Chronologic Changes in Transcranial Motor Evoked Potential During Anterior Temporal Lobectomy in Patients with Temporal Lobe Epilepsy: A Single-Center Cross-Sectional Analytic Study.

Autor: Kubota Y; Department of Neurosurgery, Tokyo Women Medical University Adachi Medical Center, Tokyo, Japan; Stroke and Epilepsy Center, TMG Asaka Medical Center, Asaka, Sataima, Japan. Electronic address: kubota.yuichi@twmu.ac.jp., Prado M; Department of Neurosurgery, Tokyo Women Medical University Adachi Medical Center, Tokyo, Japan; Department of Physiology, College of Medicine, University of the Philippines, Manila, Philippines., Fukuchi S; Stroke and Epilepsy Center, TMG Asaka Medical Center, Asaka, Sataima, Japan., Miyao S; Stroke and Epilepsy Center, TMG Asaka Medical Center, Asaka, Sataima, Japan., Nakamoto H; Stroke and Epilepsy Center, TMG Asaka Medical Center, Asaka, Sataima, Japan.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Sep; Vol. 189, pp. e411-e418. Date of Electronic Publication: 2024 Jun 18.
DOI: 10.1016/j.wneu.2024.06.079
Abstrakt: Objective: Despite the benefits of anterior temporal lobectomy with amygdalohippocampectomy in patients with temporal lobe epilepsy (TLE), approximately up to 5% may have hemiparesis as its postoperative complication. This paper aims to describe which step/s of the anterior temporal lobectomy with amygdalohippocampectomy have the highest probability of having the greatest decrease in motor evoked potential (MEP) amplitude.
Methods: This study used a cross-sectional design of obtaining data from TLE patients who underwent anterior temporal lobectomy with amygdalohippocampectomy with transcranial MEP monitoring. Each of the following steps were evaluated for reduction in MEP amplitude: 1) dural opening, 2) opening the inferior horn, 2) vertical temporal lobe resection 3) subpial dissection, 4) temporal lobe stem resection, 5) lateral temporal lobe resection, 6) hippocampal resection, 7) amygdala resection, 8) uncus resection, and 9) dural closure.
Results: Nineteen patients were included in the study. Based on the Friedman Test, 1 or more steps had significantly different average MEP amplitude reductions (Friedman = 50.7, P = 0.0001). When compared with baseline (100%, cutoff P = 0.005), hippocampal resection (z = -3.81, P < 0.0001), T1 subpial dissection (z = -3.2, P = 0.0010), uncus resection (z = -3.48, P = 0.0002), temporal stem resection (z = -3.26, P = 0.001), lateral temporal lobe resection (z = -3.13, P = 0.002), and amygdalectomy (-z = -3.37, P = 0.0005) were significantly lower. Of these, hippocampal resection, uncus resection, and amygdalectomy were deemed highly significant.
Conclusions: MEP amplitude tends to decrease during amygdala, hippocampal, and uncal resection because of surgical manipulation of anterior choroidal arteries, which can potentially cause hemiparesis. Careful attention should be paid to changes in MEP during these steps.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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