM was low, the sample size was not large enough. Second, as the electrodes placed in the spinal cord were not licensed in China, no intraoperative D wave was applied in the monitorability and motor outcome in spinal surgery. Finally, no control group was established.

5 Conclusions

In conclusion, the combination of SEP and MEP for intraoperative monitoring during surgical removal of the SCM can effectively prevent postoperative neurological dysfunction. Warning criteria for MEP can be based on staged amplitude reductions, with a threshold typically set at an 80% reduction. When removing intraspinal space-occupying lesions, various monitoring systems and early warning criteria may have distinct characteristics based on the location and type of lesion.

  1. Funding information: This study was financially supported by the National Natural Science Foundation of China (Grant No. 81971113) and China University Industry, University and Research Innovation Fund (Grant No. 2022BC075).

  2. Author contributions: Xiaoyu Li conducted the conceptualization, methodology, and writing of the original draft; Jian Ren carried out formal analysis, utilized resources, and conducted the investigation; Hongqi Zhang provided validation, supervision, and contributed to the writing – review and editing of the manuscript. All authors read and approved the final manuscript.

  3. Conflict of interest: The authors declare that there is no conflict of interest.

  4. Data availability statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

[1] Cosgrove GR, Bertrand G, Fontaine S, Robitaille Y, Melanson D. Cavernous angiomas of the spinal cord. J Neurosurg. 1988;68(1):31–6.10.3171/jns.1988.68.1.0031Search in Google Scholar PubMed

[2] Gross BA, Du R, Popp AJ, Day AL. Intramedullary spinal cord cavernous malformations. Neurosurg Focus. 2010;29(3):E14.10.3171/2010.6.FOCUS10144Search in Google Scholar PubMed

[3] Asimakidou E, Meszaros LT, Anestis DM, Tsitsopoulos PP. A systematic review on the outcome of intramedullary spinal cord cavernous malformations. Eur Spine J. 2022;31(11):3119–29.10.1007/s00586-022-07332-6Search in Google Scholar PubMed

[4] Sutter M, Deletis V, Dvorak J, Eggspuehler A, Grob D, Macdonald D, et al. Current opinions and recommendations on multimodal intraoperative monitoring during spine surgeries. Eur Spine J. 2007;16(Suppl 2):S232–7.10.1007/s00586-007-0421-zSearch in Google Scholar PubMed PubMed Central

[5] Korn A, Halevi D, Lidar Z, Biron T, Ekstein P, Constantini S. Intraoperative neurophysiological monitoring during resection of intradural extramedullary spinal cord tumors: experience with 100 cases. Acta Neurochir (Wien). 2015;157(5):819–30.10.1007/s00701-014-2307-2Search in Google Scholar PubMed

[6] Hilibrand AS, Schwartz DM, Sethuraman V, Vaccaro AR, Albert TJ. Comparison of transcranial electric motor and somatosensory evoked potential monitoring during cervical spine surgery. J Bone Joint Surg Am. 2004;86(6):1248–53.10.2106/00004623-200406000-00018Search in Google Scholar PubMed

[7] Zornow MH, Grafe MR, Tybor C, Swenson MR. Preservation of evoked potentials in a case of anterior spinal artery syndrome. Electroencephalogr Clin Neurophysiol. 1990;77(2):137–9.10.1016/0168-5597(90)90028-CSearch in Google Scholar PubMed

[8] Pelosi L, Jardine A, Webb JK. Neurological complications of anterior spinal surgery for kyphosis with normal somatosensory evoked potentials (SEPs). J Neurol Neurosurg Psychiatry. 1999;66(5):662–4.10.1136/jnnp.66.5.662Search in Google Scholar PubMed PubMed Central

[9] Lesser RP, Raudzens P, Luders H, Nuwer MR, Goldie WD, Morris 3rd HH, et al. Postoperative neurological deficits may occur despite unchanged intraoperative somatosensory evoked potentials. Ann Neurol. 1986;19(1):22–5.10.1002/ana.410190105Search in Google Scholar PubMed

