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Brainstem

Brainstem

The brainstem, located inferior to the brain and superior to the spinal cord, serves as a bridge between the cerebrum and the spinal cord. It plays a vital role in relaying information and controlling critical life functions. It comprises three primary regions: the midbrain, pons, and medulla oblongata.
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Intraoperative preservation of corticospinal function in the brainstem.

G Neuloh¹, J Bogucki, J Schramm

¹Department of Neurosurgery, University Hospital, Bonn, Germany. neuloh@ukb.uni-bonn.de

Journal of Neurology, Neurosurgery, and Psychiatry

|December 17, 2008

Summary

Motor-evoked potential (MEP) monitoring effectively tracks corticospinal function during brainstem surgery. Changes in MEPs can help predict and prevent new motor deficits, offering a valuable tool for surgical safety.

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Area of Science:

Neurosurgery
Neurophysiology
Neurology

Background:

The corticospinal tract's vulnerability during brainstem surgery necessitates reliable monitoring methods.
Large-scale case series on motor-evoked potential (MEP) monitoring in brainstem procedures are lacking.

Purpose of the Study:

To analyze intraoperative MEP changes during brainstem-related surgeries.
To evaluate the efficacy of MEP monitoring in preventing permanent new paresis.

Main Methods:

Myogenic MEPs were monitored using transcranial electrical train stimulation in 70 patients with brainstem lesions (intraparenchymal and extraparenchymal).
MEP recordings failed in 5 cases; motor outcomes were prospectively documented and correlated with MEP findings.

Main Results:

Significant MEP changes were observed in 46% of cases.
Stable or reversibly deteriorating MEPs correlated with unimpaired motor outcomes (71%).
Irreversible MEP deterioration or loss indicated a 37% risk of transient deficit, and irreversible loss predicted permanent paresis (1.5%).

Conclusions:

MEP monitoring is a reliable indicator of corticospinal tract function during brainstem surgery, outperforming somatosensory-evoked potentials (SEPs).
While pronounced MEP changes are needed to predict deficits compared to supratentorial surgery, MEPs can help prevent permanent motor deficits.