Corticobulbar motor evoked potentials in surgical treatment of tumors of the IV ventricle and brainstem

Abstract

BACKGROUND: Intraoperative neurophysiological monitoring is an obligatory tool during fossa posterior surgery. Corticobulbar motor evoked potentials is the modality of intraoperative neurophysiological monitoring, which can be used during such neurosurgery interventions. It is used to determine the functional state of the caudal cranial nerves during surgery. However, there are technical features of this modality, therefore, corticobulbar motor evoked potentials are not used routine in neurosurgery now.

AIM: To establish the predictive value of corticobulbar motor evoked potentials for development of dysphagia after removal of tumors of brainstem and fourth ventricle.

MATERIALS AND METHODS: We analyzed 80 patients aged from 11 months to 67 years. In 49 cases tumor located in forth ventricle (34 adults and 15 children). In 31 cases tumor located in upper brainstem and craniospinal region (16 adults and 15 children). All patients underwent neurosurgery removal of tumor with intraoperative neurophysiological monitoring. We analyzed otoneurological symptoms before and after operation, MR-images, the volume of removed tumor was estimated. We analyzed data of intraoperative neurophysiological monitoring; the main modality of intraoperative neurophysiological monitoring was corticobulbar motor evoked potentials.

RESULTS: Progress in neurological symptoms from caudal nerves was observed in 35% cases. Amplitude of corticobulbar motor evoked potentials statistically depends on neurological symptoms from caudal nerves in early postoperative period. When the amplitude of the corticobulbar motor evoked potentials decreases by more than 34% from the initial level, there is a high probability of appearance or increase of symptoms from the caudal group of cranial nerves after surgery. The sensitivity and specificity of the corticobulbar motor evoked potentails are 94.4 and 89.2%, respectively.

CONCLUSIONS: It is necessary to use the corticobulbar motor evoked potentials to determine the functional state of the caudal group of cranial nerves during brainstem and forth ventricle surgery and to predict the development of dysphagia and dysarthria after surgery. The modality has a high prognostic value both in children and in adults.

Keywords

intraoperative neurophysiological monitoring / corticobulbar motor evoked potentials / dysphagia / forth ventricle tumors / brainstem tumors

References

[1] Sala F, Coppola A, Tramontano V. Intraoperative neurophysiology in posterior fossa tumor surgery in children. Child’s Nerv Syst. 2015;31(10):1791–1806. DOI: 10.1007/s00381-015-2893-1

[2] Sala F., Coppola A., Tramontano V. Intraoperative neurophysiology in posterior fossa tumor surgery in children // Child’s Nerv. Syst. 2015. Vol. 31, No. 10. P. 1791–1806. DOI: 10.1007/s00381-015-2893-1

[3] Jasper H. The ten-twenty electrode system of the International Federation. Electroencephalogr Clin Neurophysiol Suppl. 1958;(10):371–375.

[4] Jasper H. The ten-twenty electrode system of the International Federation // Electroencephalogr Clin. Neurophysiol. Suppl. 1958. No. 10. P. 371–375.

[5] Kullmann M, Tatagiba M, Liebsch M, Feigl G. Evaluation of the predictive value of intraoperative changes in motor-evoked potentials of caudal cranial nerves for the postoperative functional outcome. World Neurosurg. 2016;(95):329–334. DOI: 10.1016/j.wneu.2016.07.078

[6] Kullmann M., Tatagiba M., Liebsch M., Feigl G. Evaluation of the predictive value of intraoperative changes in motor-evoked potentials of caudal cranial nerves for the postoperative functional outcome // World Neurosurg. 2016. No. 95. P. 329–334. DOI: 10.1016/j.wneu.2016.07.078

[7] Deletis V, Fernandez-Conejero I, Ulkatan S, Costantino P. Methodology for intraoperatively eliciting motor evoked potentials in the vocal muscles by electrical stimulation of the corticobulbar tract. Clin Neurophysiol. 2009;120(2):336–341. DOI: 10.1016/j.clinph.2008.11.013

[8] Deletis V., Fernandez-Conejero I., Ulkatan S., Costantino P. Methodology for intraoperatively eliciting motor evoked potentials in the vocal muscles by electrical stimulation of the corticobulbar tract // Clin. Neurophysiol. 2009. Vol. 120, No. 2. P. 336–341. DOI: 10.1016/j.clinph.2008.11.013

[9] Deletis V, Fernandez-Conejero I. Intraoperative monitoring and mapping of the functional integrity of the brainstem. J Clin Neurol. 2016;12(3):262–273. DOI: 10.3988/jcn.2016.12.3.262

[10] Deletis V., Fernandez-Conejero I. Intraoperative monitoring and mapping of the functional integrity of the brainstem // J. Clin. Neurol. 2016. Vol. 12, No. 3. P. 262–273. DOI: 10.3988/jcn.2016.12.3.262