[10] Langeloo DD, Lelivelt A, Louis Journee H, Slappendel R, de Kleuver M. Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity: a study of 145 patients. Spine (Phila Pa 1976). 2003;28(10):1043–50.10.1097/01.BRS.0000061995.75709.78Search in Google Scholar PubMed

[11] Kurokawa R, Kim P, Itoki K, Yamamoto S, Shingo T, Kawamoto T, et al. False-positive and false-negative results of motor evoked potential monitoring during surgery for intramedullary spinal cord tumors. Oper Neurosurg (Hagerstown). 2018;14(3):279–87.10.1093/ons/opx113Search in Google Scholar PubMed PubMed Central

[12] Park T, Park J, Park YG, Lee J. Intraoperative neurophysiological monitoring for spinal cord tumor surgery: comparison of motor and somatosensory evoked potentials according to tumor types. Ann Rehabil Med. 2017;41(4):610–20.10.5535/arm.2017.41.4.610Search in Google Scholar PubMed PubMed Central

[13] Ren J, Hong T, He C, Li X, Ma Y, Yu J, et al. Surgical approaches and long-term outcomes of intramedullary spinal cord cavernous malformations: a single-center consecutive series of 219 patients. J Neurosurg Spine. 2019;31(1):123–32.10.3171/2018.12.SPINE181263Search in Google Scholar PubMed

[14] MacDonald DB. Overview on criteria for MEP monitoring. J Clin Neurophysiol. 2017;34(1):4–11.10.1097/WNP.0000000000000302Search in Google Scholar PubMed

[15] Lakomkin N, Mistry AM, Zuckerman SL, Ladner T, Kothari P, Lee NJ, et al. Utility of intraoperative monitoring in the resection of spinal cord tumors: an analysis by tumor location and anatomical region. Spine (Phila Pa 1976). 2018;43(4):287–94.10.1097/BRS.0000000000002300Search in Google Scholar PubMed

[16] Kim DG, Son, YR, Park, YS, Hyun, SJ, Kim, KJ, Jahng, TA, et al. Differences in multimodality intraoperative neurophysiological monitoring changes between spinal intramedullary ependymoma and hemangioblastoma. J Clin Neurophysiol. 2016;33(2):120–6.10.1097/WNP.0000000000000247Search in Google Scholar PubMed

[17] Li X, Zhang HQ, Ling F, He C, Hu P, Hu T, et al. Intraoperative neurophysiological monitoring during the surgery of spinal arteriovenous malformation: sensitivity, specificity, and warning criteria. Clin Neurol Neurosurg. 2018;165:29–37.10.1016/j.clineuro.2017.12.016Search in Google Scholar PubMed

[18] Yoshida G, Ando M, Imagama S, Kawabata S, Yamada K, Kanchiku T, et al. Alert timing and corresponding intervention with intraoperative spinal cord monitoring for high-risk spinal surgery. Spine (Phila Pa 1976). 2019;44(8):E470–9.10.1097/BRS.0000000000002900Search in Google Scholar PubMed

[19] Ghadirpour R, Nasi D, Iaccarino C, Giraldi D, Sabadini R, Motti L, et al. Intraoperative neurophysiological monitoring for intradural extramedullary tumors: why not? Clin Neurol Neurosurg. 2015;130:140–9.10.1016/j.clineuro.2015.01.007Search in Google Scholar PubMed

[20] van der Wal EC, Klimek M, Rijs K, Scheltens-de Boer M, Biesheuvel K, Harhangi BS. Intraoperative neuromonitoring in patients with intradural extramedullary spinal cord tumor: a single-center case series. World Neurosurg. 2021;147:e516–23.10.1016/j.wneu.2020.12.099Search in Google Scholar PubMed

Received: 2024-01-19
Revised: 2024-06-24
Accepted: 2024-07-03
Published Online: 2024-10-18

