Studio finanziato dalla Brain Research Foundation Verona.
Articolo pubblicato online il 23 gennaio 2021: https://www.frontiersin.org/articles/10.3389/fimmu.2020.576745/full
© 2021 The Author(s). Published by Oxford University Press on behalf of the Guarantors of Brain.
Autori
Davide Giampiccolo, Cristiano Parisi, Pietro Meneghelli, Vincenzo Tramontano, Federica Basaldella, Marco Pasetto, Giampietro Pinna, Luigi Cattaneo, Francesco Sala.
Abstract
Muscle motor evoked potentials (MEPs) are commonly monitored during brain tumour surgery in motor areas, as these are assumed to reflect the integrity of descending motor pathways, including the corticospinal tract. However, while the loss of MEPs at the end of surgery is associated with long-term motor deficits (MEP-related deficits), there is increasing evidence that motor deficit can occur despite no change in MEPs (MEP-unrelated deficits), particularly following surgery of non-primary regions involved in motor control. In this study we aimed to investigate the incidence of MEP-unrelated deficits and to identify the associated brain regions. We retrospectively reviewed one hundred and twenty-five consecutive patients who underwent surgery for peri-Rolandic lesions using intraoperative neurophysiological monitoring. Intraoperative changes in MEPs were correlated with motor outcome, assessed by the Medical Research Council scale. We performed voxel-lesion-symptom mapping to identify which resected regions were associated with short-and long-term MEP-associated motor deficits. MEP reductions significantly predicted long-term motor deficits. However, in over half of patients who experienced long-term deficits (12/22 patients), no MEP reduction was reported during surgery. Lesion analysis showed that MEP-related long-term motor deficits were associated with direct or ischemic damage to the corticospinal tract, whereas MEP-unrelated deficits occurred when supplementary motor areas were resected in conjunction with dorsal premotor regions and the anterior cingulate. Our results indicate that long-term motor deficits unrelated to the corticospinal tract can occur more often than currently reported. As these deficits cannot be predicted by MEPs, a combination of awake and/or novel asleep techniques other than MEP monitoring should be implemented.
Responsabile: Francesco Sala – Università degli Studi di Verona – francesco.sala@univr.it
Articolo open access con licenza CC BY Creative Commons.
