Motor tract monitoring during insular glioma surgery

Neuloh, Georg; Pechstein, U.; Schramm, Johannes

doi:10.3171/jns.2007.106.4.582

Cited by 188 publications

(152 citation statements)

References 41 publications

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“…In intramedullary spinal cord tumor surgery, total MEP loss was shown to be a valid warning criterion. [5] For supratentorial surgery, a 50% reduction of MEP response amplitude has been proposed as a warning criterion [10,11,17].…”

Section: Mep Warning Criteria In Spinal and Supratentorial Surgerymentioning

confidence: 99%

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Motor-evoked potentials (MEP) during brainstem surgery to preserve corticospinal function

Sarnthein

Bozinov²,

Melone

et al. 2011

Acta Neurochir

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Brainstem surgery bears a risk of damage to the corticospinal tract (CST). Motor-evoked potentials (MEPs) are used intraoperatively to monitor CST function in order to detect CST damage at a reversible stage and thus impede permanent neurological deficits. While the method of MEP is generally accepted, warning criteria in the context of brainstem surgery still have to be agreed on. Conclusions: Adjustment of surgical strategy contributed to good motor outcome in 33/39 patients. MEP monitoring may help significantly to prevent motor deficits during demanding neurosurgical procedures on the brainstem.

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Section: Mep Warning Criteria In Spinal and Supratentorial Surgerymentioning

confidence: 99%

“…Although MEPs are well established for the early detection of impending motor deficit during surgery of cranial procedures [10,11,14,17,19] and the spinal cord [1,5,15,16], for brainstem surgery a warning criterion has not yet become generally accepted.…”

Section: Introductionmentioning

confidence: 99%

Motor-evoked potentials (MEP) during brainstem surgery to preserve corticospinal function

Sarnthein

Bozinov²,

Melone

et al. 2011

Acta Neurochir

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“…52,69,96 Reversible MEP amplitude declines of 50% or more are generally associated with temporary motor deficits, whereas irreversible MEP declines or an MEP loss predicts a permanent new motor deficit. 48,66,[68][69][70]109,110 Recently the reliability of this modality in terms of potentially false-negative events was investigated, proving that these events are mainly due to secondary injury to the motor system (hemorrhages, secondary ischemia) or resections in supplementary motor areas resulting in temporary motor deficits. 52 This study clarified that postoperative events such as hematoma causing deterioration of motor function do not represent false-negative results when MEPs have remained stable during surgery.…”

Section: Cortical Monitoring and Mappingmentioning

confidence: 99%

“…Certain criteria for a significant MEP change with predictive value concerning motor outcome have been described, as follows: 1) an amplitude reduction of 50% or more; 43,44,66,67,69,71,72,108 or 2) a necessary ≥ 4-mA increase in stimulation energy to maintain amplitude height. 101 However, the majority uses a 50% or more amplitude decline as a significant warning criterion.…”

Section: Cortical Monitoring and Mappingmentioning

confidence: 99%

Functional preoperative and intraoperative mapping and monitoring: increasing safety and efficacy in glioma surgery

Ottenhausen¹,

Krieg²,

Meyer³

et al. 2015

FOC

122

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Greater extent of resection (EOR) of low-grade gliomas is associated with improved survival. Proximity to eloquent cortical regions often limits resectability and elevates the risk of surgery-related deficits. Therefore, functional localization of eloquent cortex or subcortical fiber tracts can enhance the EOR and functional outcome. Imaging techniques such as functional MRI and diffusion tensor imaging fiber tracking, and neurophysiological methods like navigated transcranial magnetic stimulation and magnetoencephalography, make it possible to identify eloquent areas prior to resective surgery and to tailor indication and surgical approach but also to assess the surgical risk. Intraoperative monitoring with direct cortical stimulation and subcortical stimulation enables surgeons to preserve essential functional tissue during surgery. Through tailored pre- and intraoperative mapping and monitoring the EOR can be maximized, with reduced rates of surgery-related deficits.

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“…8,11,16,18,26 We aimed to evaluate the feasibility and value of the threshold criterion in glioma surgery by using a new approach for interpreting changes in threshold level involving the contra-and ipsilateral MEP.…”

mentioning

confidence: 99%

A novel threshold criterion in transcranial motor evoked potentials during surgery for gliomas close to the motor pathway

Abboud

Schaper

Dührsen

et al. 2016

JNS

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S urgical removal of gliomas is a part of multidisciplinary treatment. Maximal resection should be achieved when feasible, with no or minimal neurological deficit to allow patients to have a reasonable quality of life after the procedure. 15,22 Unlike cerebral metastases, supratentorial gliomas, especially low-grade ones, are not well defined, and complete tumor resection can be challenging. In addition to modalities such as diffusion tensor imaging-based functional neuronavigation, 28 fluorescence-guided surgery, 25 to evoke a stable motor response from each of the muscles being monitored) from the baseline set before dural opening. An increase in threshold level on the contralateral side (facial, arm, or leg muscles contralateral to the affected hemisphere) of more than 20% beyond the percentage increase on the ipsilateral side (facial, arm, or leg muscles ipsilateral to the affected hemisphere) was considered a significant alteration. Recorded alterations were subsequently correlated with postoperative neurological deterioration and MRI findings. results TES-MEP could be elicited in all patients, including those with recurrent glioma (31 patients) and preoperative paresis (20 patients). Five of 73 patients without preoperative paresis showed a significant increase in threshold level, and all of them developed new paresis postoperatively (transient in 4 patients and permanent in 1 patient). Eight of 20 patients with preoperative paresis showed a significant increase in threshold level, and all of them developed postoperative neurological deterioration (transient in 4 patients and permanent in 4 patients). In 80 patients no significant change in threshold level was detected, and none of them showed postoperative neurological deterioration. The specificity and sensitivity in this series were estimated at 100%. Postoperative MRI revealed gross-total tumor resection in 56 of 82 patients (68%) in whom complete tumor resection was attainable; territorial ischemia was detected in 4 patients. coNclusioNs The novel threshold criterion has made TES-MEP a useful method for predicting postoperative motor deficit in patients who undergo glioma surgery, and has been feasible in patients with preoperative paresis as well as in patients with recurrent glioma. Including contra- and ipsilateral changes in threshold level has led to a high sensitivity and specificity.

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Motor tract monitoring during insular glioma surgery

Cited by 188 publications

References 41 publications

Motor-evoked potentials (MEP) during brainstem surgery to preserve corticospinal function

Motor-evoked potentials (MEP) during brainstem surgery to preserve corticospinal function

Functional preoperative and intraoperative mapping and monitoring: increasing safety and efficacy in glioma surgery

A novel threshold criterion in transcranial motor evoked potentials during surgery for gliomas close to the motor pathway

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