© 2024 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  3. STK11 (LKB1) mutation suppresses ferroptosis in lung adenocarcinoma by facilitating monounsaturated fatty acid synthesis
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https://doi.org/10.1515/med-2024-1008
Keywords for this article
motor evoked potentials; electrophysiological monitoring; spinal cavernous malformations; somatosensory evoked potentials; intraoperative neuromonitoring
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. EDNRB inhibits the growth and migration of prostate cancer cells by activating the cGMP-PKG pathway
  3. STK11 (LKB1) mutation suppresses ferroptosis in lung adenocarcinoma by facilitating monounsaturated fatty acid synthesis
  4. Association of SOX6 gene polymorphisms with Kashin-Beck disease risk in the Chinese Han population
  5. The pyroptosis-related signature predicts prognosis and influences the tumor immune microenvironment in dedifferentiated liposarcoma
  6. METTL3 attenuates ferroptosis sensitivity in lung cancer via modulating TFRC
  7. Identification and validation of molecular subtypes and prognostic signature for stage I and stage II gastric cancer based on neutrophil extracellular traps
  8. Novel lumbar plexus block versus femoral nerve block for analgesia and motor recovery after total knee arthroplasty
  9. Correlation between ABCB1 and OLIG2 polymorphisms and the severity and prognosis of patients with cerebral infarction
  10. Study on the radiotherapy effect and serum neutral granulocyte lymphocyte ratio and inflammatory factor expression of nasopharyngeal carcinoma
  11. Transcriptome analysis of effects of Tecrl deficiency on cardiometabolic and calcium regulation in cardiac tissue
  12. Aflatoxin B1 induces infertility, fetal deformities, and potential therapies
  13. Serum levels of HMW adiponectin and its receptors are associated with cytokine levels and clinical characteristics in chronic obstructive pulmonary disease
  14. METTL3-mediated methylation of CYP2C19 mRNA may aggravate clopidogrel resistance in ischemic stroke patients
  15. Understand how machine learning impact lung cancer research from 2010 to 2021: A bibliometric analysis
  16. Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay
  17. Metformin plus L-carnitine enhances brown/beige adipose tissue activity via Nrf2/HO-1 signaling to reduce lipid accumulation and inflammation in murine obesity
  18. Downregulation of carbonic anhydrase IX expression in mouse xenograft nasopharyngeal carcinoma model via doxorubicin nanobubble combined with ultrasound
  19. Feasibility of 3-dimensional printed models in simulated training and teaching of transcatheter aortic valve replacement
  20. miR-335-3p improves type II diabetes mellitus by IGF-1 regulating macrophage polarization
  21. The analyses of human MCPH1 DNA repair machinery and genetic variations
  22. Activation of Piezo1 increases the sensitivity of breast cancer to hyperthermia therapy
  23. Comprehensive analysis based on the disulfidptosis-related genes identifies hub genes and immune infiltration for pancreatic adenocarcinoma
  24. Changes of serum CA125 and PGE2 before and after high-intensity focused ultrasound combined with GnRH-a in treatment of patients with adenomyosis
  25. The clinical value of the hepatic venous pressure gradient in patients undergoing hepatic resection for hepatocellular carcinoma with or without liver cirrhosis
  26. Development and validation of a novel model to predict pulmonary embolism in cardiology suspected patients: A 10-year retrospective analysis
  27. Downregulation of lncRNA XLOC_032768 in diabetic patients predicts the occurrence of diabetic nephropathy
  28. Circ_0051428 targeting miR-885-3p/MMP2 axis enhances the malignancy of cervical cancer
  29. Effectiveness of ginkgo diterpene lactone meglumine on cognitive function in patients with acute ischemic stroke
  30. The construction of a novel prognostic prediction model for glioma based on GWAS-identified prognostic-related risk loci
  31. Evaluating the impact of childhood BMI on the risk of coronavirus disease 2019: A Mendelian randomization study
  32. Lactate dehydrogenase to albumin ratio is associated with in-hospital mortality in patients with acute heart failure: Data from the MIMIC-III database
  33. CD36-mediated podocyte lipotoxicity promotes foot process effacement
  34. Efficacy of etonogestrel subcutaneous implants versus the levonorgestrel-releasing intrauterine system in the conservative treatment of adenomyosis
  35. FLRT2 mediates chondrogenesis of nasal septal cartilage and mandibular condyle cartilage
  36. Challenges in treating primary immune thrombocytopenia patients undergoing COVID-19 vaccination: A retrospective study
