Transcranial Motor Evoked Potentials Electrically Elicited by Multi-train Stimulation Can Reflect Isolated Nerve Root Injury More Precisely Than Those by Conventional Multi-pulse Stimulation: an Experimental Study in Rats

Overview

Journal J Clin Monit Comput

Publisher Springer

Specialties Anesthesiology
General Medicine
Medical Informatics

Date 2019 Mar 6

PMID 30835023

Citations 1

Authors

Takuhei Kozaki

Shunji Tsutsui

Hiroshi Yamada

Affiliations

Soon will be listed here.

Abstract

Nerve root injury can occur in complex spine surgeries. Recording transcranial motor-evoked potentials (TcMEPs) has been the most popular method to monitor motor function during surgery. However, TcMEPs cannot detect single nerve root injury satisfactorily. Recently, multi-train stimulation (MTS) was demonstrated to effectively enhance TcMEPs. The aim of this study was to investigate the utility of TcMEPs elicited by MTS for intraoperative nerve root monitoring. TcMEPs were recorded from the quadriceps femoris (QF) and gastrocnemius (GC) muscles in the hindlimbs of 20 rats before and after transection of the nerve root at L6 (dominant root innervating the GC). For MTS, a multipulse (train) stimulus was delivered repeatedly at 5 Hz. The change ratio of the amplitude after transection of the nerve root was compared between MTS and conventional single-train stimulation (STS). The change in TcMEP amplitudes for QF after transection of the nerve root at L6 was 97.8 ± 12.2% with MTS and 100.1 ± 7.2% with STS (p = 0.496), whereas that for GC was 40.6 ± 11.5% with MTS and 64.8 ± 8.8% with STS (p < 0.001). MTS could improve the ability to detect isolated nerve root injury in intraoperative TcMEP monitoring.

Citing Articles

Motor-Evoked Potential Monitoring With Multi-train Electrical Stimulation During Thoracoabdominal Aortic Aneurysm Surgery: A Case Report.

Yuno T, Nakade Y, Iino K, Taniguchi T, Oe H Cureus. 2024; 16(2):e53872.

PMID: 38465173 PMC: 10924977. DOI: 10.7759/cureus.53872.

References

MacDonald D, Stigsby B, Al Homoud I, Abalkhail T, Mokeem A . Utility of motor evoked potentials for intraoperative nerve root monitoring. J Clin Neurophysiol. 2012; 29(2):118-25. DOI: 10.1097/WNP.0b013e31824ceeaf. View

Nakatoh S, Kitagawa H, Kawaguchi Y, Nakamura H, Takano H . Change of muscle motor-evoked potentials after motor cortex stimulation caused by acute spinal cord injury in cats. J Spinal Disord. 2001; 14(1):32-8. DOI: 10.1097/00002517-200102000-00006. View

Deguchi T, Tsutsui S, Iwahashi H, Nakagawa Y, Yoshida M . Efficacy and safety of novel high-frequency multi-train stimulation for recording transcranial motor evoked potentials in a rat model. J Clin Monit Comput. 2016; 31(5):1053-1058. DOI: 10.1007/s10877-016-9930-9. View

Mohan R, Tosolini A, Morris R . Segmental distribution of the motor neuron columns that supply the rat hindlimb: A muscle/motor neuron tract-tracing analysis targeting the motor end plates. Neuroscience. 2015; 307:98-108. DOI: 10.1016/j.neuroscience.2015.08.030. View

Resnick D, Choudhri T, Dailey A, Groff M, Khoo L, Matz P . Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 15: electrophysiological monitoring and lumbar fusion. J Neurosurg Spine. 2005; 2(6):725-32. DOI: 10.3171/spi.2005.2.6.0725. View

Iwasaki H, Tamaki T, Yoshida M, Ando M, Yamada H, Tsutsui S . Efficacy and limitations of current methods of intraoperative spinal cord monitoring. J Orthop Sci. 2003; 8(5):635-42. DOI: 10.1007/s00776-003-0693-z. View

Hilibrand A, Schwartz D, Sethuraman V, Vaccaro A, Albert T . Comparison of transcranial electric motor and somatosensory evoked potential monitoring during cervical spine surgery. J Bone Joint Surg Am. 2004; 86(6):1248-53. DOI: 10.2106/00004623-200406000-00018. View

Holland N, Kostuik J . Continuous electromyographic monitoring to detect nerve root injury during thoracolumbar scoliosis surgery. Spine (Phila Pa 1976). 1997; 22(21):2547-50. DOI: 10.1097/00007632-199711010-00016. View

Pateder D, Kostuik J . Lumbar nerve root palsy after adult spinal deformity surgery. Spine (Phila Pa 1976). 2005; 30(14):1632-6. DOI: 10.1097/01.brs.0000170292.87470.92. View

10.

