Utility and the Limit of Motor Evoked Potential Monitoring for Preventing Complications in Surgery for Cerebral Arteriovenous Malformation

Ichikawa, Tsuyoshi; Suzuki, Koichi; Sasaki, Tatsuya; Matsumoto, Masato; Sakuma, Jun; Oinuma, Masahiro; Kasuya, Hiromichi; Kodama, Namio

doi:10.1227/01.neu.0000374696.84827.22

Cited by 13 publications

(8 citation statements)

References 21 publications

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“…Various methods of defining alert criteria have been discussed in previous studies, with the majority of authors suggesting that a decrease in amplitude of greater than 50% be considered the clinical warning sign. 13,22,25,26,37,57,63,64,69 Thus, we applied this criterion, and when any such reduction occurred, the neurophysiology team immediately shared the EP results with the surgeon. MEP stimulation was routinely performed after clipping.…”

Section: Ep Monitoringmentioning

confidence: 99%

Intraoperative use of transcranial motor/sensory evoked potential monitoring in the clipping of intracranial aneurysms: evaluation of false-positive and false-negative cases

Chung¹,

Park²,

Hong³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Somatosensory and motor evoked potentials (SEPs and MEPs) are often used to prevent ischemic complications during aneurysm surgeries. However, surgeons often encounter cases with suspicious false-positive and false-negative results from intraoperative evoked potential (EP) monitoring, but the incidence and possible causes for these results are not well established. The aim of this study was to investigate the efficacy and reliability of EP monitoring in the microsurgical treatment of intracranial aneurysms by evaluating false-positive and false-negative cases. METHODS From January 2012 to April 2016, 1514 patients underwent surgery for unruptured intracranial aneurysms (UIAs) with EP monitoring at the authors' institution. An EP amplitude decrease of 50% or greater compared with the baseline amplitude was defined as a significant EP change. Correlations between immediate postoperative motor weakness and EP monitoring results were retrospectively reviewed. The authors calculated the sensitivity, specificity, and positive and negative predictive values of intraoperative MEP monitoring, as well as the incidence of false-positive and false-negative results. RESULTS Eighteen (1.19%) of the 1514 patients had a symptomatic infarction, and 4 (0.26%) had a symptomatic hemorrhage. A total of 15 patients showed motor weakness, with the weakness detected on the immediate postoperative motor function test in 10 of these cases. Fifteen false-positive cases (0.99%) and 8 false-negative cases (0.53%) were reported. Therefore, MEP during UIA surgery resulted in a sensitivity of 0.10, specificity of 0.94, positive predictive value of 0.01, and negative predictive value of 0.99. CONCLUSIONS Intraoperative EP monitoring has high specificity and negative predictive value. Both false-positive and false-negative findings were present. However, it is likely that a more meticulously designed protocol will make EP monitoring a better surrogate indicator of possible ischemic neurological deficits.

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Section: Ep Monitoringmentioning

confidence: 99%

Intraoperative use of transcranial motor/sensory evoked potential monitoring in the clipping of intracranial aneurysms: evaluation of false-positive and false-negative cases

Chung¹,

Park²,

Hong³

et al. 2019

Journal of Neurosurgery

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“…For instance, MEP change within 1 min of BFI in perforators (i.e. anterior choroidal artery, lenticulostriate arteries), also changing with excessive pressure and tratography may fail to localize corticospinal tract lesions because of brain shift due to CSF drainage [13,26].…”

Section: Cerebral Arteriovenous Malformationmentioning

confidence: 99%

“…In this context, MEP assessment reduced surgical time not being limited by general anesthesia or surgery related cerebral edema and real time information makes it suitable for arterial venous malformation procedures with postoperative motor deficit risk [13,26].…”

Section: Cerebral Arteriovenous Malformationmentioning

confidence: 99%

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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“…The train-of-4 ratio, [(acceleration by the fourth stimulation/acceleration by the first stimulation) × 100] was maintained between 1% and 15%. 9,10 Motor Evoked Potential Recording Motor evoked potential monitoring was started after the train-of-4 ratio became stable. Stimulation-elicited compound muscle action potentials were recorded repetitively during surgical procedures.…”

Section: Anesthesiamentioning

confidence: 99%

Motor evoked potential monitoring of the vagus nerve with transcranial electrical stimulation during skull base surgeries

Ito

Ichikawa

Itakura

et al. 2013

JNS

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Vagal MEP monitoring with transcranial electrical stimulation and endotracheal tube electrode recording was a safe and effective method to provide continuous real-time information on the integrity of both the supranuclear and infranuclear vagal pathway. This method is useful to prevent intraoperative injury of the brainstem corticobulbar tract or the vagal rootlets and to avoid the postoperative dysphagia that is often associated with brainstem or skull base surgeries.

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Utility and the Limit of Motor Evoked Potential Monitoring for Preventing Complications in Surgery for Cerebral Arteriovenous Malformation

Abstract: In arteriovenous malformation surgery, MEP monitoring facilitates the detection of blood flow insufficiency and/or direct injury of the corticospinal tract and mapping of the motor area. It contributes to reducing the incidence of postoperative motor paresis.

Cited by 13 publications

References 21 publications

Intraoperative use of transcranial motor/sensory evoked potential monitoring in the clipping of intracranial aneurysms: evaluation of false-positive and false-negative cases

Intraoperative use of transcranial motor/sensory evoked potential monitoring in the clipping of intracranial aneurysms: evaluation of false-positive and false-negative cases

Intraoperative Evoked Potentials: A Review of Clinical Impact and Limitations

Motor evoked potential monitoring of the vagus nerve with transcranial electrical stimulation during skull base surgeries

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