Poor diagnostic accuracy of transcranial motor and somatosensory evoked potential monitoring during brainstem cavernoma resection.
OBJECTIVE
Microsurgical resection of brainstem cavernomas carries a high risk of new postoperative morbidity such as cranial nerve, motor and sensory deficits as well as functional deterioration. Intraoperative monitoring is used to avoid impending damage to these highly eloquent tracts. However, data on neurophysiological monitoring during resection of brainstem cavernomas are lacking.


METHODS
Consecutive patients with brainstem cavernomas who underwent surgical removal from June 2007 to December 2014 were retrospectively analysed. Transcranial motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) monitorings were performed in all cases. The evoked potential (EP) monitoring data were reviewed and related to new postoperative motor and sensory deficits and postoperative imaging. Clinical outcomes were assessed during follow-up.


RESULTS
Twenty-six consecutive patients with brainstem cavernoma underwent 27 surgical resections within this study. MEP and SSEP monitoring was technically feasible in 26 and 27 cases, respectively. MEP sensitivity and specificity were 33 and 88 %, respectively. MEP positive and negative predictive values were 28 and 78 %, respectively. SSEP sensitivity and specificity were 20 and 81 %, respectively. SSEP positive and negative predictive values were 20 and 81 %, respectively.


CONCLUSIONS
In continuous MEP and SSEP monitoring during brainstem cavernoma microsurgery, high rates of false-positive and -negative results are encountered, resulting in low positive and relatively high negative predictive values. Careful interpretation of the intraoperative monitoring results is essential in order to avoid potentially unjustified termination of brainstem cavernoma resection.
Department of Neurosurgery, Technische Universität München, Munich, Germany. ehab.shiban@lrz.tum.de.
Ehab
E
Shiban
Department of Neurosurgery, Technische Universität München, Munich, Germany. Marinazerr@hotmail.com.
Marina
M
Zerr
Department of Radiology, Division of Neuroradiology, Technische Universität München, Munich, Germany. Thomas-huber@tum.de.
Thomas
T
Huber
Department of Radiology, Division of Neuroradiology, Technische Universität München, Munich, Germany. Boeckh-behrens@tum.de.
Tobias
T
Boeck-Behrends
Department of Neurosurgery, Technische Universität München, Munich, Germany. Maria.Wostrack@lrz.tum.de.
Maria
M
Wostrack
Department of Neurosurgery, Technische Universität München, Munich, Germany. Florian.ringel@lrz.tum.de.
Florian
F
Ringel
Department of Neurosurgery, Technische Universität München, Munich, Germany. Bernhard.Meyer@lrz.tum.de.
Bernhard
B
Meyer
Department of Neurosurgery, Technische Universität München, Munich, Germany. Jens.Lehmberg@lrz.tum.de.
Jens
J
Lehmberg
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020295:Brain Stem Neoplasms / Q000601:surgery*; D004558:Electric Stimulation; D004569:Electroencephalography; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006392:Hemangioma, Cavernous / Q000601:surgery*; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods / Q000592:standards*; D008297:Male; D008866:Microsurgery / Q000592:standards; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
Brainstem; Cavernoma; Intraoperative neuromonitoring; Predictive value; Surgery