  37. Let-7 family regulates HaCaT cell proliferation and apoptosis via the ΔNp63/PI3K/AKT pathway
  38. Phospholipid transfer protein ameliorates sepsis-induced cardiac dysfunction through NLRP3 inflammasome inhibition
  39. Postoperative cognitive dysfunction in elderly patients with colorectal cancer: A randomized controlled study comparing goal-directed and conventional fluid therapy
  40. Long-pulsed ultrasound-mediated microbubble thrombolysis in a rat model of microvascular obstruction
  41. High SEC61A1 expression predicts poor outcome of acute myeloid leukemia
  42. Comparison of polymerase chain reaction and next-generation sequencing with conventional urine culture for the diagnosis of urinary tract infections: A meta-analysis
  43. Secreted frizzled-related protein 5 protects against renal fibrosis by inhibiting Wnt/β-catenin pathway
  44. Pan-cancer and single-cell analysis of actin cytoskeleton genes related to disulfidptosis
  45. Overexpression of miR-532-5p restrains oxidative stress response of chondrocytes in nontraumatic osteonecrosis of the femoral head by inhibiting ABL1
  46. Autologous liver transplantation for unresectable hepatobiliary malignancies in enhanced recovery after surgery model
  47. Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section
  48. Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study
  49. No genetic causality between obesity and benign paroxysmal vertigo: A two-sample Mendelian randomization study
  50. Identification and validation of autophagy-related genes in SSc
  51. Long non-coding RNA SRA1 suppresses radiotherapy resistance in esophageal squamous cell carcinoma by modulating glycolytic reprogramming
  52. Evaluation of quality of life in patients with schizophrenia: An inpatient social welfare institution-based cross-sectional study
  53. The possible role of oxidative stress marker glutathione in the assessment of cognitive impairment in multiple sclerosis
  54. Compilation of a self-management assessment scale for postoperative patients with aortic dissection
  55. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation
  56. Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study
  57. Clinical characteristics and assessment of risk factors in patients with influenza A-induced severe pneumonia after the prevalence of SARS-CoV-2
  58. Analgesia nociception index is an indicator of laparoscopic trocar insertion-induced transient nociceptive stimuli
  59. High STAT4 expression correlates with poor prognosis in acute myeloid leukemia and facilitates disease progression by upregulating VEGFA expression
  60. Factors influencing cardiovascular system-related post-COVID-19 sequelae: A single-center cohort study
  61. HOXD10 regulates intestinal permeability and inhibits inflammation of dextran sulfate sodium-induced ulcerative colitis through the inactivation of the Rho/ROCK/MMPs axis
  62. Mesenchymal stem cell-derived exosomal miR-26a induces ferroptosis, suppresses hepatic stellate cell activation, and ameliorates liver fibrosis by modulating SLC7A11
  63. Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke
  64. ANO6 (TMEM16F) inhibits gastrointestinal stromal tumor growth and induces ferroptosis
  65. Prognostic value of EIF5A2 in solid tumors: A meta-analysis and bioinformatics analysis
  66. The role of enhanced expression of Cx43 in patients with ulcerative colitis
  67. Choosing a COVID-19 vaccination site might be driven by anxiety and body vigilance
  68. Role of ICAM-1 in triple-negative breast cancer
  69. Cost-effectiveness of ambroxol in the treatment of Gaucher disease type 2
  70. HLA-DRB5 promotes immune thrombocytopenia via activating CD8+ T cells
  71. Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome
  72. Efficacy of tacrolimus monotherapy in primary membranous nephropathy
  73. Mechanisms of Tripterygium wilfordii Hook F on treating rheumatoid arthritis explored by network pharmacology analysis and molecular docking
  74. FBXO45 levels regulated ferroptosis renal tubular epithelial cells in a model of diabetic nephropathy by PLK1
  75. Optimizing anesthesia strategies to NSCLC patients in VATS procedures: Insights from drug requirements and patient recovery patterns
  76. Alpha-lipoic acid upregulates the PPARγ/NRF2/GPX4 signal pathway to inhibit ferroptosis in the pathogenesis of unexplained recurrent pregnancy loss
  77. Correlation between fat-soluble vitamin levels and inflammatory factors in paediatric community-acquired pneumonia: A prospective study
  78. CD1d affects the proliferation, migration, and apoptosis of human papillary thyroid carcinoma TPC-1 cells via regulating MAPK/NF-κB signaling pathway
