| Autor: |
Dulfer SE; Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands., Gadella MC; Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.; Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands., Tamási K; Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.; Department of Epidemiology, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands., Absalom AR; Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands., Lange F; Department of Neurology, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands., Scholtens-Henzen CHM; Department of Neurology, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands., Faber C; Department of Orthopaedics, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands., Wapstra FH; Department of Orthopaedics, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands., Groen RJM; Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands., Sahinovic MM; Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands., Ulkatan S; Department of Intraoperative Neurophysiology Mount Sinai West Hospital, New York, NY 10029, USA., Drost G; Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.; Department of Neurology, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands. |
| Abstrakt: |
In the NERFACE study part I, the characteristics of muscle transcranial electrical stimulation motor evoked potentials (mTc-MEPs) recorded from the tibialis anterior (TA) muscles with surface and subcutaneous needle electrodes were compared. The aim of this study (NERFACE part II) was to investigate whether the use of surface electrodes was non-inferior to the use of subcutaneous needle electrodes in detecting mTc-MEP warnings during spinal cord monitoring. mTc-MEPs were simultaneously recorded from TA muscles with surface and subcutaneous needle electrodes. Monitoring outcomes (no warning, reversible warning, irreversible warning, complete loss of mTc-MEP amplitude) and neurological outcomes (no, transient, or permanent new motor deficits) were collected. The non-inferiority margin was 5%. In total, 210 (86.8%) out of 242 consecutive patients were included. There was a perfect agreement between both recording electrode types for the detection of mTc-MEP warnings. For both electrode types, the proportion of patients with a warning was 0.12 (25/210) (difference, 0.0% (one-sided 95% CI, 0.014)), indicating non-inferiority of the surface electrode. Moreover, reversible warnings for both electrode types were never followed by permanent new motor deficits, whereas among the 10 patients with irreversible warnings or complete loss of amplitude, more than half developed transient or permanent new motor deficits. In conclusion, the use of surface electrodes was non-inferior to the use of subcutaneous needle electrodes for the detection of mTc-MEP warnings recorded over the TA muscles. |
