Sensitivity and specificity in transcranial motor-evoked potential monitoring during neurosurgical operations

Intraoperative transcranial motor-evoked potential (TCMEP) monitoring is widely performed during neurosurgical operations. Sensitivity and specificity in TCMEP during neurosurgical operations were examined according to the type of operation.

TCMEP monitoring was performed during 283 neurosurgical operations for patients without preoperative motor palsy, including 121 spinal operations, 84 cerebral aneurysmal operations, and 31 brain tumor operations. Transcranial stimulation at 100-600 V was applied by screw electrodes placed in the scalp and electromyographic responses were recorded with surface electrodes placed on the affected muscles. To exclude the effects of muscle relaxants on TCMEP, compound muscle action potential (CMAP) by supramaximal stimulation of the peripheral nerve immediately after transcranial stimulation was used for compensation of TCMEP.

In spinal operations, with an 80% reduction in amplitude as the threshold for motor palsy, the sensitivity and specificity with CMAP compensation were 100% and 96.4%, respectively. In aneurysmal operations, with a 70% reduction in amplitude as the threshold for motor palsy, the sensitivity and specificity with CMAP compensation were 100% and 94.8%, respectively. Compensation by CMAP was especially useful in aneurysmal operations. In all neurosurgical operations, with a 70% reduction in amplitude as the threshold for motor palsy, the sensitivity and specificity with CMAP compensation were 95.0% and 90.9%, respectively.

Intraoperative TCMEP monitoring is a significantly reliable method for preventing postoperative motor palsy in both cranial and spinal surgery. A 70% reduction in the compensated amplitude is considered to be a suitable alarm point in all neurological operations.