Publications

Authors:

Giampiccolo, Davide; Parisi, Cristiano; Meneghelli, Pietro; Tramontano, Vincenzo; Basaldella, Federica; Pasetto, Marco; Pinna, Giampietro; Cattaneo, Luigi; Sala, Francesco

Title:

Long-term motor deficit in brain tumour surgery with preserved intra-operative motor-evoked potentials

Year:

2021

Type of item:

Articolo in Rivista

Tipologia ANVUR:

Articolo su rivista

Language:

Inglese

Format:

Elettronico

Referee:

Sì

Name of journal:

BRAIN COMMUNICATIONS

ISSN of journal:

2632-1297

N° Volume:

3

Number or Folder:

fcaa226

Page numbers:

1-12

Keyword:

SMA-syndrome; brain mapping; intra-operative neurophysiological monitoring (IONM); motor-evoked potentials (MEPs); neuro-oncology

Short description of contents:

Muscle motor-evoked potentials are commonly monitored during brain tumour surgery in motor areas, as these are assumed to reflect the integrity of descending motor pathways, including the corticospinal tract. However, while the loss of muscle motor-evoked potentials at the end of surgery is associated with long-term motor deficits (muscle motor-evoked potential-related deficits), there is increasing evidence that motor deficit can occur despite no change in muscle motor-evoked potentials (muscle motor-evoked potential-unrelated deficits), particularly after surgery of non-primary regions involved in motor control. In this study, we aimed to investigate the incidence of muscle motor-evoked potential-unrelated deficits and to identify the associated brain regions. We retrospectively reviewed 125 consecutive patients who underwent surgery for peri-Rolandic lesions using intra-operative neurophysiological monitoring. Intraoperative changes in muscle motor-evoked potentials were correlated with motor outcome, assessed by the Medical Research Council scale. We performed voxel-lesion-symptom mapping to identify which resected regions were associated with short- and long-term muscle motor-evoked potential-associated motor deficits. Muscle motor-evoked potentials reductions significantly predicted long-term motor deficits. However, in more than half of the patients who experienced long-term deficits (12/22 patients), no muscle motor-evoked potential reduction was reported during surgery. Lesion analysis showed that muscle motor-evoked potential-related long-term motor deficits were associated with direct or ischaemic damage to the corticospinal tract, whereas muscle motor-evoked potential-unrelated deficits occurred when supplementary motor areas were resected in conjunction with dorsal premotor regions and the anterior cingulate. Our results indicate that long-term motor deficits unrelated to the corticospinal tract can occur more often than currently reported. As these deficits cannot be predicted by muscle motor-evoked potentials, a combination of awake and/or novel asleep techniques other than muscle motor-evoked potentials monitoring should be implemented.

Note:

Luigi Cattaneo and Francesco Sala contributed equally as senior authors to this work.

Web page:

https://doi.org/10.1093/braincomms/fcaa226

Product ID:

119579

Handle IRIS:

11562/1037255

Last Modified:

November 10, 2022

Bibliographic citation:

Giampiccolo, Davide; Parisi, Cristiano; Meneghelli, Pietro; Tramontano, Vincenzo; Basaldella, Federica; Pasetto, Marco; Pinna, Giampietro; Cattaneo, Luigi; Sala, Francesco, Long-term motor deficit in brain tumour surgery with preserved intra-operative motor-evoked potentials «BRAIN COMMUNICATIONS» , vol. 3 , n. fcaa226 , 2021 , pp. 1-12

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