Diagnostic Accuracy of Combined Multimodality Somatosensory Evoked Potential and Transcranial Motor Evoked Potential Intraoperative Monitoring in Patients With Idiopathic Scoliosis

OBJECTIVE Corrective surgery for spinal deformities can lead to neurological complications. Several reports have described spinal cord monitoring in surgery for spinal deformity, but only a few have included patients younger than 20 years with adolescent idiopathic scoliosis (AIS). The goal of this study was to evaluate the characteristics of cases with intraoperative transcranial motor evoked potential (Tc-MEP) waveform deterioration during posterior corrective fusion for AIS. METHODS A prospective database was reviewed, comprising 68 patients with AIS who were treated with posterior corrective fusion in a prospective database. A total of 864 muscles in the lower extremities were chosen for monitoring, and acceptable baseline responses were obtained from 819 muscles (95%). Intraoperative Tc-MEP waveform deterioration was defined as a decrease in intraoperative amplitude of ≥ 70% of the control waveform. Age, Cobb angle, flexibility, operative time, estimated blood loss (EBL), intraoperative body temperature, blood pressure, number of levels fused, and correction rate were examined in patients with and without waveform deterioration. RESULTS The patients (3 males and 65 females) had an average age of 14.4 years (range 11–19 years). The mean Cobb angles before and after surgery were 52.9° and 11.9°, respectively, giving a correction rate of 77.4%. Fourteen patients (20%) exhibited an intraoperative waveform change, and these occurred during incision (14%), after screw fixation (7%), during the rotation maneuver (64%), during placement of the second rod after the rotation maneuver (7%), and after intervertebral compression (7%). Most waveform changes recovered after decreased correction or rest. No patient had a motor deficit postoperatively. In multivariate analysis, EBL (OR 1.001, p = 0.085) and number of levels fused (OR 1.535, p = 0.045) were associated with waveform deterioration. CONCLUSIONS Waveform deterioration commonly occurred during rotation maneuvers and more frequently in patients with a larger preoperative Cobb angle. The significant relationships of EBL and number of levels fused with waveform deterioration suggest that these surgical invasions may be involved in waveform deterioration.

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Intraoperative motor and somatosensory evoked potential monitoring during surgical clipping of ruptured and unruptured intracranial aneurysms: a comparative study

Journal of Neurosurgery ◽

10.3171/2021.8.jns21479 ◽

2021 ◽

pp. 1-8

Author(s):

Hao You ◽

Xing Fan ◽

Jiajia Liu ◽

Dongze Guo ◽

Zhibao Li ◽

...

Keyword(s):

Evoked Potential ◽

Motor Evoked Potential ◽

Critical Values ◽

Somatosensory Evoked Potential ◽

Short Term ◽

Surgical Clipping ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Unruptured Intracranial Aneurysms

OBJECTIVE The current study investigated the correlation between intraoperative motor evoked potential (MEP) and somatosensory evoked potential (SSEP) monitoring and both short-term and long-term motor outcomes in aneurysm patients treated with surgical clipping. Moreover, the authors provide a relatively optimal neurophysiological predictor of postoperative motor deficits (PMDs) in patients with ruptured and unruptured aneurysms. METHODS A total of 1017 patients (216 with ruptured aneurysms and 801 with unruptured aneurysms) were included. Patient demographic characteristics, clinical features, intraoperative monitoring data, and follow-up data were retrospectively reviewed. The efficacy of using changes in MEP/SSEP to predict PMDs was assessed using binary logistic regression analysis. Subsequently, receiver operating characteristic curve analysis was performed to determine the optimal critical value for duration of MEP/SSEP deterioration. RESULTS Both intraoperative MEP and SSEP monitoring were significantly effective for predicting short-term (p < 0.001 for both) and long-term (p < 0.001 for both) PMDs in aneurysm patients. The critical values for predicting short-term PMDs were amplitude decrease rates of 57.30% for MEP (p < 0.001 and area under the curve [AUC] 0.732) and 64.10% for SSEP (p < 0.001 and AUC 0.653). In patients with an unruptured aneurysm, the optimal critical values for predicting short-term PMDs were durations of deterioration of 17 minutes for MEP (p < 0.001 and AUC 0.768) and 21 minutes for SSEP (p < 0.001 and AUC 0.843). In patients with a ruptured aneurysm, the optimal critical values for predicting short-term PMDs were durations of deterioration of 12.5 minutes for MEP (p = 0.028 and AUC 0.706) and 11 minutes for SSEP (p = 0.043 and AUC 0.813). CONCLUSIONS The authors found that both intraoperative MEP and SSEP monitoring are useful for predicting short-term and long-term PMDs in patients with unruptured and ruptured aneurysms. The optimal intraoperative neuromonitoring method for predicting PMDs varies depending on whether the aneurysm has ruptured or not.

