Intraoperative monitoring of motor-evoked potential for parenchymal brain tumor removal: An analysis of false-negative cases

Umemura, Takeru; Nishizawa, Shigeru; Nakano, Yoshiteru; Saito, Takeshi; Kitagawa, Takehiro; Miyaoka, Ryo; Suzuki, Kohei; Yamamoto, Junkoh

doi:10.1016/j.jocn.2018.08.019

Cited by 14 publications

(13 citation statements)

References 16 publications

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“…[33][34][35] On the other hand, false-negative cases, in which new postoperative motor deficits were noted without warning signs of IOM abnormalities, can be explained in part by a "bypass" mechanism in which Tc-MEPs reach the motor pathways beyond the point of operation. 33,45 Transient postoperative motor deficits can also be explained by the late development of local edema around the pyramidal tracts or by resections involving the supplementary motor area, which are known to improve with time and do not manifest with IOM abnormalities. 2,13,33,45 Language mapping is a common modality for guiding resection near eloquent areas in awake operations.…”

Section: Intraoperative Indicators Of Strokementioning

confidence: 99%

“…33,45 Transient postoperative motor deficits can also be explained by the late development of local edema around the pyramidal tracts or by resections involving the supplementary motor area, which are known to improve with time and do not manifest with IOM abnormalities. 2,13,33,45 Language mapping is a common modality for guiding resection near eloquent areas in awake operations. 26 Among the tested parameters, intraoperative confusion was associated with the occurrence of infarcts on postoperative MRI and thus may be considered as a possible indicator of the development of stroke in awake procedures (Table 6).…”

Section: Intraoperative Indicators Of Strokementioning

confidence: 99%

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Incidence and impact of stroke following surgery for low-grade gliomas

Berger¹,

Tzarfati²,

Costa³

et al. 2021

Journal of Neurosurgery

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OBJECTIVEIschemic complications are a common cause of neurological deficits following low-grade glioma (LGG) surgeries. In this study, the authors evaluated the incidence, risk factors, and long-term implications of intraoperative ischemic events.METHODSThe authors retrospectively evaluated patients who had undergone resection of an LGG between 2013 and 2017. Analysis included pre- and postoperative demographic, clinical, radiological, and anesthetic data, as well as intraoperative neurophysiology data, overall survival, and functional and neurocognitive outcomes.RESULTSAmong the 82 patients included in the study, postoperative diffusion-weighted imaging showed evidence of acute ischemic strokes in 19 patients (23%), 13 of whom (68%) developed new neurological deficits. Infarcts were more common in recurrent and insular surgeries (p < 0.05). Survival was similar between the patients with and without infarcts. Immediately after surgery, 27% of the patients without infarcts and 58% of those with infarcts experienced motor deficits (p = 0.024), decreasing to 16% (p = 0.082) and 37% (p = 0.024), respectively, at 1 year. Neurocognitive functions before and 3 months after surgery were generally stable for the two groups, with the exception of a decline in verbal rhyming ability among patients with infarcts. Confusion during awake craniotomy was a strong predictor of the occurrence of an ischemic stroke. Mean arterial pressure at the beginning of surgery was significantly lower in the infarct group.CONCLUSIONSRecurrent surgeries and insular tumor locations are risk factors for intraoperative strokes. Although they do not affect survival, these strokes negatively affect patient activity and performance status, mainly during the first 3 postoperative months, with gradual functional improvement over 1 year. Several intraoperative parameters may suggest the impending development of an infarct.

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Section: Intraoperative Indicators Of Strokementioning

confidence: 99%

Section: Intraoperative Indicators Of Strokementioning

confidence: 99%

Incidence and impact of stroke following surgery for low-grade gliomas

Berger¹,

Tzarfati²,

Costa³

et al. 2021

Journal of Neurosurgery

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“…This situation is acceptable if the monitored structures are below the foramen magnum such as the spine [ 1 ]. If the monitored structures are within the pyramidal tract in the white matter, it is advisable to use minimum MEP stimulus intensity so that any changes within these structures during, for example, brain tumour excision surgeries could be identified [ 36 ]. Response duration would also be increasing when stimulation intensity is increased [ 35 ].…”

Section: The Significance Of Mep Improvementmentioning

confidence: 99%

Transcranial Electrical Motor Evoked Potential in Predicting Positive Functional Outcome of Patients after Decompressive Spine Surgery: Review on Challenges and Recommendations towards Objective Interpretation

