Intraoperative monitoring during decompression of the spinal cord and spinal nerves using transcranial motor-evoked potentials: The law of twenty percent

Tanaka, Satoshi; Hirao, Jun; Oka, Hiroyuki; Akimoto, Jiro; Takanashi, Junko; Yamada, Jun−ichi

doi:10.1016/j.jocn.2015.03.011

Cited by 9 publications

(2 citation statements)

References 19 publications

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“…11,12 We reported that CMAP normalization in MEP is useful for predicting postoperative recovery after spinal cord and spinal nerve decompression surgery. 23 In the present study, we also showed that CMAP normalization corrected the decrease in synaptic transmission at the neuromuscular junction because of propofol accumulation, and its muscle-relaxant effect at the neuromuscular junction.…”

Section: Discussionsupporting

confidence: 78%

Effect of Compound Muscle Action Potential After Peripheral Nerve Stimulation Normalization on Anesthetic Fade of Intraoperative Transcranial Motor-Evoked Potential

Tanaka

Watanabe²,

Takanashi³

et al. 2020

Journal of Clinical Neurophysiology

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Purpose: Anesthetic fade refers to the time-dependent decrease in the amplitude of the intraoperative motor-evoked potential. It is thought to be caused by the accumulation of propofol. The authors examined whether normalization by the compound muscle action potential (CMAP) after peripheral nerve stimulation could compensate for anesthetic fade.Methods: In 1,842 muscles in 578 surgeries, which did not exhibit a motor-neurologic change after the operation, the motor-evoked potential amplitude was normalized by the CMAP amplitude after peripheral nerve stimulation, and the CMAP amplitude and operation times were analyzed.

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Section: Discussionsupporting

confidence: 78%

Effect of Compound Muscle Action Potential After Peripheral Nerve Stimulation Normalization on Anesthetic Fade of Intraoperative Transcranial Motor-Evoked Potential

Tanaka

Watanabe²,

Takanashi³

et al. 2020

Journal of Clinical Neurophysiology

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“…We previously reported that intraoperative MEP monitoring made it possible to predict motor-neurologic recovery from compressive spinal and spinal nerve disorders. 29 In spinal operations and brain tumor operation, a decrease of 80% in amplitude should be used as the cutoff point. In aneurysmal operations monitored by tcMEP, a decrease of 70% in amplitude should be used.…”

Section: Discussionmentioning

confidence: 99%

Cutoff Points, Sensitivities, and Specificities of Intraoperative Motor-Evoked Potential Monitoring Determined Using Receiver Operating Characteristic Analysis

Tanaka

Akimoto²,

Takanashi

et al. 2018

J Neurol Surg A Cent Eur Neurosurg

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Background Although intraoperative motor-evoked potential (MEP) monitoring is widely performed during neurosurgical operations, evaluating its results is controversial. Study Aims The cutoff point of MEP monitoring should be determined not only to predict but also to prevent postoperative neurologic deficits. Material and Methods MEP monitoring was performed during 484 neurosurgical operations for patients without definitive preoperative motor palsy including 325 spinal operations, 102 cerebral aneurysmal operations, and 57 brain tumor operations, all monitored by transcranial stimulation, and 34 brain tumor operations monitored under direct cortical stimulation. To exclude the effects of muscle relaxants on MEP, the compound muscle action potential (CMAP), measured immediately after transcranial stimulation or direct cortical stimulation at supramaximal stimulation of the peripheral nerve, was used for normalization. The cutoff points, sensitivity, and specificity of MEP recorded during neurosurgery were examined by receiver operating characteristic (ROC) analyses and categorized according to the type of operation and stimulation. Results In spinal operations under transcranial stimulation, amplitude reduction of 77.9% and 80.6% as cutoff points for motor palsy with and without CMAP normalization, respectively, provided a sensitivity of 100% and specificity of 96.8% and 96.5%. In aneurysmal operations under transcranial stimulation, cutoff points of 70.7% and 69.6% offered specificities of 95.2% and 95.7% with and without CMAP normalization, respectively. The sensitivities for both were 100%. In brain tumor operations under direct stimulation, cutoff points were 83.5% and 86.3% with or without CMAP normalization, respectively, and the sensitivity and specificity for both were 100%. Conclusion An amplitude decrease of 80% in brain tumor operations, 75% in spinal operations, and 70% in aneurysmal operations should be used as the cutoff points.

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Prediction of Spine Decompression Post-surgery Outcome Through Transcranial Motor Evoked Potential Using Linear Discriminant Analysis Algorithm

Ridzuan

Beng²,

Chuah

et al. 2022

6th Kuala Lumpur International Conference on Biomedical Engineering 2021

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Intraoperative monitoring during decompression of the spinal cord and spinal nerves using transcranial motor-evoked potentials: The law of twenty percent

Cited by 9 publications

References 19 publications

Effect of Compound Muscle Action Potential After Peripheral Nerve Stimulation Normalization on Anesthetic Fade of Intraoperative Transcranial Motor-Evoked Potential

Effect of Compound Muscle Action Potential After Peripheral Nerve Stimulation Normalization on Anesthetic Fade of Intraoperative Transcranial Motor-Evoked Potential

Cutoff Points, Sensitivities, and Specificities of Intraoperative Motor-Evoked Potential Monitoring Determined Using Receiver Operating Characteristic Analysis

Prediction of Spine Decompression Post-surgery Outcome Through Transcranial Motor Evoked Potential Using Linear Discriminant Analysis Algorithm

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