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BMC Neurology
Published in: BMC Neurology 1/2015

Open Access 01-12-2015 | Research article

Intraoperative neuromonitoring for function-guided resection differs for supratentorial motor eloquent gliomas and metastases

Authors: Thomas Obermueller, Michael Schaeffner, Ehab Shiban, Doris Droese, Chiara Negwer, Bernhard Meyer, Florian Ringel, Sandro M. Krieg

Published in: BMC Neurology | Issue 1/2015

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Abstract

Background

Recent data show differences in intraoperative neuromonitoring (IOM) in relation to the operated brain lesion. Due to the recently shown infiltrative nature of cerebral metastases, this work investigates the differences of IOM for cerebral metastases and glioma resection concerning sensitivity, specificity, and predictive values when aiming on preservation of motor function.

Methods

Between 2006 and 2011 we resected 171 eloquently located tumors (56 metastases, 115 gliomas) associated with the rolandic cortex or the pyramidal tract using IOM via direct cortical motor evoked potentials (MEPs). Postoperatively, MEP data were re-analyzed with respect to surgery-related paresis, residual tumor, and postoperative MRI with two different thresholds for MEP decline (50 and 80 % below baseline).

Results

MEP monitoring was successful in 158 cases (92.4 %). MEPs were stable in 54.7 % of all metastases cases and in 65.2 % of all glioma cases (p < 0.0001). After metastases resection, 21.4 % of patients improved and 21.9 % deteriorated in motor function. Glioma patients improved in only 5.4 % and worsened in 31.3 % of cases (p < 0.05). Resection was stopped due to MEP decline in 8.0 % (metastases) and 34.8 % of cases (gliomas) (p < 0.0002).

Conclusion

There is significant difference between glioma and metastases resection. Post-hoc, metastases show more stable MEPs but a surprisingly high rate of surgery-related paresis and therefore a higher rate of false negative IOM.
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Metadata
Title
Intraoperative neuromonitoring for function-guided resection differs for supratentorial motor eloquent gliomas and metastases
Authors
Thomas Obermueller
Michael Schaeffner
Ehab Shiban
Doris Droese
Chiara Negwer
Bernhard Meyer
Florian Ringel
Sandro M. Krieg
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2015
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-015-0476-0

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