Giampiccolo Davide, Parisi Cristiano, Meneghelli Pietro, Tramontano Vincenzo, Basaldella Federica, Pasetto Marco, Pinna Giampietro, Cattaneo Luigi, Sala Francesco
Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Verona, Italy.
Division of Neurology and Intraoperative Neurophysiology Unit, University Hospital, Verona, Italy.
Brain Commun. 2021 Jan 23;3(1):fcaa226. doi: 10.1093/braincomms/fcaa226. eCollection 2021.
Muscle motor-evoked potentials are commonly monitored during brain tumour surgery in motor areas, as these are assumed to reflect the integrity of descending motor pathways, including the corticospinal tract. However, while the loss of muscle motor-evoked potentials at the end of surgery is associated with long-term motor deficits (muscle motor-evoked potential-related deficits), there is increasing evidence that motor deficit can occur despite no change in muscle motor-evoked potentials (muscle motor-evoked potential-unrelated deficits), particularly after surgery of non-primary regions involved in motor control. In this study, we aimed to investigate the incidence of muscle motor-evoked potential-unrelated deficits and to identify the associated brain regions. We retrospectively reviewed 125 consecutive patients who underwent surgery for peri-Rolandic lesions using intra-operative neurophysiological monitoring. Intraoperative changes in muscle motor-evoked potentials were correlated with motor outcome, assessed by the Medical Research Council scale. We performed voxel-lesion-symptom mapping to identify which resected regions were associated with short- and long-term muscle motor-evoked potential-associated motor deficits. Muscle motor-evoked potentials reductions significantly predicted long-term motor deficits. However, in more than half of the patients who experienced long-term deficits (12/22 patients), no muscle motor-evoked potential reduction was reported during surgery. Lesion analysis showed that muscle motor-evoked potential-related long-term motor deficits were associated with direct or ischaemic damage to the corticospinal tract, whereas muscle motor-evoked potential-unrelated deficits occurred when supplementary motor areas were resected in conjunction with dorsal premotor regions and the anterior cingulate. Our results indicate that long-term motor deficits unrelated to the corticospinal tract can occur more often than currently reported. As these deficits cannot be predicted by muscle motor-evoked potentials, a combination of awake and/or novel asleep techniques other than muscle motor-evoked potentials monitoring should be implemented.
在脑肿瘤手术中，运动区的肌肉运动诱发电位通常会被监测，因为这些电位被认为能反映下行运动通路的完整性，包括皮质脊髓束。然而，虽然手术结束时肌肉运动诱发电位的消失与长期运动功能缺损（与肌肉运动诱发电位相关的缺损）有关，但越来越多的证据表明，即使肌肉运动诱发电位没有变化（与肌肉运动诱发电位无关的缺损），运动功能缺损也可能发生，特别是在涉及运动控制的非主要区域手术后。在本研究中，我们旨在调查与肌肉运动诱发电位无关的缺损的发生率，并确定相关的脑区。我们回顾性分析了125例连续接受罗兰多周围病变手术并术中进行神经生理监测的患者。术中肌肉运动诱发电位的变化与运动结果相关，运动结果通过医学研究委员会量表进行评估。我们进行了体素病变症状映射，以确定哪些切除区域与短期和长期的与肌肉运动诱发电位相关的运动缺损有关。肌肉运动诱发电位的降低显著预测了长期运动缺损。然而，在超过一半经历长期缺损的患者（12/22例患者）中，手术期间未报告肌肉运动诱发电位降低。病变分析表明，与肌肉运动诱发电位相关的长期运动缺损与皮质脊髓束的直接或缺血性损伤有关，而与肌肉运动诱发电位无关的缺损发生在辅助运动区与背侧运动前区和前扣带回一并被切除时。我们的结果表明，与皮质脊髓束无关的长期运动缺损的发生率可能比目前报道的更高。由于这些缺损无法通过肌肉运动诱发电位预测，应采用除肌肉运动诱发电位监测之外的清醒和/或新型睡眠技术相结合的方法。
