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Transcranial motor-evoked potentials disappear with pons transection.

Ryota Sasaki1, Tae Kyun Kim2, Tsunenori Takatani3

  • 1Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8552, Japan. ryotasasaki2601@gmail.com.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|August 21, 2024
PubMed
Summary

Motor-evoked potential (MEP) monitoring during neurosurgery can be unreliable. A case study shows transcranial electrical stimulation (TES) MEPs disappeared with pons transection, highlighting the importance of interpreting these findings cautiously.

Keywords:
Cerebellar anaplastic ependymomaIntraoperative motor-evoked potentialPediatric craniotomyPonsTetanic stimulation

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Area of Science:

  • Neurosurgery
  • Neurophysiology
  • Neurology

Background:

  • Motor-evoked potential (MEP) monitoring via transcranial electrical stimulation (TES) is crucial for assessing motor function during neurosurgery.
  • However, false-negative MEP results can occur, necessitating careful interpretation of monitoring data.

Observation:

  • A 5-year-old patient with cerebellar anaplastic ependymoma underwent surgery for a recurrent tumor in the left anterior pons.
  • Intraoperative transcranial electrical stimulation (TES) of the operative side resulted in the disappearance of motor-evoked potentials (MEPs), despite increased stimulation intensity.
  • Contralateral TES consistently showed stable MEPs throughout the procedure.

Findings:

  • The disappearance of MEPs on the operative side correlated with a pons transection during tumor resection.
  • Complete tumor resection was confirmed postoperatively.
  • Post-surgery, the patient experienced temporary flaccid paralysis, which later recovered to preoperative levels.

Implications:

  • Transcranial MEPs cannot be elicited if the corticospinal tract is transected at the pons level.
  • Intraoperative MEP monitoring using TES can accurately reflect corticospinal tract integrity when the injury is located caudal to the pons.
  • These findings underscore the critical role of lesion location in the interpretation of MEP monitoring during neurosurgical procedures.