Article
The value of motor evoked potentials in detecting mechanical versus vascular injury during resection of supratentorial mass lesions
Der Wert motorisch evozierter Potenziale bei der Erkennung von mechanischen versus vaskulären Verletzungen während der Resektion supratentorieller Raumforderungen
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Authors
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Pablo Alvarez Abut
- Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
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Evridiki Asimakidou
- Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
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Andreas Raabe
- Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
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Kathleen Seidel
- Inselspital, Universitätsspital Bern, Universitätsklinik für Neurochirurgie, Bern, Schweiz
| Published: | May 25, 2022 |
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Outline
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Objective: During resection of supratentorial mass lesions, motor deficits might be caused by different patterns of injury: mechanical (damage of primary motor cortex/corticospinal tract), ischemic (due to coagulation of perforator arteries), or lesion of associative motor areas. Recently, we performed a scoping review to asses motor evoked potentials (MEP) warning criteria. Here we present the data of a subgroup of patients, with focus on the pattern of injury.
Methods: A systematic search of the literature using PubMed, Embase, Scopus, CINAHL and the Cochrane Library was undertaken. Inclusion criteria were electrically elicited MEP with predefined alarm criterion in anesthetized patients undergoing supratentorial brain surgery with quantitative report of motor outcome. For this subgroup analyses we focused on supratentorial parenchymal lesions.
Results: Of the included papers, 54.8% described the different injury patterns. For permanent deficits, 2 groups described exclusive mechanical injury, 6 exclusive vascular and 8 mixed patterns. For transient deficits, 3 groups described exclusive mechanical injury, 1 exclusive vascular and 3 mixed patterns.
Of 1551 cases, there were 7.8% of permanent deficits (3.2% mechanical, 2.6% vascular and 1.9% of unclear cause). For mechanical injury 38, 6 and 4 cases had irreversible, reversible and no change of MEP, respectively; whereas for vascular injury the corresponding numbers were 30, 5, and 5 (Table 1 [Tab. 1]).
For transient deficits, 27 cases were due to mechanical injury, of which 9 had irreversible, 1 reversible and 17 no change of MEP. For vascular injuries (12 cases) the corresponding numbers were 4, 5 and 3, respectively (Table 2 [Tab. 2]), with more reversible changes in vascular than mechanical cases (P=0.01-Chi square test).
Conclusion: In the group of patients with transient motor deficits, the subgroup with vascular injury had more reversible MEP changes than the mechanical injury patients. This suggests that an MEP alert may reduce permanent motor deficits caused by ischemia.
In the whole group, we observed a slight predominance of mechanical injury. Thus, mapping strategies may improve surgical guidance.