Jamaludin

Lai

Chuah

et al. 2021

Behavioural Neurology

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Spine surgeries impose risk to the spine’s surrounding anatomical and physiological structures especially the spinal cord and the nerve roots. Intraoperative neuromonitoring (IONM) is a technology developed to monitor the integrity of the spinal cord and the nerve roots via the surgery. Transcranial motor evoked potential (TcMEP) (one of the IONM modalities) is adopted to monitor the integrity of the motor pathway of the spinal cord and the motor nerve roots. Recent research suggested that the IONM is conducive as a prognostic tool towards the patient’s functional outcome. This paper summarizes the researches of IONM being adopted as a prognostic tool. In addition, this paper highlights the problems associated with the signal parameters as the improvement criteria in the previous researches. Lastly, we review the challenges of TcMEP to achieve a prognostic tool focusing on the factors that could interfere with the generation of a stable TcMEP response. The final section will discuss recommendations for IONM technology to achieve an objective prognostic tool.

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“…Of the included articles, 29 used the neuronavigated TMS technique (nTMS), one article reported using a navigated-repeated TMS (nrTMS), 16 four other studies used a transcranial electric stimulation (TES), 17–20 one article reported using standard TMS (TMS), 21 three other articles did not report the technique description with enough details. 22–24 All articles reporting details of the stimulation coil (32/38) used a figure of eight stimulation coil instruments. The resting motor thresholds (RMT) were the most utilized TMS parameter presented in all, but one, of the articles that reported any parameters (25/38).…”

Section: Resultsmentioning

confidence: 99%

Assessing the Capabilities of Transcranial Magnetic Stimulation (TMS) to Aid in the Removal of Brain Tumors Affecting the Motor Cortex: A Systematic Review

Schiavao¹,

Neville²,

Hayashi³

et al. 2022

NDT

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Introduction The brain tumor is frequently related to severe motor impairment and impacts the quality of life. The corticospinal tract can sometimes be affected depending on the type and size of the neoplasm, so different tools can evaluate motor function and connections. It is essential to organize surgical procedures and plan the approach. Functional motor status is mapped before, during, and after surgery. Studying corticospinal tract status can help map the functional areas, predict postoperative outcomes, and help the decision, reducing neurological deficits, aiming to preserve functional networks, using the concepts of white matters localization and fibbers connections. Nowadays, there are new techniques that provide functional information regarding the motor cortex, such as transcranial magnetic stimulation (TMS), direct cortical stimulation (DCS), and navigated TMS (nTMS). These tools can be used to plan a customized surgical strategy and the role of motor evoked potentials (MEPs) is well described during intra-operative, using intraoperative neuromonitoring. MEPs can help to localize primary motor areas and delineate the cut-off point of resection in real-time, using direct stimulation. In the post-operative, the MEP has increased your function as a predictive marker of permanent or transitory neurological lesion marker. Methods Systematic review performed in MEDLINE via PUBMED, EMBASE, and SCOPUS databases regarding the post-operative assessment of MEP in patients with brain tumors. The search strategy included the following terms: ((“Evoked Potentials, Motor”[Mesh]) AND “Neoplasms”[Mesh]) AND “Transcranial Magnetic Stimulation”[Mesh] AND “Brain Tumor”[Mesh]), the analysis followed the PRISMA guidelines for systematic reviews, the review spanned until 06/04/2021, inclusion criteria were studies presenting confirmed diagnosis of brain tumor (primary or metastatic), patients >18 y/o, using TMS, Navigated TMS, and/or Evoked Potentials as tools in preoperative planning or at the intra-operative helping the evaluation of the neurological status of the motor cortex, articles published in peer-reviewed journals, and written in English or Portuguese. Results A total of 38 studies were selected for this review, of which 14 investigated the potential of nTMS to predict the occurrence of motor deficits, while 25 of the articles investigated the capabilities of the nTMS technique in performing pre/intraoperative neuro mapping of the motor cortex. Conclusion Further studies regarding motor function assessment are needed and standardized protocols for MEPs also need to be defined.

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Intraoperative monitoring of motor-evoked potential for parenchymal brain tumor removal: An analysis of false-negative cases

Cited by 14 publications

References 16 publications

Incidence and impact of stroke following surgery for low-grade gliomas

Incidence and impact of stroke following surgery for low-grade gliomas

Transcranial Electrical Motor Evoked Potential in Predicting Positive Functional Outcome of Patients after Decompressive Spine Surgery: Review on Challenges and Recommendations towards Objective Interpretation

Assessing the Capabilities of Transcranial Magnetic Stimulation (TMS) to Aid in the Removal of Brain Tumors Affecting the Motor Cortex: A Systematic Review

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