Feasibility of adjunct facial motor evoked potential monitoring to reduce the number of false-positive results during cervical spine surgery

Restricted access

OBJECTIVE

False-positive intraoperative muscle motor evoked potential (mMEP) monitoring results due to systemic effects of anesthetics and physiological changes continue to be a challenging issue. Although control MEPs recorded from the unaffected side are useful for identifying a true-positive signal, there are no muscles on the upper or lower extremities to induce control MEPs in cervical spine surgery. Therefore, this study was conducted to clarify if additional MEPs derived from facial muscles can feasibly serve as controls to reduce false-positive mMEP monitoring results in cervical spine surgery.

METHODS

Patients who underwent cervical spine surgery at the authors’ institution who did not experience postoperative neurological deterioration were retrospectively studied. mMEPs were induced with transcranial supramaximal stimulation. Facial MEPs (fMEPs) were subsequently induced with suprathreshold stimulation. The mMEP and subsequently recorded fMEP waveforms were paired during each moment during surgery. The initial pair was regarded as the baseline. A significant decline in mMEP and fMEP amplitude was defined as > 80% and > 50% decline compared with baseline, respectively. All mMEP alarms were considered false positives. Based on 2 different alarm criteria, either mMEP alone or both mMEP and fMEP, rates of false-positive mMEP monitoring results were calculated.

RESULTS

Twenty-three patients were included in this study, corresponding to 102 pairs of mMEPs and fMEPs. This included 23 initial and 79 subsequent pairs. Based on the alarm criterion of mMEP alone, 17 false-positive results (21.5%) were observed. Based on the alarm criterion of both mMEP and fMEP, 5 false-positive results (6.3%) were observed, which was significantly different compared to mMEP alone (difference 15.2%; 95% CI 7.2%–23.1%; p < 0.01).

CONCLUSIONS

fMEPs might be used as controls to reduce false-positive mMEP monitoring results in cervical spine surgery.

ABBREVIATIONS fMEP = facial motor evoked potential; mMEP = muscle motor evoked potential.
Article Information

Contributor Notes

Correspondence Yasuhiro Takeshima: Nara Medical University School of Medicine, Nara, Japan. takeshim@naramed-u.ac.jp.INCLUDE WHEN CITING Published online December 13, 2019; DOI: 10.3171/2019.9.SPINE19800.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Headings
References
  • 1

    Abboud TSchaper MDührsen LSchwarz CSchmidt NOWestphal M: A novel threshold criterion in transcranial motor evoked potentials during surgery for gliomas close to the motor pathway. J Neurosurg 125:7958022016

    • Search Google Scholar
    • Export Citation
  • 2

    Akagami RDong CCWesterberg BD: Localized transcranial electrical motor evoked potentials for monitoring cranial nerves in cranial base surgery. Neurosurgery 57 (1 Suppl):78852005

    • Search Google Scholar
    • Export Citation
  • 3

    Brauer MKnuettgen DQuester RDoehn M: Electromyographic facial nerve monitoring during resection for acoustic neurinoma under moderate to profound levels of peripheral neuromuscular blockade. Eur J Anaesthesiol 13:6126151996

    • Search Google Scholar
    • Export Citation
  • 4

    Burke DHicks RG: Surgical monitoring of motor pathways. J Clin Neurophysiol 15:1942051998

  • 5

    Caffrey RRWarren MLBecker KE Jr: Neuromuscular blockade monitoring comparing the orbicularis oculi and adductor pollicis muscles. Anesthesiology 65:95971986

    • Search Google Scholar
    • Export Citation
  • 6

    Cheng JSIvan MEStapleton CJQuinones-Hinojosa AGupta NAuguste KI: Intraoperative changes in transcranial motor evoked potentials and somatosensory evoked potentials predicting outcome in children with intramedullary spinal cord tumors. J Neurosurg Pediatr 13:5915992014

    • Search Google Scholar
    • Export Citation
  • 7

    Cosetti MKXu MRivera AJethanamest DKuhn MABeric A: Intraoperative transcranial motor-evoked potential monitoring of the facial nerve during cerebellopontine angle tumor resection. J Neurol Surg B Skull Base 73:3083152012

