Schiavao Lucas Jose Vaz, Neville Ribeiro Iuri, Yukie Hayashi Cintya, Gadelha Figueiredo Eberval, Russowsky Brunoni Andre, Jacobsen Teixeira Manoel, Pokorny Gabriel, Silva Paiva Wellingson
Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo- FMUSP - University of São Paulo, São Paulo, Brazil.
Neurology, Instituto do Câncer do Estado de São Paulo - ICESP, São Paulo, Brazil.
Neuropsychiatr Dis Treat. 2022 Jun 16;18:1219-1235. doi: 10.2147/NDT.S359855. eCollection 2022.
The brain tumor is frequently related to severe motor impairment and impacts the quality of life. The corticospinal tract can sometimes be affected depending on the type and size of the neoplasm, so different tools can evaluate motor function and connections. It is essential to organize surgical procedures and plan the approach. Functional motor status is mapped before, during, and after surgery. Studying corticospinal tract status can help map the functional areas, predict postoperative outcomes, and help the decision, reducing neurological deficits, aiming to preserve functional networks, using the concepts of white matters localization and fibbers connections. Nowadays, there are new techniques that provide functional information regarding the motor cortex, such as transcranial magnetic stimulation (TMS), direct cortical stimulation (DCS), and navigated TMS (nTMS). These tools can be used to plan a customized surgical strategy and the role of motor evoked potentials (MEPs) is well described during intra-operative, using intraoperative neuromonitoring. MEPs can help to localize primary motor areas and delineate the cut-off point of resection in real-time, using direct stimulation. In the post-operative, the MEP has increased your function as a predictive marker of permanent or transitory neurological lesion marker.
Systematic review performed in MEDLINE via PUBMED, EMBASE, and SCOPUS databases regarding the post-operative assessment of MEP in patients with brain tumors. The search strategy included the following terms: (("Evoked Potentials, Motor"[Mesh]) AND "Neoplasms"[Mesh]) AND "Transcranial Magnetic Stimulation"[Mesh] AND "Brain Tumor"[Mesh]), the analysis followed the PRISMA guidelines for systematic reviews, the review spanned until 06/04/2021, inclusion criteria were studies presenting confirmed diagnosis of brain tumor (primary or metastatic), patients >18 y/o, using TMS, Navigated TMS, and/or Evoked Potentials as tools in preoperative planning or at the intra-operative helping the evaluation of the neurological status of the motor cortex, articles published in peer-reviewed journals, and written in English or Portuguese.
A total of 38 studies were selected for this review, of which 14 investigated the potential of nTMS to predict the occurrence of motor deficits, while 25 of the articles investigated the capabilities of the nTMS technique in performing pre/intraoperative neuro mapping of the motor cortex.
Further studies regarding motor function assessment are needed and standardized protocols for MEPs also need to be defined.
脑肿瘤常与严重的运动功能障碍相关，影响生活质量。根据肿瘤的类型和大小，皮质脊髓束有时会受到影响，因此不同的工具可用于评估运动功能和连接情况。组织手术程序并规划手术入路至关重要。在手术前、手术中和手术后对运动功能状态进行映射。研究皮质脊髓束状态有助于映射功能区、预测术后结果并辅助决策，减少神经功能缺损，旨在利用白质定位和纤维连接的概念保留功能网络。如今，有新技术可提供有关运动皮层的功能信息，如经颅磁刺激（TMS）、直接皮质刺激（DCS）和导航经颅磁刺激（nTMS）。这些工具可用于规划定制的手术策略，运动诱发电位（MEP）在术中使用术中神经监测时的作用已得到充分描述。MEP可通过直接刺激帮助实时定位初级运动区并划定切除的界限。在术后，MEP作为永久性或暂时性神经损伤标志物的预测指标，其作用有所增强。
通过PUBMED、EMBASE和SCOPUS数据库在MEDLINE中对脑肿瘤患者术后MEP评估进行系统评价。检索策略包括以下术语：（（ “诱发电位，运动”[医学主题词] ） AND “肿瘤”[医学主题词] ） AND “经颅磁刺激”[医学主题词] AND “脑肿瘤”[医学主题词]），分析遵循PRISMA系统评价指南，该评价涵盖至2021年4月6日，纳入标准为呈现脑肿瘤（原发性或转移性）确诊诊断的研究、年龄>18岁的患者、在术前规划中或术中使用TMS、导航TMS和/或诱发电位作为评估运动皮层神经状态的工具、发表在同行评审期刊上且用英语或葡萄牙语撰写的文章。
本评价共纳入38项研究，其中14项研究了nTMS预测运动功能缺损发生的潜力，25篇文章研究了nTMS技术在进行运动皮层术前/术中神经映射方面的能力。
需要进一步开展关于运动功能评估的研究，还需要定义MEP的标准化方案。
