Tetanic Stimulation of the Pudendal Nerve Amplifies Intraoperative Motor Evoked Potential in Pediatric Craniotomy

Sasaki, Ryota; Tamura, Kentaro; Kim, Tae Kyun; Takatani, Tsunenori; Nakagawa, Ichiro; Park, Young-Soo; Nakase, Hiroyuki

doi:10.1016/j.wneu.2023.03.071

Cited by 2 publications

References 9 publications

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Intraoperative motor-evoked potential with tetanic stimulation changes pre- and post-hemispherotomy

Sasaki,

Tamura,

Takatani

et al. 2023

Childs Nerv Syst

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Careful examination of motor evoked potential (MEP) ndings is critical to the safety of intraoperative neuromonitoring during neurosurgery. We reviewed the intraoperative MEP ndings in a pediatric patient who had undergone hemispherotomy for refractory epilepsy. The patient was a four-year-and-two-month-old boy with extensive right cerebral hemisphere, drug-resistant epilepsy, left upper and lower extremity paralysis, and cognitive impairment. We examined intraoperative MEP results both before and after hemispherotomy. Posthemispherotomy, MEPs were successfully elicited through transcranial electrical stimulation (TES) but not via direct cortical stimulation on the right side. Furthermore, TES on the right side, following hemispherotomy, led to a reduction in the MEP ampli cation effect resulting from tetanic stimulation of the left unilateral median and tibial nerves. Conversely, we observed the effects of MEP ampli cation during TES on the left side after tetanic stimulation of these nerves. Postoperatively, the patient underwent magnetic resonance imaging and electroencephalogram examinations, con rming the anatomical and electrophysiological completeness of the dissection. Notably, the seizures disappeared, and no apparent complications were observed. Collectively, our ndings suggest that TES can still activate deep structures and elicit MEPs, even in cases where the corticospinal connections to the posterior limb of the internal capsule are entirely severed. Thalamocortical interactions may affect the MEP ampli cation, observed during tetanic stimulation. Injury to the corticospinal tracts of the white matter may be obscured on conventional MEP ndings; however, it may be identi ed by MEP changes in tetanic stimulation.

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Intraoperative motor-evoked potential with tetanic stimulation changes pre- and post-hemispherotomy

Sasaki,

Tamura,

Takatani

et al. 2023

Childs Nerv Syst

Self Cite

View full text Add to dashboard Cite

show abstract

Intraoperative motor-evoked potential with tetanic stimulation changes pre- and post-hemispherotomy

Sasaki,

Tamura,

Takatani

et al. 2023

Preprint

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View full text Add to dashboard Cite

Careful examination of motor evoked potential (MEP) findings is critical to the safety of intraoperative neuromonitoring during neurosurgery. We reviewed the intraoperative MEP findings in a pediatric patient who had undergone hemispherotomy for refractory epilepsy. The patient was a four-year-and-two-month-old boy with extensive right cerebral hemisphere, drug-resistant epilepsy, left upper and lower extremity paralysis, and cognitive impairment. We examined intraoperative MEP results both before and after hemispherotomy. Post-hemispherotomy, MEPs were successfully elicited through transcranial electrical stimulation (TES) but not via direct cortical stimulation on the right side. Furthermore, TES on the right side, following hemispherotomy, led to a reduction in the MEP amplification effect resulting from tetanic stimulation of the left unilateral median and tibial nerves. Conversely, we observed the effects of MEP amplification during TES on the left side after tetanic stimulation of these nerves. Postoperatively, the patient underwent magnetic resonance imaging and electroencephalogram examinations, confirming the anatomical and electrophysiological completeness of the dissection. Notably, the seizures disappeared, and no apparent complications were observed. Collectively, our findings suggest that TES can still activate deep structures and elicit MEPs, even in cases where the corticospinal connections to the posterior limb of the internal capsule are entirely severed. Thalamocortical interactions may affect the MEP amplification, observed during tetanic stimulation. Injury to the corticospinal tracts of the white matter may be obscured on conventional MEP findings; however, it may be identified by MEP changes in tetanic stimulation.

show abstract

Tetanic Stimulation of the Pudendal Nerve Amplifies Intraoperative Motor Evoked Potential in Pediatric Craniotomy

Cited by 2 publications

References 9 publications

Intraoperative motor-evoked potential with tetanic stimulation changes pre- and post-hemispherotomy

Intraoperative motor-evoked potential with tetanic stimulation changes pre- and post-hemispherotomy

Intraoperative motor-evoked potential with tetanic stimulation changes pre- and post-hemispherotomy

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