Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Intraoperative Monitoring of Motor-Evoked Potentials for Supratentorial Tumor Surgery

  • Lee, Jung Jae (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kim, Young Il (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Hong, Jae Taek (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Sung, Jae Hoon (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Lee, Sang Won (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Yang, Seung Ho (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea)
  • Received : 2014.04.16
  • Accepted : 2014.08.16
  • Published : 2014.08.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The purpose of this study was to assess the feasibility and clinical efficacy of motor evoked potential (MEP) monitoring for supratentorial tumor surgery. Methods : Between 2010 and 2012, to prevent postoperative motor deterioration, MEP recording after transcranial stimulation was performed in 84 patients with supratentorial brain tumors (45 males, 39 females; age range, 24-80 years; median age, 58 years). MEP monitoring results were correlated with postoperative motor outcome compared to preoperative motor status. Results : MEP recordings were stable in amplitude (<50% reduction in amplitude) during surgery in 77 patients (91.7%). No postoperative motor deficit was found in 66 out of 77 patients with stable MEP amplitudes. However, postoperative paresis developed in 11 patients. False negative findings were associated with edema in peri-resectional regions and postoperative bleeding in the tumor bed. MEP decrease in amplitude (>50%) occurred in seven patients (8.3%). However, no deficit occurred postoperatively in four patients following preventive management during the operation. Three patients had permanent paresis, which could have been associated with vascular injury during tumor resection. Conclusions : MEP monitoring during supratentorial tumor surgery is feasible and safe. However, false negative MEP results associated with postoperative events may occur in some patients. To achieve successful monitoring, collaboration between surgeon, anesthesiologist and an experienced technician is mandatory.

Keywords

References

  1. Cabraja M, Stockhammer F, Mularski S, Suess O, Kombos T, Vajkoczy P : Neurophysiological intraoperative monitoring in neurosurgery : aid or handicap? An international survey. Neurosurg Focus 27 : E2, 2009
  2. Fukuda M, Oishi M, Takao T, Hiraishi T, Kobayashi T, Aoki H, et al. : [Intraoperative monitoring of motor evoked potentials during glioma removal]. No Shinkei Geka 41 : 219-227, 2013
  3. Gempt J, Krieg SM, Huttinger S, Buchmann N, Ryang YM, Shiban E, et al. : Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials. J Neurosurg 119 : 829-836, 2013 https://doi.org/10.3171/2013.5.JNS121981
  4. Hashiguchi K, Morioka T, Yoshida F, Yoshimoto K, Shono T, Natori Y, et al. : Feasibility of intraoperative motor-evoked potential monitoring for skull base tumors with a high risk of postoperative motor deterioration. Acta Neurochir (Wien) 153 : 1191-1200; discussion 1200, 2011 https://doi.org/10.1007/s00701-011-1006-5
  5. Horiuchi K, Suzuki K, Sasaki T, Matsumoto M, Sakuma J, Konno Y, et al. : Intraoperative monitoring of blood flow insufficiency during surgery of middle cerebral artery aneurysms. J Neurosurg 103 : 275-283, 2005 https://doi.org/10.3171/jns.2005.103.2.0275
  6. Iwasaki M, Kuroda S, Niiya Y, Ishikawa T, Iwasaki Y : Sensitivity of motor evoked potential (MEP) to intraoperative cerebral ischemia : case report. Jpn J Neurosurg (Tokyo) 17 : 622-626, 2008 https://doi.org/10.7887/jcns.17.622
  7. Kang D, Yao P, Wu Z, Yu L : Ischemia changes and tolerance ratio of evoked potential monitoring in intracranial aneurysm surgery. Clin Neurol Neurosurg 115 : 552-556, 2013 https://doi.org/10.1016/j.clineuro.2012.06.029
  8. Kombos T, Kopetsch O, Suess O, Brock M : Does preoperative paresis influence intraoperative monitoring of the motor cortex? J Clin Neurophysiol 20 : 129-134, 2003 https://doi.org/10.1097/00004691-200304000-00007
  9. Kombos T, Suess O, Ciklatekerlio O, Brock M : Monitoring of intraoperative motor evoked potentials to increase the safety of surgery in and around the motor cortex. J Neurosurg 95 : 608-614, 2001 https://doi.org/10.3171/jns.2001.95.4.0608
  10. Kong DS, Park K : Hemifacial spasm : a neurosurgical perspective. J Korean Neurosurg Soc 42 : 355-362, 2007 https://doi.org/10.3340/jkns.2007.42.5.355
  11. 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) 28 : 1043-1050, 2003
  12. MacDonald DB : Safety of intraoperative transcranial electrical stimulation motor evoked potential monitoring. J Clin Neurophysiol 19 : 416-429, 2002 https://doi.org/10.1097/00004691-200210000-00005
  13. Neuloh G, Pechstein U, Cedzich C, Schramm J : Motor evoked potential monitoring with supratentorial surgery. Neurosurgery 54 : 1061-1070; discussion 1070-1072, 2004 https://doi.org/10.1227/01.NEU.0000119326.15032.00
  14. Neuloh G, Pechstein U, Schramm J : Motor tract monitoring during insular glioma surgery. J Neurosurg 106 : 582-592, 2007 https://doi.org/10.3171/jns.2007.106.4.582
  15. Quinones-Hinojosa A, Lyon R, Zada G, Lamborn KR, Gupta N, Parsa AT, et al. : Changes in transcranial motor evoked potentials during intramedullary spinal cord tumor resection correlate with postoperative motor function. Neurosurgery 56 : 982-993; discussion 982-993, 2005
  16. Smith I, White PF, Nathanson M, Gouldson R : Propofol. An update on its clinical use. Anesthesiology 81 : 1005-1043, 1994 https://doi.org/10.1097/00000542-199410000-00028
  17. Son BC, Lee SW, Kim S, Hong JT, Sung JH, Yang SH : Transzygomatic approach with intraoperative neuromonitoring for resection of middle cranial fossa tumors. J Neurol Surg B Skull Base 73 : 28-35, 2012 https://doi.org/10.1055/s-0032-1304561
  18. Tanaka S, Tashiro T, Gomi A, Takanashi J, Ujiie H : Sensitivity and specificity in transcranial motor-evoked potential monitoring during neurosurgical operations. Surg Neurol Int 2 : 111, 2011 https://doi.org/10.4103/2152-7806.83731
  19. Wiedemayer H, Fauser B, Sandalcioglu IE, Schafer H, Stolke D : The impact of neurophysiological intraoperative monitoring on surgical decisions : a critical analysis of 423 cases. J Neurosurg 96 : 255-262, 2002 https://doi.org/10.3171/jns.2002.96.2.0255

