Preliminary study on the protective effect of intraoperative direct electrical stimulation motor⁃evoked potential on brainstem motor function

Abstract

Objective Preliminary study on the protective effect of intraoperative direct electrical stimulation motor ⁃ evoked potential (DES ⁃ MEP) on motor function during brainstem tumor surgery. Methods Total 136 patients with brainstem tumor surgery from January 2017 to May 2020 were enrolled, including 68 patients treated with intraoperative routine electrophysiological monitoring combined with neuronavigation and 68 patients with DES ⁃ MEP combined with neuronavigation on the basis of routine electrophysiological monitoring. According to the changes of muscle strength (Lovett Muscle Strength Classification) before and after operation, the patients were judged to have new dyskinesia motor function or not. The true positive, false positive, true negative and false negative were judged by DES ⁃ MEP monitoring and postoperative motor function prognosis. The sensitivity and specificity, positive predictive value and negative predictive value, and accuracy of DES ⁃ MEP monitoring results in predicting postoperative motor function prognosis were calculated. Results Patients undergoing DES⁃MEP combined with routine electrophysiological monitoring had 16.18% (11/68) of severe new dyskinesia (Lovett Muscle Strength Classification reduction ≥ 2 grade) 2 weeks after surgery, which was lower than patients undergoing routine electrophysiological monitoring [32.35% (22/68); χ² = 4.841, P = 0.028]. There were 44 true positive cases, 4 false positive cases, 7 true negative cases, and 13 false negative cases detected by DES ⁃ MEP. The sensitivity and specificity of DES ⁃ MEP were 77.19% (44/57) and 7/11, the positive predictive value and negative predictive value of DES ⁃ MEP were 91.67% (44/48) and 35% (7/20), and accuracy of DES ⁃ MEP was 75% (51/68), respectively. Conclusions The application of DES ⁃ MEP in brainstem tumor surgery can effectively protect the brainstem motor function and make up for the deficiency of intraoperative neural monitoring technology in the protection of brainstem corticospinal tract function.

DOI:10.3969/j.issn.1672⁃6731.2020.11.004