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Predictive Value and Safety of Intraoperative Neurophysiological Monitoring With Motor Evoked Potentials in Glioma Surgery

Krieg, Sandro M. MD*; Shiban, Ehab MD*; Droese, Doris; Gempt, Jens MD*; Buchmann, Niels MD*; Pape, Haiko MD*; Ryang, Yu-Mi MD*; Meyer, Bernhard Professor*; Ringel, Florian MD*

doi: 10.1227/NEU.0b013e31823f5ade
Research-Human-Clinical Studies

BACKGROUND: Resection of gliomas in or adjacent to the motor system is widely performed with intraoperative neuromonitoring (IOM). Despite the fact that data on the safety of IOM are available, the significance and predictive value of the procedure are still under discussion. Moreover, cases of false-negative monitoring affect the surgeon's confidence in IOM.

OBJECTIVE: To examine cases of false-negative IOM to reveal structural explanations.

METHODS: Between 2007 and 2010, we resected 115 consecutive supratentorial gliomas in or close to eloquent motor areas using direct cortical stimulation for monitoring of motor evoked potentials (MEPs). The monitoring data were reviewed and related to new postoperative motor deficit and postoperative imaging. Clinical outcomes were assessed during follow-up.

RESULTS: Monitoring of MEPs was successful in 112 cases (97.4%). Postoperatively, 30.3% of patients had a new motor deficit, which remained permanent in 12.5%. Progression-free follow-up was 9.7 months (range, 2 weeks-40.6 months). In 65.2% of all cases, MEPs were stable throughout the operation, but 8.9% showed a new temporary motor deficit, whereas 4.5% (5 patients) presented with permanently deteriorated motor function representing false-negative monitoring at first glance. However, these cases were caused by secondary hemorrhage, ischemia, or resection of the supplementary motor area.

CONCLUSION: Continuous MEP monitoring provides reliable monitoring of the motor system, influences the course of operation in some cases, and has to be regarded as the standard for IOM of the motor system. In our series, we found no false-negative MEP results.

Departments of *Neurosurgery

Anesthesiology, Technische Universität München, Munich, Germany

Correspondence: Bernhard Meyer, MD, Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany. E-mail: Bernhard.Meyer@lrz.tum.de

Received January 27, 2011

Accepted October 14, 2011

Copyright © by the Congress of Neurological Surgeons