Cited by

  1. Surgical Resection of Non-Glial Tumors in the Motor Cortex vol.4, pp.2, 2014, https://doi.org/10.14791/btrt.2016.4.2.70
  2. A novel threshold criterion in transcranial motor evoked potentials during surgery for gliomas close to the motor pathway vol.125, pp.4, 2014, https://doi.org/10.3171/2015.8.jns151439
  3. The impact of several craniotomies on transcranial motor evoked potential monitoring during neurosurgery vol.127, pp.3, 2014, https://doi.org/10.3171/2016.7.jns152759
  4. The impact of several craniotomies on transcranial motor evoked potential monitoring during neurosurgery vol.127, pp.3, 2014, https://doi.org/10.3171/2016.7.jns152759
  5. Effects of transcranial stimulating electrode montages over the head for lower-extremity transcranial motor evoked potential monitoring vol.126, pp.6, 2014, https://doi.org/10.3171/2016.7.jns16643
  6. Effects of transcranial stimulating electrode montages over the head for lower-extremity transcranial motor evoked potential monitoring vol.126, pp.6, 2014, https://doi.org/10.3171/2016.7.jns16643
  7. An Alternative Transcranial Motor Evoked Potential Montage to Minimize Ipsilateral “Crossover” Motor Responses vol.58, pp.4, 2018, https://doi.org/10.1080/21646821.2018.1532198
  8. 운동피질영역 주변의 뇌종양 환자에서 수술 중 직접피질자극 검사의 유용성 vol.50, pp.2, 2018, https://doi.org/10.15324/kjcls.2018.50.2.211
  9. Direct Cortical Motor Evoked Potentials Versus Transcranial Motor Evoked Potentials for the Detection of Cortical Ischemia During Supratentorial Craniotomy: Case Report vol.10, pp.12, 2014, https://doi.org/10.7759/cureus.3771
  10. A comparison between threshold criterion and amplitude criterion in transcranial motor evoked potentials during surgery for supratentorial lesions vol.131, pp.3, 2019, https://doi.org/10.3171/2018.4.jns172468
  11. Loss of Motor Evoked Potentials Due to Carotid Artery Retraction in an Exoscopic Clipping of a Basilar Tip Aneurysm vol.60, pp.4, 2014, https://doi.org/10.1080/21646821.2020.1810520
  12. Usefulness of Intraoperative Neurophysiological Monitoring During the Clipping of Unruptured Intracranial Aneurysm: Diagnostic Efficacy and Detailed Protocol vol.8, pp.None, 2021, https://doi.org/10.3389/fsurg.2021.631053
  13. Intraoperative Lumbar Muscle Motor Evoked Potential Monitoring With Transcortical Stimulation vol.146, pp.None, 2014, https://doi.org/10.1016/j.wneu.2020.11.115
  14. Motor Evoked Potential Warning Criteria in Supratentorial Surgery: A Scoping Review vol.13, pp.11, 2021, https://doi.org/10.3390/cancers13112803