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Please use this identifier to cite or link to this item: http://hdl.handle.net/10564/4340

Title: Effects of intraoperative motor evoked potential amplification following tetanic stimulation of the pudendal nerve in pediatric craniotomy
Other Titles: 小児開頭手術におけるテタヌス刺激による術中MEP増幅効果の検討
Authors: Sasaki, Ryota
Tamura, Kentaro
Yamazaki, Shintaro
Kim, Tae Kyun
Takatani, Tsunenori
Hayashi, Yoshinobu
Motoyama, Yasushi
Nakagawa, Ichiro
Park, Young-Soo
Kawaguchi, Masahiko
Nakase, Hiroyuki
Keywords: amplification
intraoperative motor evoked potential
pediatric craniotomy
pudendal nerve
surgical technique
tetanic stimulation
Issue Date: Feb-2023
Publisher: American Association of Neurological Surgeons
Citation: Journal of Neurosurgery-Pediatrics. 2023 Feb, vol.24, no.31, p.488-495
Abstract: Objective: Monitoring the intraoperative motor evoked potentials (MEPs) in pediatric craniotomy is challenging because of its low detection rate, which makes it unreliable. Tetanic stimulation of the peripheral nerves of the extremities and pudendal nerves prior to transcranial electrical stimulation (TES) or direct cortical stimulation (DCS) amplifies the MEPs. The authors investigated the effects of MEP amplification following tetanic stimulation of the median and tibial nerve or the pudendal nerve in pediatric patients undergoing craniotomy. Methods: This prospective observational study included 15 patients ≤ 15 years of age (mean age 8.9 ± 4.9 years) undergoing craniotomy. MEPs were obtained with TES (15 cases) or DCS (8 cases)-conventional MEP without tetanic stimulation (c-MEP) and MEP following tetanic stimulation of the unilateral median and tibial nerves (mt-MEP) or following tetanic stimulation of the pudendal nerve (p-MEP) were used. Compound muscle action potentials were elicited from the abductor pollicis brevis, gastrocnemius, tibialis anterior, and abductor hallucis longus muscles. The authors compared the identification rate and the rate of amplitude increase of each MEP. Results: For both TES and DCS, the identification and amplitude increase rates were significantly higher in cases without preoperative hemiparesis for p-MEPs than in those for c-MEPs and mt-MEPs. In comparison to patients with preoperative hemiparesis, p-MEPs displayed a higher identification rate, with fewer false negatives in DCS cases. Conclusions: In pediatric craniotomy, the authors observed the amplification effect of MEPs with pudendal nerve tetanic stimulation and the amplification effect of DCS on MEPs without increasing false negatives. These findings suggested the likelihood of more reliable intraoperative MEP monitoring in pediatric cases.
Description: 権利情報:© AANS 2023, except where prohibited by US copyright law.
URI: http://hdl.handle.net/10564/4340
ISSN: 1933-0707
DOI: https://doi.org/10.3171/2023.1.peds22505
Academic Degrees and number: 24601甲第896号
Degree-granting date: 2024-03-14
Degree name: 博士(医学)
Degree-granting institutions: 奈良県立医科大学
Appears in Collections:2023年度

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