Brain Tumor Res Treat.  2024 Jan;12(1):50-57. 10.14791/btrt.2023.0050.

Temporal Analysis of Postoperative Outcomes With or Without Intraoperative Motor Evoked Potentials and Somatosensory Evoked Potentials Monitoring for Intracranial Meningioma Surgery

• Shin NI
• Hong HJ
• Kim YI
• Kim IS
• Sung JH
• Lee SW
• Yang SH

• KMID: 2552338
• DOI: http://doi.org/10.14791/btrt.2023.0050

Abstract

Background
This study aimed to retrospectively assess results of intracranial meningioma surgery with or without intraoperative neuromonitoring (IONM) in a single institution.
Methods
Two cohorts (a historical cohort and a monitoring cohort) were collected for the analy- sis. Before IONM was introduced, a total of 107 patients underwent intracranial meningioma operation without IONM from January 2000 to December 2008 by one neurosurgeon (historical cohort). After IONM was introduced, a total of 99 patients with intracranial meningioma were operated under IONM between November 2018 and February 2023 by two neurosurgeons (monitoring cohort). A retrospective comparison was made on the complications from meningioma surgery between the two groups.
Results
In the monitoring cohort, warning signals of motor evoked potential (MEPs) or so- matosensory evoked potential (SSEPs) were alarmed in 10 patients. Two of these 10 patients aborted the operation and eight of these 10 patients with warning signals underwent tumor resection. Of these eight patients, five showed postoperative morbidity. Five of 89 patients without warning signals developed neurological deficits. In the historical cohort, 14 of 107 patients showed postoperative morbidity or mortality.
Conclusion
Even after successful resection of intracranial meningiomas prior to the advent of IONM, integration of MEPs and SSEPs monitoring yielded valuable insights for surgical teams during operative procedures.

Keyword

Meningioma; Intraoperative neurophysiological monitoring; Evoked potentials; Morbidity; Surgery

Figure

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  Fig. 1 Summary of intraoperative neuroneuromonitoring changes and postoperative morbidities. MEP, motor evoked potential; SSEP, somatosensory evoked potential.

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  Fig. 2 A case with warning sings of somatosensory evoked potentials. A: Enhanced T1-weighted axial image showing a 23×30-mm-sized extra-axial mass adjacent to the right central sulcus. B: Intraoperative somatosensory evoked potentials were alarmed during the operation. C: Postoperative diffusion MR image showing restriction around the resection cavity.

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  Fig. 3 A case of warning signs of motor evoked potentials and somatosensory evoked potentials. A and B: Enhanced T1-weighted and T2-weighted axial image showing 32×38-mm-sized and well enhancing extra-axial mass in the right prepontine cistern. This lesion abuts posterior aspect of clivus and compresses the pons. Diffuse dilatation of the ventricular system is noted. C and D: Intraoperative motor evoked potentials and somatosensory evoked potentials were alarmed but disappeared during operation. Decreased amplitudes are highlighted in red square with arrows.

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