Prognostic Values of Motor Evoked Potentials in Insular, Precental, or Postcentral Resections

Boëx, Colette; Haemmerli, Julien; Momjian, Shahan; Schaller, Karl

doi:10.1097/wnp.0000000000000227

Cited by 10 publications

(11 citation statements)

References 29 publications

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“…The introduction of phase reversal for the precise allocation of the central sulcus, in combination with transcranial or direct subsequent motor mapping and motor evoked potential (MEP) monitoring, has allowed to define entry zones for surgery in and around the central region and for the placement of subdural strip electrodes for continuous MEP monitoring during i.e. tumor surgery or during resective epilepsy surgical procedures in the vicinity of the somatosensory cortex [ 23 , 28 , 93 ]. Subsequent developments in monitoring and mapping of cerebral functions, of white matter fiber tracts, and cranial/peripheral nerves have since become a mainstay of functional preservation during neurosurgical procedures [ 29 , 45 , 46 , 79 , 81 , 114 ].…”

Section: Monitoring and Mapping In Neurosurgerymentioning

confidence: 99%

The perspectives of mapping and monitoring of the sense of self in neurosurgical patients

et al. 2021

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Surgical treatment of tumors, epileptic foci or of vascular origin, requires a detailed individual pre-surgical workup and intra-operative surveillance of brain functions to minimize the risk of post-surgical neurological deficits and decline of quality of life. Most attention is attributed to language, motor functions, and perception. However, higher cognitive functions such as social cognition, personality, and the sense of self may be affected by brain surgery. To date, the precise localization and the network patterns of brain regions involved in such functions are not yet fully understood, making the assessment of risks of related post-surgical deficits difficult. It is in the interest of neurosurgeons to understand with which neural systems related to selfhood and personality they are interfering during surgery. Recent neuroscience research using virtual reality and clinical observations suggest that the insular cortex, medial prefrontal cortex, and temporo-parietal junction are important components of a neural system dedicated to self-consciousness based on multisensory bodily processing, including exteroceptive and interoceptive cues (bodily self-consciousness (BSC)). Here, we argue that combined extra- and intra-operative approaches using targeted cognitive testing, functional imaging and EEG, virtual reality, combined with multisensory stimulations, may contribute to the assessment of the BSC and related cognitive aspects. Although the usefulness of particular biomarkers, such as cardiac and respiratory signals linked to virtual reality, and of heartbeat evoked potentials as a surrogate marker for intactness of multisensory integration for intra-operative monitoring has to be proved, systemic and automatized testing of BSC in neurosurgical patients will improve future surgical outcome.

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Section: Monitoring and Mapping In Neurosurgerymentioning

confidence: 99%

The perspectives of mapping and monitoring of the sense of self in neurosurgical patients

et al. 2021

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“…This is similar to the application of different alarm criteria for transcranial as opposed to direct cortical stimulation during the resection of insular, pre-, or postcentral lesions. 26 Dong et al 24 and Matthies et al 17 also found a lower alarm criterion, that is, a 35% decrease in MEP amplitude, prone to trigger more warnings than with a 50% decrease in MEP amplitude, in similar and larger groups of patients. This low alarm criterion is in line with the previous observation of the high rates of poor facial nerve outcomes in the cases with a 50% decrease in MEP amplitude.…”

Section: Discussionmentioning

confidence: 93%

Sensitivity and Negative Predictive Value of Motor Evoked Potentials of the Facial Nerve

Bovo

Momjian

Gondar³

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Objective The objective of this study was to determine the performance of the standard alarm criterion of motor evoked potentials (MEPs) of the facial nerve in surgeries performed for resections of vestibular schwannomas or of other lesions of the cerebellopontine angle. Methods This retrospective study included 33 patients (16 with vestibular schwannomas and 17 with other lesions) who underwent the resection surgery with transcranial MEPs of the facial nerve. A reproducible 50% decrease in MEP amplitude, resistant to a 10% increase in stimulation intensity, was applied as the alarm criterion during surgery. Facial muscular function was clinically evaluated with the House–Brackmann score (HBS), pre- and postsurgery at 3 months. Results In the patient group with vestibular schwannoma, postoperatively, the highest sensitivity and negative predictive values were found for a 30% decrease in MEP amplitude, that is, a criterion stricter than the 50% decrease in MEP amplitude criterion, prone to trigger more warnings, used intraoperatively. With this new criterion, the sensitivity would be 88.9% and the negative predictive value would be 85.7%. In the patient group with other lesions of the cerebellopontine angle, the highest sensitivity and negative predictive values were found equally for 50, 60, or 70% decrease in MEP amplitude. With these criteria, the sensitivities and the negative predictive values would be 100.0%. Conclusion Different alarm criteria were found for surgeries for vestibular schwannomas and for other lesions of the cerebellopontine angle. The study consolidates the stricter alarm criterion, that is, a criterion prone to trigger early warnings, as found previously by others for vestibular schwannoma surgeries (30% decrease in MEP amplitude).

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“…Interestingly, Ostry et al [ 42 ] used during supratentorial tumor surgery a threshold increase >2 mA not as an indicator for surgical intervention but for the performance of subcortical mapping. The definition of a minimum MEP amplitude to be monitored varied significantly among the papers from 10 to 100 μV with an average of 30–50 μV [ 8 , 10 , 11 , 29 , 32 , 33 , 35 , 38 , 42 , 48 , 53 , 66 , 73 , 74 , 76 , 78 ]. However, in many, it was not clearly defined.…”

Section: Discussionmentioning

confidence: 99%

Motor Evoked Potential Warning Criteria in Supratentorial Surgery: A Scoping Review

Asimakidou

Abut

Raabe

et al. 2021

Cancers

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During intraoperative monitoring of motor evoked potentials (MEP), heterogeneity across studies in terms of study populations, intraoperative settings, applied warning criteria, and outcome reporting exists. A scoping review of MEP warning criteria in supratentorial surgery was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Sixty-eight studies fulfilled the eligibility criteria. The most commonly used alarm criteria were MEP signal loss, which was always a major warning sign, followed by amplitude reduction and threshold elevation. Irreversible MEP alterations were associated with a higher number of transient and persisting motor deficits compared with the reversible changes. In almost all studies, specificity and Negative Predictive Value (NPV) were high, while in most of them, sensitivity and Positive Predictive Value (PPV) were rather low or modest. Thus, the absence of an irreversible alteration may reassure the neurosurgeon that the patient will not suffer a motor deficit in the short-term and long-term follow-up. Further, MEPs perform well as surrogate markers, and reversible MEP deteriorations after successful intervention indicate motor function preservation postoperatively. However, in future studies, a consensus regarding the definitions of MEP alteration, critical duration of alterations, and outcome reporting should be determined.

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Prognostic Values of Motor Evoked Potentials in Insular, Precental, or Postcentral Resections

Cited by 10 publications

References 29 publications

The perspectives of mapping and monitoring of the sense of self in neurosurgical patients

The perspectives of mapping and monitoring of the sense of self in neurosurgical patients

Sensitivity and Negative Predictive Value of Motor Evoked Potentials of the Facial Nerve

Motor Evoked Potential Warning Criteria in Supratentorial Surgery: A Scoping Review

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