Does Preoperative Paresis Influence Intraoperative Monitoring of the Motor Cortex?

Summary Intraoperative monitoring of motor function by means of motor evoked potentials (MEPs) is a new method. The current study examines the influence of preoperative paresis on the feasibility and reliability of this method. Intraoperative monitoring of MEPs was performed in 58 patients during surgery in the central region. The patients were divided into three groups according to their preoperative strength (group I, muscle strength less than or equal to grade 4 according to the British Medical Research Council grading system [n = 17]; group II, normal strength (n = 36); and group III, muscle strength less than grade 5 but not worse than grade 4 [n = 5]). The motor cortex was stimulated directly with a high-frequency monopolar anodal train. In groups II and III, MEPs were elicited in all patients on cortical stimulation, whereas in group I a response was obtained in only 88% of patients. The MEP parameters in all groups had a broad interindividual range of variation. A correlation between individual intraoperative potential changes and surgical maneuvers was observed in seven patients in group II and in four patients in group I. No MEP changes were recorded in group III. Irreversible MEP changes (groups I and II) resulted in postoperative clinical deterioration. No postoperative deterioration of motor function was observed in patients with reversible MEP changes. Preoperative paresis reduces the feasibility of the method; however, it has no influence on the intraoperative pattern and reaction of the MEPs.

[1]  J. Schramm,et al.  Electrophysiological considerations regarding electrical stimulation of motor cortex and brain stem in humans. , 1998, Neurosurgery.

[2]  M. Brock,et al.  O-17-241 Monopolar motor cortex stimulation: A new mapping technique? , 1997, Clinical Neurology and Neurosurgery.

[3]  J. Schramm,et al.  Somatosensory evoked potential phase reversal and direct motor cortex stimulation during surgery in and around the central region. , 1996, Neurosurgery.

[4]  Makoto Taniguchi,et al.  Modification of cortical stimulation for motor evoked potentials under general anesthesia: technical description. , 1993, Neurosurgery.

[5]  S. Ueno,et al.  Magnetic Stimulation of the Human Brain , 1992, Annals of the New York Academy of Sciences.

[6]  G A Ojemann,et al.  Correlation of motor cortex brain mapping data with magnetic resonance imaging. , 1990, Journal of neurosurgery.

[7]  Mitchel S. Berger,et al.  Brain Mapping Techniques to Maximize Resection, Safety, and Seizure Control in Children with Brain Tumors , 1989 .

[8]  C. C. Wood,et al.  Human cortical potentials evoked by stimulation of the median nerve. I. Cytoarchitectonic areas generating short-latency activity. , 1989, Journal of neurophysiology.

[9]  J. Schramm,et al.  Effect of a subdural air collection on the sensory evoked potential during surgery in the sitting position. , 1989, Electroencephalography and clinical neurophysiology.

[10]  J. Schramm,et al.  Detailed analysis of intraoperative changes monitoring brain stem acoustic evoked potentials. , 1988, Neurosurgery.

[11]  R B King,et al.  Cortical localization and monitoring during cerebral operations. , 1987, Journal of neurosurgery.

[12]  T. Allison.  Localization of sensorimotor cortex in neurosurgery by recording of somatosensory evoked potentials. , 1987, The Yale journal of biology and medicine.

[13]  W. Lougheed,et al.  Monitoring of Sensory Evoked Potentials During Surgery of Skull Base Tumours , 1985, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[14]  J. Piatt,et al.  Limitations of brain stem auditory evoked potentials for intraoperative monitoring during a posterior fossa operation: case report and technical note. , 1985, Neurosurgery.

[15]  T. Lenarz,et al.  Prognostic factors for postsurgical hearing and facial nerve function in cases of cerebellopontine angle-tumours , 1985, Acta Neurochirurgica.

[16]  S. Goldring,et al.  Surgical management of epilepsy using epidural recordings to localize the seizure focus. Review of 100 cases. , 1984, Journal of neurosurgery.

[17]  R P Lesser,et al.  Cortical somatosensory evoked potentials in response to hand stimulation. , 1983, Journal of neurosurgery.

