Central European neurosurgery · 2009
Are there false-negative results of motor evoked potential monitoring in brain surgery?
Клинический случайКлиническое исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Neuloh G, Schramm J
Аннотация
OBJECT: The present study explores the causes of occasional postoperative pareses despite unchanged or fully recovered intraoperative motor evoked potentials (MEPs) in supratentorial brain surgeries.
METHODS: In a prospective, observational design, MEP monitoring results, motor outcome, and perioperative imaging were correlated in 200 procedures for brain tumours and cortical dysplasias critically related to motor areas and pathways.
RESULTS: Persisting pareses after unchanged or recovered MEPs occurred in four cases due to delayed ischemia, or venous congestive oedema. Transient new deficit in four cases after stable MEP monitoring occurred due to inadvertently strong stimulation bypassing the target lesion, due to marked postresectional oedema, and after cortical transsections for alleviation of epilepsy.
DISCUSSION AND CONCLUSIONS: With technically adequate MEP monitoring, truly false-negative results missing manifest corticospinal impairment do not occur. However, sustained vascular dynamics (vasospasm, congestive oedema) may cause delayed pareses which are missed, or hardly reflected by intraoperative MEP changes. Even minor MEP changes must therefore be observed to prevent impending motor deficit.
METHODS: In a prospective, observational design, MEP monitoring results, motor outcome, and perioperative imaging were correlated in 200 procedures for brain tumours and cortical dysplasias critically related to motor areas and pathways.
RESULTS: Persisting pareses after unchanged or recovered MEPs occurred in four cases due to delayed ischemia, or venous congestive oedema. Transient new deficit in four cases after stable MEP monitoring occurred due to inadvertently strong stimulation bypassing the target lesion, due to marked postresectional oedema, and after cortical transsections for alleviation of epilepsy.
DISCUSSION AND CONCLUSIONS: With technically adequate MEP monitoring, truly false-negative results missing manifest corticospinal impairment do not occur. However, sustained vascular dynamics (vasospasm, congestive oedema) may cause delayed pareses which are missed, or hardly reflected by intraoperative MEP changes. Even minor MEP changes must therefore be observed to prevent impending motor deficit.
Предметные рубрики MeSH
AdolescentAdultAgedAstrocytomaBrainBrain EdemaChildChild, PreschoolElectric StimulationElectroencephalographyEvoked Potentials, MotorFalse Negative ReactionsFemaleGlioblastomaHemispherectomyHumansMaleMiddle AgedMonitoring, IntraoperativeNeurosurgical ProceduresParesisPostoperative ComplicationsProspective StudiesSupratentorial NeoplasmsTreatment OutcomeVasospasm, IntracranialYoung Adult