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Corticobulbar Motor Evoked Potentials: A Systematic Review of Technical Variations.
Casey A Jarvis1, Matthew Toczylowski2, Mitali Bose2
1Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA.
Neurosurgery Practice
|May 8, 2026
Summary
Corticobulbar motor evoked potentials (coMEPs) offer continuous intraoperative neuromonitoring but face adoption challenges due to technical variations. Standardization is needed to improve sensitivity and specificity reporting for broader acceptance.
Area of Science:
- Neurosurgery
- Neuromonitoring
- Surgical Innovation
Background:
- Corticobulbar motor evoked potentials (coMEPs) were developed for continuous facial nerve monitoring during skull base surgery.
- The technique has expanded to monitor multiple cranial nerves (CNs) across various pathologies.
- Despite its potential, widespread adoption of coMEPs has been limited.
Purpose of the Study:
- To systematically map current practices and characterize variations in coMEP technical implementation and reporting.
- To understand the reasons behind the lagging adoption of coMEPs in intraoperative neuromonitoring.
- To identify areas for standardization to facilitate broader acceptance.
Main Methods:
- A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines was conducted.
- Publications reporting coMEP neuromonitoring from 2005 to December 2023 were screened and included.
- Data extraction used a standardized template for quantitative and qualitative synthesis, focusing on incidence, variability, and accuracy.
Main Results:
- 72 studies reported 2711 cases using coMEPs between 2005 and 2023.
- Significant heterogeneity in coMEP techniques (stimulation, accuracy measurement) was observed.
- While 81.9% reported clinical outcomes, only 25% compared coMEPs to other modalities; sensitivity/specificity reporting was notably low, especially for the vagus nerve.
Conclusions:
- coMEPs are a valuable evolving technique for continuous motor pathway monitoring of CNs.
- Inconsistent reporting of sensitivity and specificity limits comparisons with other neuromonitoring modalities.
- Standardization of coMEP techniques and reporting is crucial for wider adoption and acceptance.