Calancie B, Molano M . Alarm criteria for motor-evoked potentials: what's wrong with the "presence-or-absence" approach?. Spine (Phila Pa 1976). 2008; 33(4):406-14. DOI: 10.1097/BRS.0b013e3181642a2f. View

11.

Woodforth I, HICKS R, CRAWFORD M, Stephen J, Burke D . Variability of motor-evoked potentials recorded during nitrous oxide anesthesia from the tibialis anterior muscle after transcranial electrical stimulation. Anesth Analg. 1996; 82(4):744-9. DOI: 10.1097/00000539-199604000-00012. View

12.

Tsutsui S, Yamada H, Hashizume H, Minamide A, Nakagawa Y, Iwasaki H . Quantification of the proportion of motor neurons recruited by transcranial electrical stimulation during intraoperative motor evoked potential monitoring. J Clin Monit Comput. 2013; 27(6):633-7. DOI: 10.1007/s10877-013-9480-3. View

13.

Meylaerts S, Jacobs M, van Iterson V, de Haan P, Kalkman C . Comparison of transcranial motor evoked potentials and somatosensory evoked potentials during thoracoabdominal aortic aneurysm repair. Ann Surg. 2000; 230(6):742-9. PMC: 1420937. DOI: 10.1097/00000658-199912000-00002. View

14.

Sakaki K, Kawabata S, Ukegawa D, Hirai T, Ishii S, Tomori M . Warning thresholds on the basis of origin of amplitude changes in transcranial electrical motor-evoked potential monitoring for cervical compression myelopathy. Spine (Phila Pa 1976). 2012; 37(15):E913-21. DOI: 10.1097/BRS.0b013e31824caab6. View

15.

Beatty R, McGuire P, Moroney J, Holladay F . Continuous intraoperative electromyographic recording during spinal surgery. J Neurosurg. 1995; 82(3):401-5. DOI: 10.3171/jns.1995.82.3.0401. View

16.

Tsutsui S, Iwasaki H, Yamada H, Hashizume H, Minamide A, Nakagawa Y . Augmentation of motor evoked potentials using multi-train transcranial electrical stimulation in intraoperative neurophysiologic monitoring during spinal surgery. J Clin Monit Comput. 2014; 29(1):35-9. DOI: 10.1007/s10877-014-9565-7. View

17.

Gunnarsson T, Krassioukov A, Sarjeant R, Fehlings M . Real-time continuous intraoperative electromyographic and somatosensory evoked potential recordings in spinal surgery: correlation of clinical and electrophysiologic findings in a prospective, consecutive series of 213 cases. Spine (Phila Pa 1976). 2004; 29(6):677-84. DOI: 10.1097/01.brs.0000115144.30607.e9. View

18.

Kothbauer K, Deletis V, Epstein F . Intraoperative spinal cord monitoring for intramedullary surgery: an essential adjunct. Pediatr Neurosurg. 1997; 26(5):247-54. DOI: 10.1159/000121199. View

19.

Langeloo D, Lelivelt A, Journee H, Slappendel R, de Kleuver M . Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity: a study of 145 patients. Spine (Phila Pa 1976). 2003; 28(10):1043-50. DOI: 10.1097/01.BRS.0000061995.75709.78. View

20.

Fan D, Schwartz D, Vaccaro A, Hilibrand A, Albert T . Intraoperative neurophysiologic detection of iatrogenic C5 nerve root injury during laminectomy for cervical compression myelopathy. Spine (Phila Pa 1976). 2002; 27(22):2499-502. DOI: 10.1097/00007632-200211150-00014. View