  79. miR-let-7a inhibits sympathetic nerve remodeling after myocardial infarction by downregulating the expression of nerve growth factor
  80. Immune response analysis of solid organ transplantation recipients inoculated with inactivated COVID-19 vaccine: A retrospective analysis
  81. The H2Valdien derivatives regulate the epithelial–mesenchymal transition of hepatoma carcinoma cells through the Hedgehog signaling pathway
  82. Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets
  83. Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis
  84. Lycopene inhibits pyroptosis of endothelial progenitor cells induced by ox-LDL through the AMPK/mTOR/NLRP3 pathway
  85. Methylation regulation for FUNDC1 stability in childhood leukemia was up-regulated and facilitates metastasis and reduces ferroptosis of leukemia through mitochondrial damage by FBXL2
  86. Correlation of single-fiber electromyography studies and functional status in patients with amyotrophic lateral sclerosis
  87. Risk factors of postoperative airway obstruction complications in children with oral floor mass
  88. Expression levels and clinical significance of serum miR-19a/CCL20 in patients with acute cerebral infarction
  89. Physical activity and mental health trends in Korean adolescents: Analyzing the impact of the COVID-19 pandemic from 2018 to 2022
  90. Evaluating anemia in HIV-infected patients using chest CT
  91. Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court
  92. Causal association of circulating immune cells and lymphoma: A Mendelian randomization study
  93. Assessment of the renal function and fibrosis indexes of conventional western medicine with Chinese medicine for dredging collaterals on treating renal fibrosis: A systematic review and meta-analysis
  94. Comprehensive landscape of integrator complex subunits and their association with prognosis and tumor microenvironment in gastric cancer
  95. New target-HMGCR inhibitors for the treatment of primary sclerosing cholangitis: A drug Mendelian randomization study
  96. Population pharmacokinetics of meropenem in critically ill patients
  97. Comparison of the ability of newly inflammatory markers to predict complicated appendicitis
  98. Comparative morphology of the cruciate ligaments: A radiological study
  99. Immune landscape of hepatocellular carcinoma: The central role of TP53-inducible glycolysis and apoptosis regulator
  100. Serum SIRT3 levels in epilepsy patients and its association with clinical outcomes and severity: A prospective observational study
  101. SHP-1 mediates cigarette smoke extract-induced epithelial–mesenchymal transformation and inflammation in 16HBE cells
  102. Acute hyper-hypoxia accelerates the development of depression in mice via the IL-6/PGC1α/MFN2 signaling pathway
  103. The GJB3 correlates with the prognosis, immune cell infiltration, and therapeutic responses in lung adenocarcinoma
  104. Physical fitness and blood parameters outcomes of breast cancer survivor in a low-intensity circuit resistance exercise program
  105. Exploring anesthetic-induced gene expression changes and immune cell dynamics in atrial tissue post-coronary artery bypass graft surgery
  106. Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism
  107. Analysis of the risk factors of the radiation-induced encephalopathy in nasopharyngeal carcinoma: A retrospective cohort study
  108. Reproductive outcomes in women with BRCA 1/2 germline mutations: A retrospective observational study and literature review
  109. Evaluation of upper airway ultrasonographic measurements in predicting difficult intubation: A cross-section of the Turkish population
  110. Prognostic and diagnostic value of circulating IGFBP2 in pancreatic cancer
  111. Postural stability after operative reconstruction of the AFTL in chronic ankle instability comparing three different surgical techniques
  112. Research trends related to emergence agitation in the post-anaesthesia care unit from 2001 to 2023: A bibliometric analysis
  113. Frequency and clinicopathological correlation of gastrointestinal polyps: A six-year single center experience
  114. ACSL4 mediates inflammatory bowel disease and contributes to LPS-induced intestinal epithelial cell dysfunction by activating ferroptosis and inflammation
  115. Affibody-based molecular probe 99mTc-(HE)3ZHER2:V2 for non-invasive HER2 detection in ovarian and breast cancer xenografts
  116. Effectiveness of nutritional support for clinical outcomes in gastric cancer patients: A meta-analysis of randomized controlled trials
  117. The relationship between IFN-γ, IL-10, IL-6 cytokines, and severity of the condition with serum zinc and Fe in children infected with Mycoplasma pneumoniae
