Ann Rehabil Med.  2018 Oct;42(5):767-772. 10.5535/arm.2018.42.5.767.

Limitation of Intraoperative Transcranial Electrical Stimulation-Motor Evoked Potential Monitoring During Brain Tumor Resection Adjacent to the Primary Motor Cortex

• Do HJ
• Seo HG
• Oh BM
• Park CK
• Kim JW
• Choi YD
• Lee SH

• KMID: 2429206
• DOI: http://doi.org/10.5535/arm.2018.42.5.767

Abstract

Transcranial electrical stimulation-motor evoked potential (TES-MEP) is a valuable intraoperative monitoring technique during brain tumor surgery. However, TES can stimulate deep subcortical areas located far from the motor cortex. There is a concern about false-negative results from the use of TES-MEP during resection of those tumors adjacent to the primary motor cortex. Our study reports three cases of TES-MEP monitoring with false-negative results due to deep axonal stimulation during brain tumor resection. Although no significant change in TES-MEP was observed during surgery, study subjects experienced muscle weakness after surgery. Deep axonal stimulation of TES could give false-negative results. Therefore, a combined method of TES-MEP and direct cortical stimulation-motor evoked potential (DCS-MEP) or direct subcortical stimulation should be considered to overcome the limitation of TES-MEP.

Keyword

Transcranial electrical stimulation; Direct cortical stimulation; Intraoperative monitoring

MeSH Terms

Axons
Brain Neoplasms*
Brain*
Evoked Potentials*
Methods
Monitoring, Intraoperative
Motor Cortex*
Muscle Weakness
Transcranial Direct Current Stimulation

Figure

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  Fig. 1. Preoperative (A) and postoperative (B) axial T2-weighted magnetic resonance images of a lesion at the left precentral gyrus and area adja cent to the middle frontal gyrus which was removed with intraoperative tran scranial electrical stimulation-motor evoked potential monitoring (see illustrative Patient 1). (C) Tracing shows transcranial electrical stimulation-motor evoked potential (TES-MEP) during the surgery. MEP amplitude was significantly decreased in the right lower extremity, but not in the right upper extremity.

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  Fig. 2. Preoperative (A) and postoperative (B) axial T2-weighted magnetic resonance images of a lesion at the left high frontal lobe involving the precentral gyrus which was removed with intraoperative transcranial electrical stimulation-motor evoked potential monitoring (see illustrative Patient 2). (C) Tracing shows transcranial electrical stimulation-motor evoked potential (TES-MEP) during surgery. No significant change in TES-MEP was observed.

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  Fig. 3. Preoperative (A) and postoperative (B) axial T2-weighted magnetic resonance images of a lesion at the left fronto-parietal lobe involving the precentral gyrus which was removed with intraoperative transcranial electrical stimulation and direct cortical stimulation-motor evoked potential monitoring (see illustrative Patient 3). (C) Tracing shows transcranial electrical stimulation-motor evoked potential (TES-MEP; waves other than arrow) and direct cortical stimulation-motor evoked potential (DCS-MEP; arrow) during surgery. While no significant change in TES-MEP of the right extremities was observed during surgery, significant loss in DCS-MEP was observed (arrow).

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