Department of Neurosurgery, Technische Universität München, Munich, Germany.
Neurosurgery. 2012 May;70(5):1060-70; discussion 1070-1. doi: 10.1227/NEU.0b013e31823f5ade.
Resection of gliomas in or adjacent to the motor system is widely performed with intraoperative neuromonitoring (IOM). Despite the fact that data on the safety of IOM are available, the significance and predictive value of the procedure are still under discussion. Moreover, cases of false-negative monitoring affect the surgeon's confidence in IOM.
To examine cases of false-negative IOM to reveal structural explanations.
Between 2007 and 2010, we resected 115 consecutive supratentorial gliomas in or close to eloquent motor areas using direct cortical stimulation for monitoring of motor evoked potentials (MEPs). The monitoring data were reviewed and related to new postoperative motor deficit and postoperative imaging. Clinical outcomes were assessed during follow-up.
Monitoring of MEPs was successful in 112 cases (97.4%). Postoperatively, 30.3% of patients had a new motor deficit, which remained permanent in 12.5%. Progression-free follow-up was 9.7 months (range, 2 weeks-40.6 months). In 65.2% of all cases, MEPs were stable throughout the operation, but 8.9% showed a new temporary motor deficit, whereas 4.5% (5 patients) presented with permanently deteriorated motor function representing false-negative monitoring at first glance. However, these cases were caused by secondary hemorrhage, ischemia, or resection of the supplementary motor area.
Continuous MEP monitoring provides reliable monitoring of the motor system, influences the course of operation in some cases, and has to be regarded as the standard for IOM of the motor system. In our series, we found no false-negative MEP results.
在运动系统或其附近切除脑胶质瘤时，广泛采用术中神经监测（IOM）。尽管已有关于 IOM 安全性的数据，但该程序的意义和预测价值仍在讨论中。此外，假阴性监测会影响外科医生对 IOM 的信心。
检查假阴性 IOM 病例，揭示结构解释。
2007 年至 2010 年，我们在 115 例连续的额顶叶胶质瘤患者中，在接近运动区的位置或在其附近，使用直接皮质刺激监测运动诱发电位（MEPs）来监测运动。对监测数据进行了回顾，并与新的术后运动障碍和术后影像学相关联。在随访期间评估临床结果。
112 例（97.4%）的 MEP 监测成功。术后，30.3%的患者出现新的运动障碍，其中 12.5%的患者为永久性。无进展随访时间为 9.7 个月（范围，2 周-40.6 个月）。在所有病例中，65.2%的 MEP 始终稳定，但 8.9%的病例出现新的暂时性运动障碍，而 4.5%（5 例）的患者表现出永久性运动功能恶化，这乍一看是假阴性监测。然而，这些病例是由继发性出血、缺血或补充运动区切除引起的。
连续的 MEP 监测为运动系统提供了可靠的监测，在某些情况下会影响手术过程，并且必须被视为运动系统 IOM 的标准。在我们的系列中，我们没有发现假阴性 MEP 结果。
