Artikel
Intraoperative neurophysiological monitoring during resection of brainstem cavernomas
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Autoren
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Ehab Shiban
- Neurochirurgische Klinik, Technische Universität München
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Maria Wostrack
- Neurochirurgische Klinik, Technische Universität München
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Jens Lehmberg
- Neurochirurgische Klinik, Technische Universität München
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Bernhard Meyer
- Neurochirurgische Klinik, Technische Universität München
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Removal of brain stem cavernomas is one of the most difficult procedures in neurosurgery. Intraoperative monitoring is used to avoid impending damage to these highly eloquent structures. However, data of neurophysiological monitoring during brain stem surgery is lacking.
Method: Consecutive patients with brain stem cavernomas lesions who underwent surgical removal from June 2007 to December 2012 were retrospectively analyzed. Transcranial Motor evoked potential (MEP) and somatosensory evoked potential (SSEP) were performed in all cases. The monitoring data were reviewed and related to new postoperative motor deficit and postoperative imaging. Clinical outcomes were assessed during follow-up.
Results: 19 consecutive cases of brain stem cavernomas were identified. 10 patients were female (52%); mean age was 47 years. 4 (21%) patients had multiple cavernomas. MEP and SSEP Monitoring was successful in 18 cases (94%). In 13 (72%) cases, MEPs were stable throughout the operation, but 3 patients (28%) developed a new neurological deficit. In 5 cases (27%) MEP and SSEP were permanently lost, but only two patient had a permanent new neurological deficit. In 12 (66%) cases, SSEPs were stable throughout the operation, but 3 patients (28%) developed a new neurological deficit. In 6 cases (33%) SSEPs were permanently lost, but only two patients had a permanent new neurological deficit. Neurological status had improved or remained the same in 13 (68%) patients, in 11 (85%) of those cases a lateral approach was chosen for cavernoma removal. 6 (31%) patients developed a new neurological deficit. For 5 (26%) of those patients, a midline approach was chosen for cavernoma removal.
Conclusions: Continuous MEP and SSEP monitoring do not provide sufficient monitoring during removal of brain stem cavernomas, as high rates of false positive and false negative results are encountered. Lateral approaches seem better than midline approaches for removal of brainstem cavernoma, as higher rates of neurological deterioration are seen following a midline approach.
