Kuwano Atsushi, Tamura Manabu, Asano Hidetsugu, Yamaguchi Tomoko, Gomez-Tames Jose, Kawamata Takakazu, Masamune Ken, Muragaki Yoshihiro
Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku City, Japan; Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Shinjuku City, Japan.
Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku City, Japan; Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Shinjuku City, Japan.
World Neurosurg. 2025 Feb;194:123381. doi: 10.1016/j.wneu.2024.10.110. Epub 2024 Nov 21.
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.
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.
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).
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.
脑胶质瘤手术的主要目标是最大程度地切除肿瘤并保留脑功能。术中运动诱发电位（MEP）监测常用于预测并尽量减少术后瘫痪。然而，关于术中MEP变化趋势与术后瘫痪的研究较少。本研究旨在确定术中MEP变化趋势与术后瘫痪之间的关系。
本回顾性研究评估了2019年10月至2022年12月期间在我院接受全身麻醉下肿瘤切除手术的229例幕上胶质瘤患者，这些患者术前无瘫痪症状。术中进行经颅MEP监测，并将患侧和健侧的整个MEP变化趋势可视化。分析术后瘫痪情况及患者相关因素。
36例患者出现术后瘫痪，随着时间推移，瘫痪情况有所改善，其中30例为永久性瘫痪，6例为暂时性瘫痪。在改善组中，经颅MEP的暂时下降迅速得到改善。即使MEP低于对照值的50%，下降后仍观察到有改善的波动。然而，在永久性瘫痪组中，经颅MEP在最初下降后直至手术结束一直持续低于对照值的50%。导致永久性瘫痪的重要因素是肿瘤位置靠近锥体束（P = 0.0304）和锥体束术后脑梗死（P = 0.0009）。
脑胶质瘤手术中MEP的总体变化趋势可反映术后瘫痪的风险。因此，可视化这一趋势有助于更好地了解术后瘫痪的预后情况。
