Chinese Journal of Contemporary Neurology and Neurosurgery (Nov 2020)
Dyskinesia predictive value of motor ⁃ evoked potential in gliomas surgery close to motor area under general anesthesia
Abstract
Objective To determine the predictive value of intraoperative motor⁃evoked potential (MEP) on the muscle strength of patients undergoing glioma close to motor area under general anesthesia. Methods A total of 49 patients were included in this study from October 2019 to March 2020. The transcranial electrical stimulation (TES), direct cortical stimulation (DCS) and subcortical stimulation (SCS) were used to locate the motor cortex and corticospinal tract (CST), and to assess the functional integrity of motor system. A decrease of ≥ 50% of the baseline amplitude of TES or DCS was regarded as an alarm criteria. Muscle strength was evaluated with "gold standard" the Medical Research Council (MRC) scale before and after operation. Results Combined application of TES⁃MEP, DCS⁃MEP and SCS⁃MEP had better results in judging the integrity of motor conduction pathway. The sensitivity and specificity of TES⁃MEP were 2/5 and 100% (44/44), the positive predictive value and negative predictive value were 2/2 and 93.62% (44/47), respectively. The sensitivity and specificity of DCS⁃MEP were 1/1 and 10/10, the positive predictive value and negative predictive value were 1/1 and 10/10, respectively. There were 5 cases (10.20%) with new dyskinesia after operation. After 3 months of follow⁃up, muscle strength of one case returned to normal. The sensitivity and specificity of TES⁃MEP were 2/4 and 100% (45/45), the positive predictive value and negative predictive value were 2/2 and 95.74% (45/47), respectively. The sensitivity and specificity of DCS⁃MEP were 1/1 and 10/10, the positive predictive value and negative predictive value were 1/1 and 10/10, respectively. Conclusions This study indicates a high false negative rate after TES⁃MEP, DCS⁃MEP results were more consistent with postoperative motor function results, but the utilization rate was low due to the lack of exposure to the precentral gyrus cortex. Combined application of TES⁃MEP, DCS⁃MEP and SCS⁃MEP are more effective in judging the integrity of motor conduction pathway. DOI:10.3969/j.issn.1672⁃6731.2020.11.006
