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

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• 作者：Johannes Sarnthein (1) (2)
  Oliver Bozinov (1)
  Angelina Graziella Melone (1) (3)
  Helmut Bertalanffy (4)
  
• 关键词：Brainstem ; Posterior fossa ; Corticospinal tract ; Motor ; evoked potential ; Intraoperative neuromonitoring
• 刊名：Acta Neurochirurgica
• 出版年：2011
• 出版时间：September 2011
• 年：2011
• 卷：153
• 期：9
• 页码：1753-1759
• 全文大小：259KB
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• 作者单位：Johannes Sarnthein (1) (2)
  Oliver Bozinov (1)
  Angelina Graziella Melone (1) (3)
  Helmut Bertalanffy (4)
  
  1. Klinik für Neurochirurgie, Universit?tsSpital Zürich, 8091, Zürich, Switzerland
  2. Center for Integrative Human Physiology, Universit?t Zürich, Zürich, Switzerland
  3. Dipartimento di Scienze Neurologiche, Università La Sapienza, Roma, Italy
  4. International Neuroscience Institute, Hannover, Germany
  

文摘

Background 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. Method We analyzed 104 consecutive patients who underwent microsurgical resection of lesions affecting the brainstem. Motor grade was documented prior to surgery, early postoperatively and at discharge. A baseline MEP stimulation intensity threshold was defined and intraoperative testing aimed to keep MEP response amplitude constant. MEPs were considered deteriorated and the surgical team was notified whenever the threshold was elevated by ?0?mA or MEP response fell under 50%. Findings On the first postoperative day, 18 patients experienced new paresis that resolved by discharge in 11. MEPs deteriorated in 39 patients, and 16 of these showed new postoperative paresis, indicating a 41% risk of new paresis. In the remaining 2/18 patients, intraoperative MEPs were stable, although new paresis appeared postoperatively. In one of these patients, intraoperative hemorrhage caused postoperative swelling, and the new motor deficit persisted until discharge. Of all 104 patients, 7 deteriorated in motor grade at discharge, 92 remained unchanged, and 5 patients have improved. 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.