Gadella Maria C, Dulfer Sebastiaan E, Absalom Anthony R, Lange Fiete, Scholtens-Henzen Carola H M, Groen Rob J M, Wapstra Frits H, Faber Christopher, Tamási Katalin, Sahinovic Marko M, Drost Gea
Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
J Clin Med. 2023 Feb 10;12(4):1404. doi: 10.3390/jcm12041404.
Muscle-recorded transcranial electrical stimulation motor-evoked potentials (mTc-MEPs) are used to assess the spinal cord integrity. They are commonly recorded with subcutaneous needle or surface electrodes, but the different characteristics of mTc-MEP signals recorded with the two types of electrodes have not been formally compared yet. In this study, mTc-MEPs were simultaneously recorded from the tibialis anterior (TA) muscles using surface and subcutaneous needle electrodes in 242 consecutive patients. Elicitability, motor thresholds, amplitude, area under the curve (AUC), signal-to-noise ratio (SNR), and the variability between mTc-MEP amplitudes were compared. Whereas amplitude and AUC were significantly higher in subcutaneous needle recordings ( < 0.01), motor thresholds and elicitability were similar for surface and subcutaneous needle recordings. Moreover, the SNRs were >2 in more than 99.5% of the surface and subcutaneous needle recordings, and the variability between consecutive amplitudes was not significantly different between the two recording electrode types ( = 0.34). Surface electrodes appear to be a good alternative to needle electrodes for spinal cord monitoring. They are non-invasive, can record signals at similar threshold intensities, have adequately high SNRs, and record signals with equivalent variability. Whether surface electrodes are non-inferior to subcutaneous needle electrodes in detecting motor warnings is investigated in part II of the NERFACE study.
肌肉记录的经颅电刺激运动诱发电位（mTc-MEPs）用于评估脊髓完整性。它们通常用皮下针电极或表面电极记录，但尚未对这两种电极记录的mTc-MEP信号的不同特性进行正式比较。在本研究中，对242例连续患者使用表面电极和皮下针电极同时记录胫前肌（TA）的mTc-MEPs。比较了引出率、运动阈值、波幅、曲线下面积（AUC）、信噪比（SNR）以及mTc-MEP波幅之间的变异性。皮下针记录的波幅和AUC显著更高（<0.01），而表面电极和皮下针记录的运动阈值和引出率相似。此外，在超过99.5%的表面电极和皮下针记录中SNR>2，并且两种记录电极类型之间连续波幅的变异性无显著差异（=0.34）。表面电极似乎是脊髓监测中针电极的良好替代物。它们是非侵入性的，能够在相似的阈值强度下记录信号，具有足够高的SNR，并且记录的信号变异性相当。NERFACE研究的第二部分探讨了表面电极在检测运动警示方面是否不劣于皮下针电极。