[11] Wadhwa R, Toms J, Chittiboina P, et al. Dysphagia following posterior fossa surgery in adults. World Neurosurg. 2014;82(5):822–827. DOI: 10.1016/j.wneu.2013.01.035

[12] Wadhwa R., Toms J., Chittiboina P. et al. Dysphagia following posterior fossa surgery in adults // World Neurosurg. 2014. Vol. 82, No. 5. P. 822–827. DOI: 10.1016/j.wneu.2013.01.035

[13] Lee W, Oh B, Seo H, et al. One-year outcome of postoperative swallowing impairment in pediatric patients with posterior fossa brain tumor. J Neurooncol. 2016;127(1):73–81. DOI: 10.1007/s11060-015-2010-z

[14] Lee W., Oh B., Seo H. et al. One-year outcome of postoperative swallowing impairment in pediatric patients with posterior fossa brain tumor // J. Neurooncol. 2016. Vol. 127, No. 1. P. 73–81. DOI: 10.1007/s11060-015-2010-z

[15] Morgan A, Sell D, Ryan M, et al. Pre and post-surgical dysphagia outcome associated with posterior fossa tumour in children. J Neurooncol. 2008;87(3):347–354. DOI: 10.1007/s11060-008-9524-6

[16] Morgan A., Sell D., Ryan M. et al. Pre and post-surgical dysphagia outcome associated with posterior fossa tumour in children // J. Neurooncol. 2008. Vol. 87, No. 3. P. 347–354. DOI: 10.1007/s11060-008-9524-6

[17] Kukanov KK, Tastanbekov MM, Olyushin VE, Pustovoy SV. The foramen magnum meningiomas: results of surgical and radio surgical treatment. Rossiiskii neirokhirurgicheskii zhurnal imeni professora A.L. Polenova. 2017;(9(1)):36–42. (In Russ.)

[18] Куканов К.К., Тастанбеков М.М., Олюшин В.Е., Пустовой С.В. Ближайшие и отделенные результаты хирургического лечения пациентов с менингиомами области БЗО // Российский нейрохирургический журнал им. проф. А.Л. Поленова. 2017. № 9(1). С. 36–42.

[19] Thompson J, Newman L, Boop F, Sanford R. Management of postoperative swallowing dysfunction after ependymoma surgery. Childs Nerv Syst. 2009;25(10):1249–1252. DOI: 10.1007/s00381-009-0880-0

[20] Thompson J., Newman L., Boop F., Sanford R. Management of postoperative swallowing dysfunction after ependymoma surgery // Childs Nerv. Syst. 2009. Vol. 25, No. 10. P. 1249–1252. DOI: 10.1007/s00381-009-0880-0

[21] Goryachev AS, Savin IA, Putsillo MV, et al. A rating scale and therapeutic strategy in dysphagia in patients with brain stem damage. Burdenko’s Journal of Neurosurgery. 2006;(4):24–28. (In Russ.)

[22] Горячев А.С., Савин И.А., Пуцилло М.В. и др. Шкала оценки и терапевтическая стратегия при нарушении глотания у больных с повреждением ствола головного мозга // Вопросы нейрохирургии. 2006. № 4. С. 24–28.

[23] Dong C, Macdonald D, Akagami R, et al. Intraoperative facial motor evoked potential monitoring with transcranial electrical stimulation during skull base surgery. Clin Neurophysiol. 2005;116(3):588–596. DOI: 10.1016/j.clinph.2004.09.013

[24] Dong C., Macdonald D., Akagami R. et al. Intraoperative facial motor evoked potential monitoring with transcranial electrical stimulation during skull base surgery // Clin. Neurophysiol. 2005. Vol. 116, No. 3. P. 588–596. DOI: 10.1016/j.clinph.2004.09.013

[25] Matthies C, Raslan F, Schweitzer T, et al. Facial motor evoked potentials in cerebellopontine angle surgery: technique, pitfalls and predictive value. Clin Neurol Neurosurg. 2011;113(10):872–879. DOI: 10.1016/j.clineuro.2011.06.011

[26] Matthies C., Raslan F., Schweitzer T. et al. Facial motor evoked potentials in cerebellopontine angle surgery: technique, pitfalls and predictive value // Clin. Neurol. Neurosurg. 2011. Vol. 113, No. 10. P. 872–879. DOI: 10.1016/j.clineuro.2011.06.011

[27] Fukuda M, Oishi T, Takao A, et al. Facial nerve motor-evoked potential monitoring during skull base surgery predicts facial nerve outcome. J Neurol Neurosurg Psychiatry. 2008;79(9):1066–1070. DOI: 10.1136/jnnp.2007.130500

