gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Differences of functional preserving resection of supratentorial motor eloquent gliomas and metastases from an electrophysiological view

Meeting Abstract

  • S.M. Krieg - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • M. Schäffner - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • E. Shiban - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • B. Meyer - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • F. Ringel - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 078

DOI: 10.3205/12dgnc465, URN: urn:nbn:de:0183-12dgnc4651

Published: June 4, 2012

© 2012 Krieg et al.
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Outline

Text

Objective: Intraoperative neuromonitoring (IOM) is routinely used for resection of gliomas within the motor system whereas resection of cerebral metastases in these regions is still frequently performed without IOM, because they are suggested to be non-infiltrative lesions. Because the infiltrative nature of cerebral metastases has been shown recently, this work investigates the differences of IOM during resection of motor eloquently located cerebral metastases compared to motor eloquent gliomas in order to evaluate the value, reliability, and consequences of IOM for resection of cerebral metastases within the motor system.

Methods: Between 2006 and 2011 we resected a consecutive series of 56 metastases and 112 gliomas within eloquent motor areas using direct cortical stimulation for monitoring of motor evoked potentials (MEPs). The recorded monitoring data were reviewed with respect to new postoperative motor deficit, residual tumor, and postoperative imaging. Clinical outcomes were assessed during follow-up.

Results: MEP monitoring was successful in 52 metastases (92.9%) and 109 gliomas (97.3%). In metastases, resection was halted due to MEP decline >50% in 8.0% and in glioma patients in 34.8% of cases. In general, MEPs were stable throughout the operation in 70.7% of all metastases case and in 34.8% of all glioma cases (p<0.0001). After resection of metastases, 21.4% of patients improved and 19.6% deteriorated in motor function. Glioma patients improved in only 5.4% and worsened in 13.4% of cases (p<0.05).

Conclusions: There is a significant difference in MEP monitoring between glioma and metastases resection. Due to the still less infiltrative nature, metastases show more stable MEP monitoring but a surprisingly high rate of operation related new motor deficits and therefore a higher rate of suspected false-negative IOM.