Monitoring of muscle motor evoked potentials during cerebral aneurysm surgery: intraoperative changes and postoperative outcome

Object The authors in this study evaluated muscle motor evoked potentials (MMEPs) elicited by transcranial electrical stimulation (TES) and direct cortical stimulation as a means of monitoring during cerebral aneurysm surgery. The analysis focused on the value and frequencies of any intraoperative changes and their correlation to the postoperative motor status. Methods One hundred nineteen patients undergoing surgery for 148 cerebral aneurysms were included in the study. Muscle motor evoked potentials were elicited by a train of five constant-current anodal stimuli with an individual pulse duration of 0.5 msec and a stimulation rate of 2 Hz. Stimulation intensity was up to 240 mA for TES and up to 33 mA for direct cortical stimulation. The MMEPs were continuously recorded from the abductor pollicis brevis and tibialis anterior muscles bilaterally and from the biceps brachii and extensor digitorum communis muscles contralateral to the surgical side. The motor status was evaluated immediately after surgery and 7 days later. In 97% of the patients MMEPs were recordable for continuous neurophysiological monitoring of the vascular territory of interest throughout the surgery. In 14 patients significant intraoperative MMEP changes occurred, resulting in a transient motor deficit in one patient and a permanent motor deficit in six. The permanent loss of MMEPs in three patients was followed by a permanent severe motor deficit in one patient and severe clinical deterioration in the other two. Conclusions Data in this study demonstrated that MMEPs are a useful means of intraoperative neurophysiological monitoring of motor pathway integrity and predicting postoperative motor status. The intraoperative loss of MMEPs reliably predicts both severe and permanent postoperative motor deficits.

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Motor Evoked Potential Monitoring during Cerebral Aneurysm Surgery: Technical Aspects and Comparison of Transcranial and Direct Cortical Stimulation

Operative Neurosurgery ◽

10.1227/01.neu.0000176643.69108.fc ◽

2005 ◽

Vol 57 (suppl_4) ◽

pp. ONS-331-ONS-338 ◽

Cited By ~ 41

Author(s):

Andrea Szelényi ◽

Karl Kothbauer ◽

Adauri Bueno de Camargo ◽

David Langer ◽

Eugene S. Flamm ◽

...

Keyword(s):

Electrical Stimulation ◽

Cerebral Aneurysm ◽

Cerebral Artery ◽

Cortical Stimulation ◽

Constant Current ◽

Transcranial Electrical Stimulation ◽

Aneurysm Surgery ◽

Vascular Territory ◽

Technical Aspects ◽

Direct Cortical Stimulation

Abstract OBJECTIVE: This study evaluates technical aspects, handling, and safety of intraoperatively applied transcranial electrical stimulation (TES) and direct cortical stimulation (DCS) for eliciting muscle motor evoked potentials (mMEPs) during cerebral aneurysm surgery. METHODS: In 119 patients undergoing cerebral aneurysm surgery, mMEPs were evoked by a train of five stimuli with individual pulse duration of 0.5 milliseconds, a repetition rate of 2 Hz, and constant current anodal stimulation. The maximal stimulation intensity was 240 mA for transcranial and 33 mA for direct stimulation. mMEPs were recorded continuously from the abductor pollicis brevis, from tibial anterior muscles bilaterally, and from the biceps brachii and extensor digitorum communis muscles contralateral to the side operated on. RESULTS: In 118 (99%) of 119 patients, transcranially evoked mMEPs were monitorable for the vascular territory of interest. DCS was performed successfully in 95 (95%) of 100 patients. In 86 (99%) of 87 patients with internal carotid artery, middle cerebral artery, or posterior circulation aneurysms, mMEPs from upper-extremity muscles were obtained with DCS. In 11 (55%) of 20 patients with anterior communicating artery, anterior cerebral artery, or pericallosal aneurysms, mMEPs from the lower-extremity muscles could be recorded. The incidence of seizures was 0.84% for TES and 1% for DCS. Minor and inconsequential subdural bleeding after positioning of the strip electrode occurred in 2%. CONCLUSION: The cogent comprehensive combination of transcranial and direct cortical electrical stimulation allows for the continuous mMEP monitoring of the cerebral vascular territory of interest in 99% of the patients with cerebral aneurysms. Unwarranted effects of electrode placement and stimulation are rare and without clinical consequences.

