Reliability of intraoperative neurophysiological monitoring using motor evoked potentials during resection of metastases in motor-eloquent brain regions

Krieg, Sandro M.; Schäffner, Michael; Shiban, Ehab; Droese, Doris; Obermüller, Theresa; Gempt, Jens; Meyer, Bernhard; Ringel, Florian

doi:10.3171/2013.2.jns121752

Cited by 58 publications

(56 citation statements)

References 33 publications

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“…Additionally, 21% exhibited postoperative neurological improvement depending on tumor location [64].…”

Section: Cerebral Surgerymentioning

confidence: 99%

“…• False negative are hard to evaluate since surgeons alter their conduct in concordance to MEP waveform alteration [64].…”

Section: Limitations Ionm Recordingsmentioning

confidence: 99%

“…On this regard, one should include all evoked potentials in multimodality IONM during selected surgeries, such as transphenoidal surgery, aneurysm clipping of posterior circulation and removal of tumors that lie near the optical radiation [64].…”

Section: Cerebral Surgerymentioning

confidence: 99%

See 2 more Smart Citations

Intraoperative Evoked Potentials: A Review of Clinical Impact and Limitations

Marafona¹,

Machado²

2017

J Anesth Clin Res

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Background: Nowadays, intraoperative evoked potentials are recommended in a variety of procedures but there is still a lack of standard protocols and consensus about warning criteria. Moreover, studies are now being made to fundament its risk-beneficial ratio through recordings' predictive value for short and long term outcomes. Furthermore, wake up test limitations encouraged intraoperative evoked potentials research, a reliable monitoring technology.

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“…Additionally, 21% exhibited postoperative neurological improvement depending on tumor location [64].…”

Section: Cerebral Surgerymentioning

confidence: 99%

“…• False negative are hard to evaluate since surgeons alter their conduct in concordance to MEP waveform alteration [64].…”

Section: Limitations Ionm Recordingsmentioning

confidence: 99%

See 1 more Smart Citation

Intraoperative Evoked Potentials: A Review of Clinical Impact and Limitations

Marafona¹,

Machado²

2017

J Anesth Clin Res

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“…DCS has been used in most of the studies that have addressed monitoring of MEP during resection of supratentorial lesions in the last 2 decades, and warning criteria such as amplitude reduction (more than 50%) or MEP loss have been well described. 6,7,9,10,21 However, little is known about the value of MEP after TES in predicting postoperative motor deficit when monitoring threshold level. This method was first presented by Calancie and colleagues for IOM during spinal surgery.…”

mentioning

confidence: 99%

A novel threshold criterion in transcranial motor evoked potentials during surgery for gliomas close to the motor pathway

Abboud

Schaper

Dührsen

et al. 2016

JNS

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S urgical removal of gliomas is a part of multidisciplinary treatment. Maximal resection should be achieved when feasible, with no or minimal neurological deficit to allow patients to have a reasonable quality of life after the procedure. 15,22 Unlike cerebral metastases, supratentorial gliomas, especially low-grade ones, are not well defined, and complete tumor resection can be challenging. In addition to modalities such as diffusion tensor imaging-based functional neuronavigation, 28 fluorescence-guided surgery, 25 to evoke a stable motor response from each of the muscles being monitored) from the baseline set before dural opening. An increase in threshold level on the contralateral side (facial, arm, or leg muscles contralateral to the affected hemisphere) of more than 20% beyond the percentage increase on the ipsilateral side (facial, arm, or leg muscles ipsilateral to the affected hemisphere) was considered a significant alteration. Recorded alterations were subsequently correlated with postoperative neurological deterioration and MRI findings. results TES-MEP could be elicited in all patients, including those with recurrent glioma (31 patients) and preoperative paresis (20 patients). Five of 73 patients without preoperative paresis showed a significant increase in threshold level, and all of them developed new paresis postoperatively (transient in 4 patients and permanent in 1 patient). Eight of 20 patients with preoperative paresis showed a significant increase in threshold level, and all of them developed postoperative neurological deterioration (transient in 4 patients and permanent in 4 patients). In 80 patients no significant change in threshold level was detected, and none of them showed postoperative neurological deterioration. The specificity and sensitivity in this series were estimated at 100%. Postoperative MRI revealed gross-total tumor resection in 56 of 82 patients (68%) in whom complete tumor resection was attainable; territorial ischemia was detected in 4 patients. coNclusioNs The novel threshold criterion has made TES-MEP a useful method for predicting postoperative motor deficit in patients who undergo glioma surgery, and has been feasible in patients with preoperative paresis as well as in patients with recurrent glioma. Including contra- and ipsilateral changes in threshold level has led to a high sensitivity and specificity.

