Academic Journal
Evaluation of the High-Frequency Monopolar Stimulation Technique for Mapping and Monitoring the Corticospinal Tract in Patients With Supratentorial Gliomas. A Proposal for Intraoperative Management Based on Neurophysiological Data Analysis in a Series of 92 Patients
| العنوان: | Evaluation of the High-Frequency Monopolar Stimulation Technique for Mapping and Monitoring the Corticospinal Tract in Patients With Supratentorial Gliomas. A Proposal for Intraoperative Management Based on Neurophysiological Data Analysis in a Series of 92 Patients |
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| المؤلفون: | Plans, Gerard, Fernández-Conejero, Isabel, Rifà-Ros, Xavier, Fernández-Coello, Alejandro, Rosselló, Aleix, Gabarrós, Andreu |
| المصدر: | Neurosurgery ; volume 81, issue 4, page 585-594 ; ISSN 0148-396X 1524-4040 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health) |
| سنة النشر: | 2017 |
| الوصف: | BACKGROUND Intraoperative identification and preservation of the corticospinal tract is often necessary for glioma resection. OBJECTIVE To make a proposal for intraoperative management with the high-frequency monopolar stimulation technique for monitoring the corticospinal tract. METHODS Ninety-two patients operated on with the assistance of the high-frequency monopolar stimulation. Clinical and neurophysiological data have been related with the motor status at 3 months to establish prognostic factors of motor deterioration. RESULTS Twenty-one patients (22.8%) presented intraoperative alterations in motor-evoked potentials (MEPs). Twelve (13%) presented an increment in the MEP threshold ≥5 mA (no deficit at 3 months). Two (2.2%) presented an MEP amplitude reduction >50% (100% deficit at 3 months). Seven (7.6%) had an intraoperative MEP loss (80% deficit at 3 months). Subcortical stimulation was positive in 75 patients (81.5%). Eighty-five patients were available for the analysis at 3 months. Fourteen presented new deficits (16.5%). Among them, 5 presented a deficit in nonmonitored muscles (5.9%) and 1 presented a new deficit not detected intraoperatively. The combination of patients with preoperative motor deficits, MEP deterioration, or loss and intensity of subcortical stimulation ≤3 mA showed the highest sensitivity and specificity in the prediction of new deficits. CONCLUSIONS Persistent MEP loss or deterioration is associated with a high probability of new deficits. It seems recommendable to stop the subcortical resection before obtaining a subcortical MEP threshold at 3 mA especially in patients with preoperative motor deficits. A careful selection of muscles for the registration of MEPs is mandatory to avoid deficits in nonmonitored muscles. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.1093/neuros/nyw087 |
| الاتاحة: | http://dx.doi.org/10.1093/neuros/nyw087 https://journals.lww.com/00006123-201710000-00004 |
| رقم الانضمام: | edsbas.F973807F |
| قاعدة البيانات: | BASE |
| DOI: | 10.1093/neuros/nyw087 |
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