%0 Journal Article
%T Chronological Changes in Transcranial Motor Evoked Potential during Anterior Temporal Lobectomy in Patients with Temporal Lobe Epilepsy: A Single Center Cross-Sectional Analytic Study.
%A Kubota Y
%A Prado M
%A Fukuchi S
%A Miyao S
%A Nakamoto H
%J World Neurosurg
%V 0
%N 0
%D 2024 Jun 18
%M 38901482
%F 2.21
%R 10.1016/j.wneu.2024.06.079
%X <B>OBJECTIVE: </B>Despite the benefits of anterior temporal lobectomy with amygdalohippocampectomy (ATL+AH) in patients with temporal lobe epilepsy (TLE), approximately up to 5% may have hemiparesis as its postoperative complication. This paper aims to describe which step/s of the ATL with AH have the highest probability of having greatest decrease in MEP amplitude.<BR><B>METHODS: </B>This study utilized a cross-sectional design of obtaining data from TLE patients who underwent ATL+AH with TcMEP monitoring. Each of the following steps were evaluated for reduction in MEP amplitude: 1) Dural Opening, 2) Opening the inferior horn, 2) Vertical temporal lobe resection 3) Subpial dissection, 4) Temporal lobe stem resection, 5) Lateral temporal lobe resection, 6) Hippocampal Resection, 7) Amygdala Resection, 8) Uncus resection and 9) Dural Closure.<BR><B>RESULTS: </B>Nineteen patients were included in the study. Based on Friedman Test, one or more steps had significantly different average MEP amplitude reductions (Friedman=50.7, p=0.0001). When compared to baseline (100%, cut off p=0.005), hippocampal resection (z=-3.81, p<0.0001), T1 subpial dissection (z=-3.2, p=0.0010), uncus resection (z=-3.48, p=0.0002), temporal stem resection (z=-3.26, p=0.001), lateral temporal lobe resection (z=-3.13, p=0.002) and amygdalectomy (-z=-3.37, p=0.0005) were significantly lower. Of these, hippocampal resection, uncus resection and amygdalectomy were deemed highly significant.<BR><B>CONCLUSIONS: </B>MEP amplitude tends to decrease during amygdala, hippocampal and uncal resection because of surgical manipulation of choroidal arteries which can potentially cause hemiparesis so careful attention should be paid to changes in MEP during these steps.