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Direct Cortical Stimulation But Not Transcranial Electrical Stimulation Motor Evoked Potentials Detect Brain Ischemia during Brain Tumor Resection

American Journal of Electroneurodiagnostic Technology ◽

10.1080/1086508x.2011.11079819 ◽

2011 ◽

Vol 51 (3) ◽

pp. 191-197 ◽

Cited By ~ 7

Author(s):

Fenghua Li ◽

Eric M. Deshaies ◽

Geoffrey Allott ◽

Gregory Canute ◽

Reza Gorji

Keyword(s):

Electrical Stimulation ◽

Brain Tumor ◽

Evoked Potentials ◽

Brain Ischemia ◽

Motor Evoked Potentials ◽

Tumor Resection ◽

Cortical Stimulation ◽

Transcranial Electrical Stimulation ◽

Direct Cortical Stimulation ◽

Brain Tumor Resection

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Surgical management of Rolandic area meningioma in the era of intraoperative neurophysiological monitoring

Romanian Neurosurgery ◽

10.33962/roneuro-2020-082 ◽

2020 ◽

pp. 488-494

Author(s):

Mihaela Coșman ◽

Ionuț Mihail Panțiru ◽

Andrei Ionuț Cucu ◽

Andreea Lenuța Atomei ◽

Gabriela Florența Dumitrecu ◽

...

Keyword(s):

Cortical Stimulation ◽

Motor Area ◽

Intraoperative Neurophysiological Monitoring ◽

Motor Deficit ◽

Cortical Mapping ◽

Neurophysiological Monitoring ◽

Direct Cortical Stimulation ◽

One Year ◽

The Impact

Introduction: The advantages and the necessity of intraoperative neurophysiological monitoring (IOM) in the surgery of motor area infiltrative tumours is well known. The use of this technique for Rolandic meningioma is still debatable. The absence or the loss of the cleavage plan and an infiltrative border make the dissection exceedingly difficult and increase the risk of new postoperative motor disfunction. Materials and methods: We evaluated the impact of IOM, especially direct cortical stimulation on the degree of resection, new postoperative deficits, symptom remission and clinical-imagistic aspects at one-year follow up of 19 cases of Rolandic meningioma admitted in Third Department of Neurosurgery,” Prof. Dr N. Oblu” Emergency Clinical Hospital, Yassi, Romania, between January 2014 and July 2018. Results: More than half of the cases (57,88%) had epileptic manifestations as the main clinical symptom with the Jacksonian seizures being on the first place (31,57%), followed by progressive paresis (26,31%) and other nonspecific symptoms. Intraparenchymal preoperative oedema was observed in 36,84% of patients. The intensity of direct cortical stimulation was between 6-13 mA (median = 9mA; mode = 12mA). Simpson degree of resection was dominated by S3– 47,36% and S4 was obtained in 15,78% of cases. Postoperative the outcome was favourable for 73,68% patients with 5,26% motor aggravation and 10,52% new deficits. At one-year follow up no imagistic recurrence was observed and the permanent motor deficit was maintained in one of the three cases (5,26%). Conclusion: Even though meningiomas are extranevraxial lesions and those located on the convexity have a low risk of complication, the absence of a clear dissection plan between the tumour and the adjacent motor cortex is associated with a high risk for new postoperative neurological deficits. Therefore, it is important to perform cortical mapping for Rolandic meningioma, to determine the location of the primary motor area and to protect it from mechanical and vascular trauma, during tumour resection.

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Intra-operative monitoring of lower extremity motor-evoked potentials by direct cortical stimulation

Clinical Neurophysiology ◽

10.1016/j.clinph.2011.09.025 ◽

2012 ◽

Vol 123 (6) ◽

pp. 1248-1254 ◽

Cited By ~ 15

Author(s):

Yuichi Maruta ◽

Masami Fujii ◽

Hirochika Imoto ◽

Sadahiro Nomura ◽

Fumiaki Oka ◽

...

