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Short and long-term prognostic value of intraoperative motor evoked potentials in brain tumor patients: a case series of 121 brain tumor patients

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Abstract

Purpose

Iatrogenic neurologic deficits adversely affect patient outcomes following brain tumor resection. Motor evoked potential (MEP) monitoring allows surgeons to assess the integrity of motor-eloquent areas in real-time during tumor resection to lessen the risk of iatrogenic insult. We retrospectively associate intraoperative transcranial and direct cortical MEPs (TC-MEPs, DC-MEPs) to early and late post-operative motor function to prognosticate short- and long-term motor recovery in brain tumor patients undergoing surgical resection in peri-eloquent regions.

Methods

We reviewed 121 brain tumor patients undergoing craniotomies with DC-MEP and/or TC-MEP monitoring. Motor function scores were recorded at multiple time-points up to 1 year postoperatively. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated at each time point.

Results

The sensitivity, specificity, PPV, and NPV of TC-MEP in the immediate postoperative period was 17.5%, 100%, 100%, and 69.4%, respectively. For DC-MEP monitoring, the respective values were 25.0%, 100%, 100%, and 68.8%. By discharge, sensitivity had increased for both TC-MEP and DC MEPs to 43.8%, and 50.0% respectively. Subset analysis on patients without tumor recurrence/progression at long term follow-up (n = 62 pts, 51.2%) found that all patients with stable monitoring maintained or improved from preoperative status. One patient with transient intraoperative TC-MEP loss and permanent DC-MEP loss suffered a permanent deficit.

Conclusion

Brain tumor patients who undergo surgery with intact MEP monitoring and experience new postoperative deficits likely suffer transient deficits that will improve over the postoperative course in the absence of disease progression.

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Acknowledgements

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Funding

The authors declare no financial support was received during the preparation of this manuscript.

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Author notes

  1. Justin W. Silverstein and Harshal A. Shah have contributed equally to this work.

Authors and Affiliations

  1. Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA

    Justin W. Silverstein

  2. Department of Clinical Neurophysiology, Neuro Protective Solutions, New York, NY, USA

    Sabena Vilaysom

  3. Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, New York, NY, 11549, USA

    Harshal A. Shah

  4. Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA

    John A. Boockvar, David J. Langer, Jason A. Ellis & Randy S. D’Amico

  5. Department of Neurosurgery, Zucker School of Medicine at Hofstra/ Northwell Health & The Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA

    Prashin Unadkat

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Contributions

All authors contributed to the design and conception of the study. Data collection and analysis were conducted by JS, HS, PU, and SV. The first draft of the manuscript was prepared by JS, HS, PU and RD. All authors commented on and critically revised previous drafts of the manuscript and approved of the final manuscript.

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Correspondence to Harshal A. Shah.

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Silverstein, J.W., Shah, H.A., Unadkat, P. et al. Short and long-term prognostic value of intraoperative motor evoked potentials in brain tumor patients: a case series of 121 brain tumor patients. J Neurooncol 161, 127–133 (2023). https://doi.org/10.1007/s11060-022-04229-8

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