Systematic review of motor evoked potentials monitoring during thoracic and thoracoabdominal aortic aneurysm open repair surgery: a diagnostic meta-analysis
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Motor evoked potential (MEP) monitoring has been used to prevent neurological complications such as paraplegia in patients who underwent thoracic or thoracoabdominal aortic aneurysm (TAA/TAAA) surgery. The object of this study was making a systematic review to survey the performance of MEP monitoring during TAA/TAAA open repair surgery. We searched electronic databases for relevant studies. We summarized the diagnostic data with summary sensitivity, summary specificity and forest plots of pooled sensitivity, and conducted sub-group analysis. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We also surveyed the reporting rate of clinical key factors such as methods of anesthesia, surgery, and success rate of MEP. Nineteen studies met our criteria. The results of meta-analysis showed 89.1 % summary sensitivity (95 % confidence interval 47.9–98.6 %) and 99.3 % summary specificity (95 % confidence interval 96.1–99.9 %). Sub-group analysis of pooled sensitivity and specificity by all-or-none cut-off point were better than other cut-off points. The results of the QUADAS-2 were not good. The performance of MEP monitoring was good for detecting postoperative paraplegia in TAA/TAAA open repair surgery. The cut-off point of all-or-none may be the best, according to our review.
KeywordsMotor evoked potential (MEP) monitoring TAAA open repair Systematic review Diagnostic meta-analysis
The authors are indebted to Mr. Takaaki Suzuki, BS for his assistance in searching the literature, abstracting the data, and proofing, and indebted to Dr. Mitsuru Ida for quality assessment of included studies by QUADAS-2. This study was conducted as part of a multicenter research project in Japan aimed at minimizing trauma to the spinal cord during TAA/TAAA surgery.
Compliance with ethical standards
Conflict of interest
None of the authors have conflicts of interest with this manuscript.
Supported by the Department of Anesthesiology, Nara Medical University.
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