Keyword(s):

Lower Extremity ◽

Evoked Potentials ◽

Motor Evoked Potentials ◽

Cortical Stimulation ◽

Direct Cortical Stimulation ◽

Operative Monitoring

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Anterior Choroidal Artery Infarction with No Abnormalities of Motor Evoked Potentials During Cerebral Aneurysm Surgery -A Case Report-

Jouranl of Korean Association of EMG Electrodiagnostic Medicine ◽

10.18214/jkaem.2017.19.2.76 ◽

2017 ◽

Vol 19 (2) ◽

pp. 76-82

Author(s):

Young Seok Kim ◽

Hosung Yi ◽

PARK JINYOUNG ◽

Soeun Pyo ◽

Dawoon Kim ◽

...

Keyword(s):

Case Report ◽

Evoked Potentials ◽

Cerebral Aneurysm ◽

Motor Evoked Potentials ◽

Anterior Choroidal Artery ◽

Aneurysm Surgery ◽

Anterior Choroidal ◽

Choroidal Artery

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The Efficacy of Motor-evoked Potentials on Cerebral Aneurysm Surgery and New-onset Postoperative Motor Deficits

Journal of Neurosurgical Anesthesiology ◽

10.1097/ana.0b013e3181de4eae ◽

2010 ◽

Vol 22 (3) ◽

pp. 247-251 ◽

Cited By ~ 43

Author(s):

Tomoya Irie ◽

Kenji Yoshitani ◽

Yoshihiko Ohnishi ◽

Masahide Shinzawa ◽

Norikazu Miura ◽

...

Keyword(s):

Evoked Potentials ◽

Cerebral Aneurysm ◽

Motor Evoked Potentials ◽

Motor Deficits ◽

Aneurysm Surgery ◽

New Onset

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Predictive Value and Safety of Intraoperative Neurophysiological Monitoring With Motor Evoked Potentials in Glioma Surgery

Neurosurgery ◽

10.1227/neu.0b013e31823f5ade ◽

2011 ◽

Vol 70 (5) ◽

pp. 1060-1071 ◽

Cited By ~ 69

Author(s):

Sandro M. Krieg ◽

Ehab Shiban ◽

Doris Droese ◽

Jens Gempt ◽

Niels Buchmann ◽

...

Keyword(s):

Evoked Potentials ◽

Predictive Value ◽

Motor System ◽

Motor Evoked Potentials ◽

False Negative ◽

Motor Deficit ◽

Neurophysiological Monitoring ◽

Glioma Surgery ◽

Supratentorial Gliomas

Abstract BACKGROUND: Resection of gliomas in or adjacent to the motor system is widely performed with intraoperative neuromonitoring (IOM). Despite the fact that data on the safety of IOM are available, the significance and predictive value of the procedure are still under discussion. Moreover, cases of false-negative monitoring affect the surgeon's confidence in IOM. OBJECTIVE: To examine cases of false-negative IOM to reveal structural explanations. METHODS: Between 2007 and 2010, we resected 115 consecutive supratentorial gliomas in or close to eloquent motor areas using direct cortical stimulation for monitoring of motor evoked potentials (MEPs). The monitoring data were reviewed and related to new postoperative motor deficit and postoperative imaging. Clinical outcomes were assessed during follow-up. RESULTS: Monitoring of MEPs was successful in 112 cases (97.4%). Postoperatively, 30.3% of patients had a new motor deficit, which remained permanent in 12.5%. Progression-free follow-up was 9.7 months (range, 2 weeks-40.6 months). In 65.2% of all cases, MEPs were stable throughout the operation, but 8.9% showed a new temporary motor deficit, whereas 4.5% (5 patients) presented with permanently deteriorated motor function representing false-negative monitoring at first glance. However, these cases were caused by secondary hemorrhage, ischemia, or resection of the supplementary motor area. CONCLUSION: Continuous MEP monitoring provides reliable monitoring of the motor system, influences the course of operation in some cases, and has to be regarded as the standard for IOM of the motor system. In our series, we found no false-negative MEP results.

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