Intraoperative monitoring of motor-evoked potential for parenchymal brain tumor removal: An analysis of false-negative cases. (November 2018)

• Record Type: Journal Article
• Authors: Umemura, Takeru; Nishizawa, Shigeru; Nakano, Yoshiteru; Saito, Takeshi; Kitagawa, Takehiro; Miyaoka, Ryo; Suzuki, Kohei; Yamamoto, Junkoh
• Is Part Of: Journal of clinical neuroscience. Volume 57(2018)
• Page Start: 105
• Page End: 110
• Publication Date: 2018-11
• Subjects: Brain tumor -- MEP -- Monitoring -- Parenchymal brain tumor -- Transcranial MEP; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.08.019
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Tc-MEP has low sensitivity in brain tumor surgery. Strong stimulation reaches the deep pyramidal tract producing false negatives. We report characteristics of false-negative cases and stimulation should be minimal to increase sensitivity. Abstract: Transcranial motor-evoked potential (tc-MEP) monitoring is unreliable for brain tumor removal due to its low sensitivity. According to previous literature, this is because transcranial stimulation seems to reach the deep pyramidal tract beyond the operation point and may thus yield false-negative results, where, although MEP recording is stable, postoperative motor deficits are encountered. Therefore, we aimed to analyze the causes for the false-negative results and investigate whether decreasing the stimulation intensity better reflects the operation point and can improve the sensitivity during parenchymal brain tumor removal. We assessed 122 patients with parenchymal brain and intraventricular tumors, who underwent surgery under tc-MEP monitoring in our hospital between 2011 and 2014. In these patients, the stimulation intensity was fixed at 200 mA. We detected 11 false-negative cases, while the sensitivity of tc-MEP monitoring was 33.9% and the specificity was 99.0%. Between 2015 and 2016, we examined 68 patients with parenchymal brain tumors, in whom the stimulation intensity was reduced to an average of 136.5 mA. Only one case was false-negative, while the sensitivity increased to 83.3% and the specificity was 98.4%. From these results, we conclude that the intensity of tc-MEP stimulation should be minimal to precisely reflect the damage to the operated location. Tc-MEP can be an easy and reliable monitor in brain tumor surgery when used at proper, lower intensity.