  118. Paraquat disrupts the blood–brain barrier by increasing IL-6 expression and oxidative stress through the activation of PI3K/AKT signaling pathway
  119. Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case–control study
  120. Dioscin protects against chronic prostatitis through the TLR4/NF-κB pathway
  121. Association of polymorphisms in FBN1, MYH11, and TGF-β signaling-related genes with susceptibility of sporadic thoracic aortic aneurysm and dissection in the Zhejiang Han population
  122. Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy
  123. Laboratory variables‐based artificial neural network models for predicting fatty liver disease: A retrospective study
  124. Decreased BIRC5-206 promotes epithelial–mesenchymal transition in nasopharyngeal carcinoma through sponging miR-145-5p
  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
  127. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures
  128. The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial
  129. Long intergenic noncoding RNA for IGF2BP2 stability suppresses gastric cancer cell apoptosis by inhibiting the maturation of microRNA-34a
  130. Role of FOXM1 and AURKB in regulating keratinocyte function in psoriasis
  131. Parental control attitudes over their pre-school children’s diet
  132. The role of auto-HSCT in extranodal natural killer/T cell lymphoma
  133. Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy
  134. Echinacoside inhibits PASMCs calcium overload to prevent hypoxic pulmonary artery remodeling by regulating TRPC1/4/6 and calmodulin
  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
  136. The risk of cancer among insulin glargine users in Lithuania: A retrospective population-based study
  137. The unusual location of primary hydatid cyst: A case series study
  138. Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation
  139. Obesity and risk of placenta accreta spectrum: A meta-analysis
  140. Shikonin alleviates asthma phenotypes in mice via an airway epithelial STAT3-dependent mechanism
  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
  152. Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy
  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
  155. Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction
  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
  169. Differences in mortality risk by levels of physical activity among persons with disabilities in South Korea
  170. Review Articles
  171. Cutaneous signs of selected cardiovascular disorders: A narrative review
  172. XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis
  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
  187. CBD’s potential impact on Parkinson’s disease: An updated overview
  188. Progress in cytokine research for ARDS: A comprehensive review
  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
  191. Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review
  192. Trends and future directions of autophagy in osteosarcoma: A bibliometric analysis
  193. Iron in ventricular remodeling and aneurysms post-myocardial infarction
  194. Case Reports
  195. Sirolimus potentiated angioedema: A case report and review of the literature
  196. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
  197. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman’s disease: A case report
  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
  201. Advancing prenatal diagnosis: Echocardiographic detection of Scimitar syndrome in China – A case series
  202. Outcomes and complications of hemodialysis in patients with renal cancer following bilateral nephrectomy
  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
  217. Elevated mRNA level indicates FSIP1 promotes EMT and gastric cancer progression by regulating fibroblasts in tumor microenvironment
  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
  221. SENP7 inhibits glioblastoma metastasis and invasion by dissociating SUMO2/3 binding to specific target proteins
  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
  223. Analysis of postoperative complications in bladder cancer patients
  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
  226. Comprehensive pan-cancer investigation of carnosine dipeptidase 1 and its prospective prognostic significance in hepatocellular carcinoma
  227. Identification of signatures associated with microsatellite instability and immune characteristics to predict the prognostic risk of colon cancer
  228. Single-cell analysis identified key macrophage subpopulations associated with atherosclerosis
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