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

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2018.08.019 ◽

2018 ◽

Vol 57 ◽

pp. 105-110

Author(s):

Takeru Umemura ◽

Shigeru Nishizawa ◽

Yoshiteru Nakano ◽

Takeshi Saito ◽

Takehiro Kitagawa ◽

...

Keyword(s):

Brain Tumor ◽

Intraoperative Monitoring ◽

Evoked Potential ◽

False Negative ◽

Motor Evoked Potential ◽

Tumor Removal

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Somatosensory and transcranial motor evoked potential monitoring in a porcine model for experimental procedures

PLoS ONE ◽

10.1371/journal.pone.0205410 ◽

2018 ◽

Vol 13 (10) ◽

pp. e0205410 ◽

Cited By ~ 2

Author(s):

Sven Maier ◽

Ulrich Goebel ◽

Sonja Krause ◽

Christoph Benk ◽

Martin A. Schick ◽

...

Keyword(s):

Evoked Potential ◽

Porcine Model ◽

Motor Evoked Potential ◽

Transcranial Motor Evoked Potential ◽

Evoked Potential Monitoring ◽

Potential Monitoring

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Poor diagnostic accuracy of transcranial motor and somatosensory evoked potential monitoring during brainstem cavernoma resection

Acta Neurochirurgica ◽

10.1007/s00701-015-2573-7 ◽

2015 ◽

Vol 157 (11) ◽

pp. 1963-1969 ◽

Cited By ~ 4

Author(s):

Ehab Shiban ◽

Marina Zerr ◽

Thomas Huber ◽

Tobias Boeck-Behrends ◽

Maria Wostrack ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Evoked Potential ◽

Somatosensory Evoked Potential ◽

Brainstem Cavernoma ◽

Evoked Potential Monitoring ◽

Potential Monitoring

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Surgeon-directed transcranial motor evoked potential spinal cord monitoring in spinal deformity surgery

The Bone & Joint Journal ◽

10.1302/0301-620x.103b3.bjj-2020-1278.r1 ◽

2021 ◽

Vol 103-B (3) ◽

pp. 547-552

Author(s):

Ramanare Sibusiso Magampa ◽

Robert Dunn

Keyword(s):

Spinal Cord ◽

Spinal Deformity ◽

Early Identification ◽

Evoked Potential ◽

Motor Evoked Potential ◽

Congenital Scoliosis ◽

Spinal Cord Monitoring ◽

Cord Injury ◽

Spinal Deformity Surgery ◽

Transcranial Motor Evoked Potential

Aims Spinal deformity surgery carries the risk of neurological injury. Neurophysiological monitoring allows early identification of intraoperative cord injury which enables early intervention resulting in a better prognosis. Although multimodal monitoring is the ideal, resource constraints make surgeon-directed intraoperative transcranial motor evoked potential (TcMEP) monitoring a useful compromise. Our experience using surgeon-directed TcMEP is presented in terms of viability, safety, and efficacy. Methods We carried out a retrospective review of a single surgeon’s prospectively maintained database of cases in which TcMEP monitoring had been used between 2010 and 2017. The upper limbs were used as the control. A true alert was recorded when there was a 50% or more loss of amplitude from the lower limbs with maintained upper limb signals. Patients with true alerts were identified and their case history analyzed. Results Of the 299 cases reviewed, 279 (93.3%) had acceptable traces throughout and awoke with normal clinical neurological function. No patient with normal traces had a postoperative clinical neurological deficit. True alerts occurred in 20 cases (6.7%). The diagnoses of the alert group included nine cases of adolescent idiopathic scoliosis (AIS) (45%) and six of congenital scoliosis (30%). The incidence of deterioration based on diagnosis was 9/153 (6%) for AIS, 6/30 (20%) for congenital scoliosis, and 2/16 (12.5%) for spinal tuberculosis. Deterioration was much more common in congenital scoliosis than in AIS (p = 0.020). Overall, 65% of alerts occurred during rod instrumentation: 15% occurred during decompression of the internal apex in vertebral column resection surgery. Four alert cases (20%) awoke with clinically detectable neurological compromise. Conclusion Surgeon-directed TcMEP monitoring has a 100% negative predictive value and allows early identification of physiological cord distress, thereby enabling immediate intervention. In resource constrained environments, surgeon-directed TcMEP is a viable and effective method of intraoperative spinal cord monitoring. Level of evidence: III Cite this article: Bone Joint J 2021;103-B(3):547–552.

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