Predictive Value of Somatosensory Evoked Potential Monitoring during Resection of Intraparenchymal and Intraventricular Tumors Using an Endoscopic Port

Abstract

Background and PurposeIntraoperative neurophysiological monitoring (IONM) using upper and lower somatosensory evoked potentials (SSEPs) is an established technique used to predict and prevent neurologic injury during intracranial tumor resections. Endoscopic port surgery (EPS) is a minimally-invasive approach to deep intraparenchymal and intraventricular brain tumors. The authors intended to evaluate the predictive value of SSEP monitoring during resection of intracranial brain tumors using a parallel endoscopic technique.MethodsA retrospective review was conducted of patients operated on from 2007-2010 utilizing IONM in whom endoscopic ports were used to remove either intraparenchymal or intraventricular tumors. Cases were eligible for review if an endoscopic port was used to resect an intracranial tumor and the electronic chart included all intraoperative monitoring data as well as pre- and post-operative neurologic exams.Results139 EPS cases met criteria for inclusion. Eighty five patients (61%) had intraparenchymal and fifty four (39%) had intraventricular tumors or colloid cysts. SSEP changes were seen in eleven cases (7.9%), being irreversible in three (2.2%) and reversible in eight cases (5.8%). Seven patients (5.0%) with intraparenchymal tumors had SSEP changes which met our criterea for significant changes while there were four (2.9%) with intraventricular (p-value=0.25). Five patients suffered post operative deficits, two reversible and two irreversible SSEP changes. Only one case exhibited post operative hemiparesis with no SSEP changes. The positive predictive value of SSEP was 45.4% and the negative predictive value was 99.2%.ConclusionsBased on the high negative and low positive predictive values, the utility of SSEP monitoring for cylindrical port resections may be limited. However, the use of SSEP monitoring can be helpful in reducing the impact of endoscopic port manipulation when the tumor is closer to the somatosensory pathway.

Intraoperative neurophysiological monitoring during endoscopic endonasal surgery for pediatric skull base tumors

“…This study was approved by the local institutional review board for retrospective review of the clinical outcomes. The subsequent description of the neurophysiological monitoring techniques has been discussed in detail in earlier publications, [35][36][37][38][39] and a brief overview is given below.…”

“…For SSEPs, a 10% increase in latency or 50% decrease in amplitude relative to baseline was considered clinically significant. 31,[35][36][37] Changes in more than 2 consecutive averaged trials were considered persistent changes. The absence of free-run EMG activity was considered baseline in each case.…”

“…Free-run EMG and triggered EMG have been shown to be effective in the past. 26,27,[35][36][37][38][39] However, a control group was not used during this study, as it is difficult to set up a control group in a pediatric patient population.…”

“…Similarly, the SSEP and BAEP values and free-run EMG of the CNs during EES for skull base tumors in adults have been previously described. [35][36][37][38][39] However, to our knowledge, sufficient data to establish the value of IONM in pediatric EES have not been published.…”

“…36 Neurological complications, including hemiparesis and cranial nerve palsies, can be predicted and prevented by utilizing real-time continuous intraoperative neurophysiological monitoring (IONM). [25][26][27][35][36][37][38][39] IONM using somatosensory evoked potentials (SSEPs), 2 brainstem auditory evoked potentials (BAEPs), and electromyography (both free-run electromyography [EMG] and triggered EMG) 26,27 have been valuable in conventional skull base surgeries. Similarly, the SSEP and BAEP values and free-run EMG of the CNs during EES for skull base tumors in adults have been previously described.…”