| Intraoperative neuromonitoring during glioma surgery: bring in the expert neurophysiologists! | |
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MedLine Citation:
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PMID: 22469679 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: Resection of gliomas in or adjacent to the motor system is widely performed using intraoperative neuromonitoring (IOM). Despite the fact that data on the safety of IOM are available, the significance and predictive value of the procedure is still under discussion. Moreover, cases of false-negative monitoring affect the surgeon's confidence in IOM. OBJECTIVE: To examine cases of false-negative IOM to reveal structural explanations. METHODS: Between 2007 and 2010 we resected 115 consecutive supratentorial gliomas in or close to eloquent motor areas using direct cortical stimulation for monitoring of motor evoked potentials (MEPs). The monitoring data were reviewed and related to new postoperative motor deficit and postoperative imaging. Clinical outcomes were assessed during follow-up. RESULTS: MEP monitoring was successful in 112 cases (97.4%). Postoperatively, 30.3% of patients had a new motor deficit, which remained permanent in 12.5%. Progression-free follow-up was 9.7 months (range: 2 weeks to 40.6 months). In 65.2% of all cases, MEPs were stable throughout the operation, but 8.9% showed a new temporary motor deficit, whereas 4.5% (5 patients) presented with permanently deteriorated motor function representing false-negative monitoring at first glance. However, these cases were caused by secondary hemorrhage, ischemia or resection of the supplementary motor area. CONCLUSION: Continuous MEP monitoring provides reliable monitoring of the motor system, influences the course of operation in some cases, and has to be regarded as the standard for IOM of the motor system. In our series, we found no false-negative MEP results. |
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Authors:
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Eva K Ritzl |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society Volume: 29 ISSN: 1537-1603 ISO Abbreviation: J Clin Neurophysiol Publication Date: 2012 Apr |
Date Detail:
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Created Date: 2012-04-03 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8506708 Medline TA: J Clin Neurophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 151-3 Citation Subset: IM |
Affiliation:
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*Department of Neurology, Johns Hopkins University, Baltimore, Maryland, U.S.A. †Intraoperative Monitoring Service, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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