World neurosurgery · 2026
Usefulness of intraoperative neuromonitoring by evaluation of motor evoked potentials from the abductor digiti minimi muscle elicited by transcranial electrical stimulation.
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Kojima Atsuhiro, Saga Isako, Fukumura Mariko, Nakamura Ryosuke
Аннотация
BACKGROUND: Evaluation of motor evoked potentials (MEPs) from the abductor pollicis brevis (APB) elicited by transcranial electrical stimulation (TES) is an established intraoperative neuromonitoring (IONM) method. However, MEPs from the APB cannot always be elicited by TES. In this study, we explored whether IONM using MEPs from the abductor digiti minimi (ADM) elicited by TES could be a reliable IONM method.
METHODS: The present study was conducted in 19 patients with no preoperative motor deficits. As TES consistently failed to elicit ADM-MEPs in one of the 19 patients, we analyzed data obtained from the remaining 18 cases. Both APB-MEPs and ADM-MEPs were simultaneously examined in 15 cases and ADM-MEPs were solely examined in 3 cases. Correlations between the APB-MEPs and ADM-MEPs were evaluated in each patient by determining the Spearman's rank correlation coefficient. A linear mixed-effects model was used to examine the overall correlation between the two MEPs across individuals.
RESULTS: In 16 out of 18 cases, IONM using the ADM-MEPs predicted the postoperative motor deficits. IONM using the ADM-MEPs showed the false-positive result in one case. In the other case, it was uncertain if IONM provided a pseudo-negative result. The Spearman's correlation coefficient was more than 0.4 in all the cases. Analysis using the linear mixed-effects model showed that the amplitude of the ADM-MEPs was significantly predictive of the APB-ADM.
CONCLUSION: IONM using ADM-MEPs could be a practical alternative to that using APB-MEPs during neurosurgical operations, although it is difficult to completely rule out false-positive and false-negative responses.
METHODS: The present study was conducted in 19 patients with no preoperative motor deficits. As TES consistently failed to elicit ADM-MEPs in one of the 19 patients, we analyzed data obtained from the remaining 18 cases. Both APB-MEPs and ADM-MEPs were simultaneously examined in 15 cases and ADM-MEPs were solely examined in 3 cases. Correlations between the APB-MEPs and ADM-MEPs were evaluated in each patient by determining the Spearman's rank correlation coefficient. A linear mixed-effects model was used to examine the overall correlation between the two MEPs across individuals.
RESULTS: In 16 out of 18 cases, IONM using the ADM-MEPs predicted the postoperative motor deficits. IONM using the ADM-MEPs showed the false-positive result in one case. In the other case, it was uncertain if IONM provided a pseudo-negative result. The Spearman's correlation coefficient was more than 0.4 in all the cases. Analysis using the linear mixed-effects model showed that the amplitude of the ADM-MEPs was significantly predictive of the APB-ADM.
CONCLUSION: IONM using ADM-MEPs could be a practical alternative to that using APB-MEPs during neurosurgical operations, although it is difficult to completely rule out false-positive and false-negative responses.