    • Search Google Scholar
    • Export Citation
  • 8

    Dong CCMacdonald DBAkagami RWesterberg BAlkhani AKanaan I: Intraoperative facial motor evoked potential monitoring with transcranial electrical stimulation during skull base surgery. Clin Neurophysiol 116:5885962005

    • Search Google Scholar
    • Export Citation
  • 9

    Goto TMuraoka HKodama KHara YYako THongo K: Intraoperative monitoring of motor evoked potential for the facial nerve using a cranial peg-screw electrode and a "threshold-level" stimulation method. Skull Base 20:4294342010

    • Search Google Scholar
    • Export Citation
  • 10

    Hayashi HKawaguchi MYamamoto YInoue SKoizumi MUeda Y: Evaluation of reliability of post-tetanic motor-evoked potential monitoring during spinal surgery under general anesthesia. Spine (Phila Pa 1976) 33:E994E10002008

    • Search Google Scholar
    • Export Citation
  • 11

    Ito ZMatsuyama YAndo MKawabata SKanchiku TKida K: What is the best multimodality combination for intraoperative spinal cord monitoring of motor function? A multicenter study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research. Global Spine J 6:2342412016

    • Search Google Scholar
    • Export Citation
  • 12

    Kalkman CJBeen HDOngerboer de Visser BW: Intraoperative monitoring of spinal cord function. A review. Acta Orthop Scand 64:1141231993

    • Search Google Scholar
    • Export Citation
  • 13

    Kaneko MFukamachi ASasaki HMiyazawa NYagishita TNukui H: Intraoperative monitoring of the motor function: experimental and clinical study. Acta Neurochir Suppl (Wien) 42:18211988

    • Search Google Scholar
    • Export Citation
  • 14

    Kelleher MOTan GSarjeant RFehlings MG: Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients. J Neurosurg Spine 8:2152212008

    • Search Google Scholar
    • Export Citation
  • 15

    Kim DGJo SRYoun MHyun SJKim KJJahng TA: Corticobulbar motor evoked potentials from tongue muscles used as a control in cervical spinal surgery. Clin Neurophysiol Pract 2:1241292017

    • Search Google Scholar
    • Export Citation
  • 16

    Kim DHZaremski JKwon BJenis LWoodard EBode R: Risk factors for false positive transcranial motor evoked potential monitoring alerts during surgical treatment of cervical myelopathy. Spine (Phila Pa 1976) 32:304130462007

    • Search Google Scholar
    • Export Citation
  • 17

    Kobayashi KAndo KShinjo RIto KTsushima MMorozumi M: Evaluation of a combination of waveform amplitude and peak latency in intraoperative spinal cord monitoring. Spine (Phila Pa 1976) 43:123112372018

    • Search Google Scholar
    • Export Citation
  • 18

    Langeloo DDJournée HLde Kleuver MGrotenhuis JA: Criteria for transcranial electrical motor evoked potential monitoring during spinal deformity surgery A review and discussion of the literature. Neurophysiol Clin 37:4314392007

    • Search Google Scholar
    • Export Citation
  • 19

    Langeloo DDLelivelt ALouis Journée HSlappendel Rde Kleuver M: Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity: a study of 145 patients. Spine (Phila Pa 1976) 28:104310502003

    • Search Google Scholar
    • Export Citation
  • 20

    Legatt AD: Current practice of motor evoked potential monitoring: results of a survey. J Clin Neurophysiol 19:4544602002

  • 21

    Legatt ADEmerson RG: Motor evoked potential monitoring—it’s about time. J Clin Neurophysiol 19:3833862002

  • 22

    Legatt ADEmerson RGEpstein CMMacDonald DBDeletis VBravo RJ: ACNS Guideline: Transcranial electrical stimulation motor evoked potential monitoring. J Clin Neurophysiol 33:42502016

