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Prediction of postoperative motor deficits using intraoperative motor-evoked potentials in middle cerebral artery
Dongze Guo1, Xing Fan1, Hao You1
1Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, 119 Fanyang Road, Beijing, 100070, China.
Abstract:
To explore the relationship between postoperative motor deficits and the duration of reduced motor-evoked potentials (MEPs) in patients with middle cerebral artery (MCA) aneurysm. This study included 285 cases of MCA aneurysm treated with clipping surgery with MEP monitoring. The effects of MEP changes on postoperative motor function were assessed, and the key time point for minimizing the incidence of postoperative motor dysfunction was found through receiver operating characteristic (ROC) curve analysis. Motor dysfunction was significantly associated with the occurrence of MEP changes, and patients with irreversible changes were more likely to suffer motor dysfunction than were those with reversible changes. The critical duration of MEP changes that minimized the risk of postoperative motor dysfunction was 8.5 min. This study revealed that MEP monitoring is an effective method for preventing ischemic brain injury during surgical treatment of MCA aneurysm and proposes a critical cutoff for the duration of MEP deterioration of 8.5 min for predicting postoperative motor dysfunction.
Insights
Motor-evoked potentials (MEPs) monitoring during middle cerebral artery (MCA) aneurysm surgery can predict motor deficits. A MEP change duration exceeding 8.5 minutes significantly increases the risk of postoperative motor dysfunction.
Area of Science:
- Neurosurgery
- Neurology
- Medical Monitoring
Background:
- Middle cerebral artery (MCA) aneurysms pose a risk of neurological deficits after surgical treatment.
- Motor-evoked potentials (MEPs) are utilized during surgery to monitor neural integrity.
- Predicting postoperative motor deficits is crucial for patient outcomes.
Purpose of the Study:
- To investigate the correlation between the duration of reduced MEPs and the occurrence of postoperative motor deficits in MCA aneurysm patients.
- To identify a critical MEP change duration threshold for predicting motor dysfunction.
- To evaluate the efficacy of MEP monitoring in preventing ischemic brain injury during MCA aneurysm surgery.
Main Methods:
- Retrospective analysis of 285 patients undergoing clipping surgery for MCA aneurysms with MEP monitoring.
- Assessment of the relationship between MEP changes (reversible vs. irreversible) and postoperative motor function.
- Receiver operating characteristic (ROC) curve analysis to determine the critical duration of MEP changes.
Main Results:
- Motor dysfunction was significantly associated with the presence of MEP changes.
- Patients experiencing irreversible MEP changes had a higher likelihood of motor dysfunction.
- A critical MEP deterioration duration of 8.5 minutes was identified as a predictor of postoperative motor dysfunction.
Conclusions:
- MEP monitoring is an effective tool for preventing ischemic brain injury during MCA aneurysm surgery.
- A MEP deterioration duration of 8.5 minutes serves as a critical cutoff for predicting postoperative motor deficits.
- This finding aids in optimizing surgical strategies and patient management for MCA aneurysms.