[18]  A. Shetter,et al.  Intraoperative monitoring of brain-stem auditory evoked potentials. , 1982, Journal of neurosurgery.

[19]  T Allison,et al.  SCALP AND CORTICAL RECORDINGS OF INITIAL SOMATOSENSORY CORTEX ACTIVITY TO MEDIAN NERVE STIMULATION IN MAN * , 1980, Annals of the New York Academy of Sciences.

[20]  G. Cheron,et al.  SOMATOSENSORY EVOKED POTENTIALS IN MAN: SUBCORTICAL AKD CORTICAL COMPONENTS AND THEIR NEURAL BASIS * , 1980, Annals of the New York Academy of Sciences.

[21]  C. Woolsey,et al.  Localization in somatic sensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation. , 1979, Journal of neurosurgery.

[22]  R P Lesser,et al.  Effect of stimulus intensity on short latency somatosensory evoked potentials. , 1979, Electroencephalography and clinical neurophysiology.

[23]  S. Goldring,et al.  A method for surgical management of focal epilepsy, especially as it relates to children. , 1978, Journal of neurosurgery.

[24]  W. Penfield,et al.  SOMATIC MOTOR AND SENSORY REPRESENTATION IN THE CEREBRAL CORTEX OF MAN AS STUDIED BY ELECTRICAL STIMULATION , 1937 .

[25]  H. Cushing.  A NOTE UPON THE FARADIC STIMULATION OF THE POSTCENTRAL GYRUS IN CONSCIOUS PATIENTS.1 , 1909 .

[26]  Roberts Bartholow,et al.  Art. I.—Experimental Investigations into the Functions of the Human Brain. , 1874 .

[27]  R. Firsching,et al.  Lesions of the sensorimotor region: Somatosensory evoked potentials and ultrasound guided surgery , 2005, Acta Neurochirurgica.

[28]  U. Ebeling,et al.  Tumour-surgery within the central motor strip: Surgical results with the aid of electrical motor cortex stimulation , 2005, Acta Neurochirurgica.

[29]  U. D. Schmid,et al.  Safe surgery of lesions near the motor cortex using intra-operative mapping techniques: a report on 50 patients , 2005, Acta Neurochirurgica.

[30]  O. Suess,et al.  Intra-Operative Mapping of the Motor Cortex During Surgery in and Around the Motor Cortex , 2000, Acta Neurochirurgica.

[31]  W. Campbell,et al.  DeJong's The neurologic examination. , 1992 .

[32]  M. Nuwer.  Localization of Motor Cortex with Median Nerve Somatosensory Evoked Potentials , 1991 .

[33]  G A Ojemann,et al.  Neurophysiological monitoring during astrocytoma surgery. , 1990, Neurosurgery clinics of North America.

[34]  G A Ojemann,et al.  Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors. , 1989, Neurosurgery.

[35]  C C Wood,et al.  Human cortical potentials evoked by stimulation of the median nerve. II. Cytoarchitectonic areas generating long-latency activity. , 1989, Journal of neurophysiology.

[36]  C. C. Wood,et al.  Localization of human sensorimotor cortex during surgery by cortical surface recording of somatosensory evoked potentials. , 1988, Journal of neurosurgery.

[37]  T. Aiba,et al.  Intraoperative identification of the central sulcus: a practical method. , 1988, Acta neurochirurgica. Supplementum.

[38]  V. Amassian,et al.  Physiological basis of motor effects of a transient stimulus to cerebral cortex. , 1987, Neurosurgery.

[39]  V E Amassian,et al.  Human cerebral cortical responses to contralateral transcranial stimulation. , 1987, Neurosurgery.

[40]  B. L. Grundy.  Intraoperative monitoring of sensory-evoked potentials. , 1983, Anesthesiology.

[41]  A. Starr,et al.  Assessment of sensory function in the operating room utilizing cerebral evoked potentials: a study of fifty-six surgically anesthetized patients. , 1981, Clinical neurosurgery.