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“…Mapping and monitoring together can identify and control surgical corridors for resection and define the limits of tumor resection during surgery for tumors of the rolandic region or those adjacent to the pyramidal tract. 8,12,22,23,29,30,41,43,45,46,48 For subcortical motor evoked potential (MEP) mapping, monopolar stimulation has further improved the precision in neurosurgery and has helped to define so-called "safety margins" by which functional boundaries are defined. Electrical stimulation of white matter at the resection cavity is helpful in assessing the proximity to the CST and determining whether the resection should be stopped to avoid injury to the CST.…”

mentioning

confidence: 99%

Intraoperative subcortical motor evoked potential stimulation: how close is the corticospinal tract?

Shiban¹,

Krieg²,

Haller

et al. 2015

JNS

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T he aim of surgery for primary and secondary intrinsic brain tumors is complete tumor resection to improve prognosis and control symptoms, and thereby improve the patient's quality of life. 24,39,45,47 However, the goal of maximum resection should be met without any new surgery-related neurological deficits arising, 13 and all efforts should be made to reduce patients' risk for neurological damage. Therefore, lesions in or near motor-eloquent regions, such as the precentral gyrus or the corticospinal tract (CST), represent particularly difficult situations in neurosurgery, and precautions need to be taken to prevent postoperative damage while maximizing resection.Intraoperative electrophysiological mapping and monitoring of the motor cortex and subcortical pyramidal tract obJect Subcortical stimulation is a method used to evaluate the distance from the stimulation site to the corticospinal tract (CST) and to decide whether the resection of an adjacent lesion should be terminated to prevent damage to the CST. However, the correlation between stimulation intensity and distance to the CST has not yet been clearly assessed. The objective of this study was to investigate the appropriate correlation between the subcortical stimulation pattern and the distance to the CST. methods Monopolar subcortical motor evoked potential (MEP) mapping was performed in addition to continuous MEP monitoring in 37 consecutive patients with lesions located in motor-eloquent locations. The proximity of the resection cavity to the CST was identified by subcortical MEP mapping. At the end of resection, the point at which an MEP response was still measurable with minimal subcortical MEP intensity was marked with a titanium clip. At this location, different stimulation paradigms were executed with cathodal or anodal stimulation at 0.3-, 0.5-, and 0.7-msec pulse durations. Postoperatively, the distance between the CST as defined by postoperative diffusion tensor imaging fiber tracking and the titanium clip was measured. The correlation between this distance and the subcortical MEP electrical charge was calculated. results Subcortical MEP mapping was successful in all patients. There were no new permanent motor deficits. Transient new postoperative motor deficits were observed in 14% (5/36) of cases. Gross-total resection was achieved in 75% (27/36) and subtotal resection (> 80% of tumor mass) in 25% (9/36) of cases. Stimulation intensity with various pulse durations as well as current intensity was plotted against the measured distance between the CST and the titanium clip on postoperative MRI using diffusion-weighted imaging fiberitracking tractography. Correlational and regression analyses showed a nonlinear correlation between stimulation intensity and the distance to the CST. Cathodal stimulation appeared better suited for subcortical stimulation. coNclusioNs Subcortical MEP mapping is an excellent intraoperative method to determine the distance to the CST during resection of motor-eloquent lesions and is highly capable of further reduc...

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Reliability of intraoperative neurophysiological monitoring using motor evoked potentials during resection of metastases in motor-eloquent brain regions

Cited by 58 publications

References 33 publications

Intraoperative Evoked Potentials: A Review of Clinical Impact and Limitations

Intraoperative Evoked Potentials: A Review of Clinical Impact and Limitations

A novel threshold criterion in transcranial motor evoked potentials during surgery for gliomas close to the motor pathway

Intraoperative subcortical motor evoked potential stimulation: how close is the corticospinal tract?

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