Abstract：
OBJECTIVE: Iatrogenic neurologic deficits adversely affect patient outcomes following brain tumor resection. Motor evoked potential (MEP) monitoring allows surgeons to assess the integrity of motor-eloquent areas in real-time during tumor resection to lessen the risk of iatrogenic insult. We retrospectively associate intraoperative transcranial and direct cortical MEPs (TC-MEPs, DC-MEPs) to early and late post-operative motor function to prognosticate short- and long-term motor recovery in brain tumor patients undergoing surgical resection in peri-eloquent regions.
METHODS: We reviewed 121 brain tumor patients undergoing craniotomies with DC-MEP and/or TC-MEP monitoring. Motor function scores were recorded at multiple time-points up to 1 year postoperatively. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated at each time point.
RESULTS: The sensitivity, specificity, PPV, and NPV of TC-MEP in the immediate postoperative period was 17.5%, 100%, 100%, and 69.4%, respectively. For DC-MEP monitoring, the respective values were 25.0%, 100%, 100%, and 68.8%. By discharge, sensitivity had increased for both TC-MEP and DC MEPs to 43.8%, and 50.0% respectively. Subset analysis on patients without tumor recurrence/progression at long term follow-up (n = 62 pts, 51.2%) found that all patients with stable monitoring maintained or improved from preoperative status. One patient with transient intraoperative TC-MEP loss and permanent DC-MEP loss suffered a permanent deficit.
CONCLUSIONS: Brain tumor patients who undergo surgery with intact MEP monitoring and experience new postoperative deficits likely suffer transient deficits that will improve over the postoperative course in the absence of disease progression.
METHODS: We reviewed 121 brain tumor patients undergoing craniotomies with DC-MEP and/or TC-MEP monitoring. Motor function scores were recorded at multiple time-points up to 1 year postoperatively. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated at each time point.
RESULTS: The sensitivity, specificity, PPV, and NPV of TC-MEP in the immediate postoperative period was 17.5%, 100%, 100%, and 69.4%, respectively. For DC-MEP monitoring, the respective values were 25.0%, 100%, 100%, and 68.8%. By discharge, sensitivity had increased for both TC-MEP and DC MEPs to 43.8%, and 50.0% respectively. Subset analysis on patients without tumor recurrence/progression at long term follow-up (n = 62 pts, 51.2%) found that all patients with stable monitoring maintained or improved from preoperative status. One patient with transient intraoperative TC-MEP loss and permanent DC-MEP loss suffered a permanent deficit.
CONCLUSIONS: Brain tumor patients who undergo surgery with intact MEP monitoring and experience new postoperative deficits likely suffer transient deficits that will improve over the postoperative course in the absence of disease progression.
摘要：
目的：医源性神经功能缺损对脑肿瘤切除术后患者预后产生不利影响。运动诱发电位（MEP）监测允许外科医生在肿瘤切除期间实时评估运动能动区域的完整性，以减少医源性损伤的风险。我们回顾性地将术中经颅和直接皮质MEP（TC-MEP，DC-MEP）术后早期和晚期运动功能，以预测在周围地区接受手术切除的脑肿瘤患者的短期和长期运动恢复。
方法：我们回顾了121例接受DC-MEP和/或TC-MEP监测的开颅手术的脑肿瘤患者。在术后1年的多个时间点记录运动功能评分。灵敏度,特异性，以及阳性和阴性预测值(PPV，在每个时间点计算NPV)。
结果：灵敏度，特异性，PPV,术后即刻TC-MEP的NPV为17.5%，100%,100%,和69.4%，分别。对于DC-MEP监控，各自的值为25.0%，100%,100%,和68.8%。通过放电，TC-MEP和DCMEP的灵敏度均提高至43.8%，分别为50.0%。长期随访中无肿瘤复发/进展患者的子集分析（n=62pts，51.2％）发现所有稳定监测的患者均维持或改善了术前状态。1例短暂术中TC-MEP丢失和永久性DC-MEP丢失的患者出现永久性缺陷。
结论：接受完整MEP监测手术并出现新的术后缺陷的脑肿瘤患者可能会出现一过性缺陷，在没有疾病进展的情况下，这些缺陷会在术后过程中得到改善。
方法：我们回顾了121例接受DC-MEP和/或TC-MEP监测的开颅手术的脑肿瘤患者。在术后1年的多个时间点记录运动功能评分。灵敏度,特异性，以及阳性和阴性预测值(PPV，在每个时间点计算NPV)。
结果：灵敏度，特异性，PPV,术后即刻TC-MEP的NPV为17.5%，100%,100%,和69.4%，分别。对于DC-MEP监控，各自的值为25.0%，100%,100%,和68.8%。通过放电，TC-MEP和DCMEP的灵敏度均提高至43.8%，分别为50.0%。长期随访中无肿瘤复发/进展患者的子集分析（n=62pts，51.2％）发现所有稳定监测的患者均维持或改善了术前状态。1例短暂术中TC-MEP丢失和永久性DC-MEP丢失的患者出现永久性缺陷。
结论：接受完整MEP监测手术并出现新的术后缺陷的脑肿瘤患者可能会出现一过性缺陷，在没有疾病进展的情况下，这些缺陷会在术后过程中得到改善。