    • Search Google Scholar
    • Export Citation
  • 23

    Lo YLDan YFTeo ATan YEYue WMRaman S: The value of bilateral ipsilateral and contralateral motor evoked potential monitoring in scoliosis surgery. Eur Spine J 17 (Suppl 2):S236S2382008

    • Search Google Scholar
    • Export Citation
  • 24

    Lyon RFeiner JLieberman JA: Progressive suppression of motor evoked potentials during general anesthesia: the phenomenon of “anesthetic fade”. J Neurosurg Anesthesiol 17:13192005

    • Search Google Scholar
    • Export Citation
  • 25

    MacDonald DB: Intraoperative motor evoked potential monitoring: overview and update. J Clin Monit Comput 20:3473772006

  • 26

    MacDonald DB: Overview on criteria for MEP monitoring. J Clin Neurophysiol 34:4112017

  • 27

    MacDonald DBAl Zayed ZKhoudeir IStigsby B: Monitoring scoliosis surgery with combined multiple pulse transcranial electric motor and cortical somatosensory-evoked potentials from the lower and upper extremities. Spine (Phila Pa 1976) 28:1942032003

    • Search Google Scholar
    • Export Citation
  • 28

    MacDonald DBSkinner SShils JYingling C: Intraoperative motor evoked potential monitoring – a position statement by the American Society of Neurophysiological Monitoring. Clin Neurophysiol 124:229123162013

    • Search Google Scholar
    • Export Citation
  • 29

    Morishige MTakeda MYamaguchi SSugiyama KKurisu K: Application of compound action potential of facial muscles evoked by transcranial stimulation as a reference waveform of motor-evoked potential in spinal surgery. Hiroshima J Med Sci 66:152017

    • Search Google Scholar
    • Export Citation
  • 30

    Park PWang ACSangala JRKim SMHervey-Jumper SThan KD: Impact of multimodal intraoperative monitoring during correction of symptomatic cervical or cervicothoracic kyphosis. J Neurosurg Spine 14:991052011

    • Search Google Scholar
    • Export Citation
  • 31

    Sakaki KKawabata SUkegawa DHirai TIshii STomori 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) 37:E913E9212012

    • Search Google Scholar
    • Export Citation
  • 32

    Sala FBricolo AFaccioli FLanteri PGerosa M: Surgery for intramedullary spinal cord tumors: the role of intraoperative (neurophysiological) monitoring. Eur Spine J 16 (Suppl 2):S130S1392007

    • Search Google Scholar
    • Export Citation
  • 33

    Sarnthein JHejrati NNeidert MCHuber AMKrayenbühl N: Facial nerve motor evoked potentials during skull base surgery to monitor facial nerve function using the threshold-level method. Neurosurg Focus 34(3):E72013

    • Search Google Scholar
    • Export Citation
  • 34

    Schmitt WRDaube JRCarlson MLMandrekar JNBeatty CWNeff BA: Use of supramaximal stimulation to predict facial nerve outcomes following vestibular schwannoma microsurgery: results from a decade of experience. J Neurosurg 118:2062122013

    • Search Google Scholar
    • Export Citation
  • 35

    Sutter MEggspuehler AGrob DJeszenszky DBenini APorchet F: The diagnostic value of multimodal intraoperative monitoring (MIOM) during spine surgery: a prospective study of 1,017 patients. Eur Spine J 16 (Suppl 2):S162S1702007

    • Search Google Scholar
    • Export Citation
  • 36

    Szelényi AHattingen EWeidauer SSeifert VZiemann U: Intraoperative motor evoked potential alteration in intracranial tumor surgery and its relation to signal alteration in postoperative magnetic resonance imaging. Neurosurgery 67:3023132010

    • Search Google Scholar
    • Export Citation
  • 37

    Verla TFridley JSKhan ABMayer RROmeis I: Neuromonitoring for intramedullary spinal cord tumor surgery. World Neurosurg 95:1081162016

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 346 346 266
Full Text Views 34 34 21
PDF Downloads 30 30 18
EPUB Downloads 0 0 0
PubMed
Google Scholar