Visualizing Intraoperative Transcranial Motor-Evoked Potentials During Glioma Surgery for Predicting Postoperative Paralysis Prognosis.

IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY
World neurosurgery Pub Date : 2025-02-01 Epub Date: 2024-11-21 DOI:10.1016/j.wneu.2024.10.110
Atsushi Kuwano, Manabu Tamura, Hidetsugu Asano, Tomoko Yamaguchi, Jose Gomez-Tames, Takakazu Kawamata, Ken Masamune, Yoshihiro Muragaki
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引用次数: 0

Abstract

Objective: The primary goals of glioma surgery are maximal tumor resection and preservation of brain function. Intraoperative motor-evoked potential (MEP) monitoring is commonly used to predict and minimize postoperative paralysis. However, studies on intraoperative MEP trends and postoperative paralysis are scarce. This study aimed to determine the relationship between intraoperative MEP trends and postoperative paralysis.

Methods: This retrospective study evaluated 229 patients with supratentorial glioma without preoperative paralysis who underwent tumor resection surgery under general anesthesia at our institution between October 2019 and December 2022. Intraoperative transcranial MEP monitoring was performed, and the entire MEP trends on affected and unaffected sides were visualized. Postoperative paralysis and patient-related factors were analyzed.

Results: Postoperative paralysis occurred in 36 patients, with the paralysis improving over time and being permanent in 30 and 6 patients, respectively. In the improvement group, the temporary decrease in transcranial MEP rapidly improved. Even when the MEPs were <50% of the control value, fluctuations indicating improvement were observed after the decrease. However, in the permanent paralysis group, transcranial MEP remained consistently <50% of the control value until the end of surgery, after its initial decrease. The significant factors contributing to permanent paralysis were tumor localization close to the pyramidal tract (P = 0.0304) and postoperative cerebral infarction in the pyramidal tract (P = 0.0009).

Conclusions: The overall intraoperative MEP trend can reflect the risk of postoperative paralysis during glioma surgery. Thus, visualizing this trend can provide a better understanding of the prognosis of postoperative paralysis.

在胶质瘤手术中可视化术中经颅运动诱发电位,以预测术后瘫痪的预后。
目的:胶质瘤手术的主要目标是最大限度地切除肿瘤和保留脑功能。术中运动诱发电位(MEP)监测通常用于预测和减少术后瘫痪。然而,有关术中 MEP 趋势和术后瘫痪的研究却很少。本研究旨在确定术中 MEP 趋势与术后瘫痪之间的关系:这项回顾性研究评估了我院2019年10月至2022年12月期间在全身麻醉下接受肿瘤切除手术的229例无术前瘫痪的幕上胶质瘤患者。术中进行了经颅MEP监测,并观察了患侧和非患侧的整个MEP趋势。对术后瘫痪和患者相关因素进行了分析:结果:36 例患者出现术后瘫痪,其中 30 例和 6 例患者的瘫痪随着时间的推移有所改善,6 例为永久性瘫痪。在改善组中,经颅 MEP 的暂时性下降迅速得到改善。即使在 MEP 为结论时也是如此:术中 MEP 的整体趋势可以反映胶质瘤手术中术后瘫痪的风险。因此,观察这一趋势可以更好地了解术后瘫痪的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
World neurosurgery
World neurosurgery CLINICAL NEUROLOGY-SURGERY
CiteScore
3.90
自引率
15.00%
发文量
1765
审稿时长
47 days
期刊介绍: World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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