J Korean Neurosurg Soc.  2014 Aug;56(2):98-102. 10.3340/jkns.2014.56.2.98.

Intraoperative Monitoring of Motor-Evoked Potentials for Supratentorial Tumor Surgery

• Lee JJ
• Kim YI
• Hong JT
• Sung JH
• Lee SW
• Yang SH

• KMID: 1956510
• DOI: http://doi.org/10.3340/jkns.2014.56.2.98

Abstract

OBJECTIVE
The purpose of this study was to assess the feasibility and clinical efficacy of motor evoked potential (MEP) monitoring for supratentorial tumor surgery.
METHODS
Between 2010 and 2012, to prevent postoperative motor deterioration, MEP recording after transcranial stimulation was performed in 84 patients with supratentorial brain tumors (45 males, 39 females; age range, 24-80 years; median age, 58 years). MEP monitoring results were correlated with postoperative motor outcome compared to preoperative motor status.
RESULTS
MEP recordings were stable in amplitude (<50% reduction in amplitude) during surgery in 77 patients (91.7%). No postoperative motor deficit was found in 66 out of 77 patients with stable MEP amplitudes. However, postoperative paresis developed in 11 patients. False negative findings were associated with edema in peri-resectional regions and postoperative bleeding in the tumor bed. MEP decrease in amplitude (>50%) occurred in seven patients (8.3%). However, no deficit occurred postoperatively in four patients following preventive management during the operation. Three patients had permanent paresis, which could have been associated with vascular injury during tumor resection.
CONCLUSIONS
MEP monitoring during supratentorial tumor surgery is feasible and safe. However, false negative MEP results associated with postoperative events may occur in some patients. To achieve successful monitoring, collaboration between surgeon, anesthesiologist and an experienced technician is mandatory.

Keyword

Brain tumor; Intraoperative monitoring; Motor-evoked potentials; Supratentorial; Surgery

MeSH Terms

Brain Neoplasms
Cooperative Behavior
Edema
Evoked Potentials, Motor
Female
Hemorrhage
Humans
Male
Monitoring, Intraoperative*
Paresis
Supratentorial Neoplasms*
Vascular System Injuries

Figure

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  Fig. 1 Summary of intraoperative motor evoked potential (MEP) change and postoperative motor status.

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  Fig. 2 A : Enhanced T1-weighted axial image showing a 5.3×4.3 cm-sized intraaxial mass in the right frontal lobe. The lesion extends into the left hemisphere through the corpus callosum. Peritumoral edema is extensive. B : Intraoperative MEP recording was stable during the operation. C : Postoperative CT scan showing acute hematoma in the right frontal lobe and subfacine herniation. MEP : motor evoked potential.

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  Fig. 3 A : Enhanced T1-weighted axial image showing a 4×3.6 cm-sized homogenously enhanced mass in the left parietal lobe. MEP deterioration was found during the tumor dissection. B : MEP recovered following discontinuation of the procedure.

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  Fig. 4 A : Enhanced T1-weighted axial image showing 6×7 cm-sized homogenously enhanced mass in the left frontotemporal lobe. B : MEP loss developed after multiple coagulation infeeding arteries. C : MEP did not recover during the operation.

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