Intraoperative Transcranial Motor-Evoked Potential Predicts Motor Function Outcome in Intracerebral Hemorrhage Surgery

• Published in: World neurosurgery 2015
• Main Authors: Ikedo, Taichi, MD, Nakamura, Kazuhito, MD, Sano, Noritaka, MD, Nagata, Manabu, MD, Okada, Yumiko, MD, Terakawa, Yuzo, MD, PhD, Murata, Takaho, MD, PhD
• Format: Article
• Language: English
• Subjects: Neurosurgery
• ISSN: 1878-8750
• DOI: 10.1016/j.wneu.2016.03.058

Abstract Objective Prediction of postintracerebral hemorrhage (ICH) motor function often poses a diagnostic challenge. This study was performed to investigate whether intraoperative monitoring of motor-evoked potential (MEP) could predict postoperative motor function recovery. Method We reviewed 16 consecutive patients undergoing evacuation of supratentorial ICH with hemiplegia between June 2011 and October 2014. Patients were categorized according to the results of MEPs before and after evacuation of hematoma. The correlation between detection of MEPs and prognosis of motor function was analyzed. Results In 10 of 16 cases (62%), stable MEPs were detected before and after evacuation of hematoma, and postoperative motor function was improved in all cases, including three cases with severe preoperative motor impairment on manual muscle test (MMT) 0-2. In three cases (19%) in which MEPs were not detected throughout the procedure, motor function was not improved. In the other three cases (19%), MEPs were not measured before evacuation of ICH, but were detected after evacuation despite poor prognosis of motor function. The results of postevacuation MEPs were considered false-negative results. Whereas intra- and postevacuation MEPs were useful for monitoring, predictions using preevacuation MEP results were completely consistent with prognosis for recovery. Conclusions Intraoperative MEPs may indicate preservation of pyramidal tracts and preevacuation MEPs can predict the motor function outcome after ICH surgery.