[28] Fukuda M., Oishi T., Takao A. et al. Facial nerve motor-evoked potential monitoring during skull base surgery predicts facial nerve outcome // J. Neurol. Neurosurg. Psychiatry. 2008. Vol. 79, No. 9. P. 1066–1070. DOI: 10.1136/jnnp.2007.130500

[29] Goto T, Muraoka H, Kodama K, et al. Intraoperative monitoring of motor evoked potential for the facial nerve using a cranial peg-screw electrode and a “Threshold-level” stimulation method. Skull Base. 2010;20(6):429–434. DOI: 10.1055/s-0030-1261270

[30] Goto T., Muraoka H., Kodama K. et al. Intraoperative monitoring of motor evoked potential for the facial nerve using a cranial peg-screw electrode and a “Threshold-level” stimulation method // Skull Base. 2010. Vol. 20, No. 6. P. 429–434. DOI: 10.1055/s-0030-1261270

[31] Ito E, Ichikawa M, Itakura T, et al. Motor evoked potential monitoring of the vagus nerve with transcranial electrical stimulation during skull base surgeries. J Neurosurg. 2013;118(1):195–201. DOI: 10.3171/2012.10.JNS12383

[32] Ito E., Ichikawa M., Itakura T. et al. Motor evoked potential monitoring of the vagus nerve with transcranial electrical stimulation during skull base surgeries // J. Neurosurg. 2013. Vol. 118, No. 1. P. 195–201. DOI: 10.3171/2012.10.JNS12383

[33] Morota N, Ihara S, Deletis V. Intraoperative neurophysiology for surgery in and around the brainstem: role of brainstem mapping and corticobulbar tract motor-evoked potential monitoring. Childs Nerv Syst. 2010;26(4):513–521. DOI: 10.1007/s00381-009-1080-7

[34] Morota N., Ihara S., Deletis V. Intraoperative neurophysiology for surgery in and around the brainstem: role of brainstem mapping and corticobulbar tract motor-evoked potential monitoring // Childs Nerv. Syst. 2010. Vol. 26, No. 4. P. 513–521. DOI: 10.1007/s00381-009-1080-7

[35] Lapteva KN, Ogurtsova AA, Kadyrov ShU, et al. Monitoring of corticobulbar motor evoked potentials during surgical removal of brainstem and fourth ventricle tumors in pediatric patients. Bulletin of Neurology, Psychiatry and Neurosurgery. 2022;(9):666–673. (In Russ.) DOI: 10.33920/med-01-2209-04

[36] Лаптева К.Н., Огурцова А.А., Кадыров Ш.У. и др. Мониторинг кортикобульбарных моторных вызванных потенциалов при хирургическом удалении опухолей ствола головного мозга и четвертого желудочка у пациентов детского возраста // Вестник неврологии, психиатрии и нейрохирургии. 2022. № 9. С. 666–673. DOI: 10.33920/med-01-2209-04

[37] Kim K, Cho C, Bang M, et al. Intraoperative neurophysiological monitoring: a review of techniques used for brain tumor surgery in children. J Korean Neurosurg Soc. 2018;61(3):363–375. DOI: 10.3340/jkns.2018.0078

[38] Kim K., Cho C., Bang M. et al. Intraoperative neurophysiological monitoring: a review of techniques used for brain tumor surgery in children // J. Korean Neurosurg. Soc. 2018. Vol. 61, No. 3. P. 363–375. DOI: 10.3340/jkns.2018.0078

[39] Bir M, Gupta U, Jaryal A, et al. Predictive value of intraoperative D-wave and m-MEP neurophysiological monitoring in patients with preoperative motor deficits in immediate and late postoperative period. J Craniovertebr Junction Spine. 2021;12(1):26–32. DOI: 10.4103/jcvjs.JCVJS_76_20

[40] Bir M., Gupta U., Jaryal A. et al. Predictive value of intraoperative D-wave and m-MEP neurophysiological monitoring in patients with preoperative motor deficits in immediate and late postoperative period // J. Craniovertebr. Junction Spine. 2021. Vol. 12, No. 1. P. 26–32. DOI: 10.4103/jcvjs.JCVJS_76_20

[41] Acioly M, Liebsch M, Carvalho C, et al. Transcranial electrocortical stimulation to monitor the facial nerve motor function during cerebellopontine angle surgery. Neurosurgery. 2010;66(6 Suppl Operative):354–361. DOI: 10.1227/01.neu.0000369654.41677.b7

[42] Acioly M., Liebsch M., Carvalho C. et al. Transcranial electrocortical stimulation to monitor the facial nerve motor function during cerebellopontine angle surgery // Neurosurgery. 2010. Vol. 66, No. 6 Suppl Operative. P. 354–361. DOI: 10.1227/01.neu.0000369654.41677.b7

RIGHTS & PERMISSIONS

Eco-Vector