J Clin Monit Comput - Quantification of the proportion of motor neurons recruited by transcranial electrical stimulation during intraoperative motor evoked potential monitoring.


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Transcranial motor evoked potentials (TcMEPs) are widely used to monitor motor function during spinal surgery. However, they are much smaller and more variable in amplitude than responses evoked by maximal peripheral nerve stimulation, suggesting that a limited number of spinal motor neurons to the target muscle are excited by transcranial stimulation. The aim of this study was to quantify the proportion of motor neurons recruited during TcMEP monitoring under general anesthesia. In twenty patients who underwent thoracic and/or lumbar spinal surgery with TcMEP monitoring, the triple stimulation technique (TST) was applied to the unilateral upper arm intraoperatively. Total intravenous anesthesia was employed. Trains of four stimuli were delivered with maximal intensity and an inter-pulse interval of 1.5?ms. TST responses were recorded from the abductor digiti minimi muscle, and the negative peak amplitude and area were measured and compared between the TST test (two collisions between transcranial and proximal and distal peripheral stimulation) and control response (two collisions between two proximal and one distal peripheral stimulation). The highest degree of superimposition of the TST test and control responses was chosen from several trials per patient. The average ratios (test:control) were 17.1?% (range 1.8-38?%) for the amplitudes and 21.6?% (range 2.9-40?%) for the areas. The activity of approximately 80?% of the motor units to the target muscle cannot be detected by TcMEP monitoring. Therefore, changes in evoked potentials must be interpreted cautiously when assessing segmental motor function with TcMEP monitoring.

Resumo Limpo

transcrani motor evok potenti tcmep wide use monitor motor function spinal surgeri howev much smaller variabl amplitud respons evok maxim peripher nerv stimul suggest limit number spinal motor neuron target muscl excit transcrani stimul aim studi quantifi proport motor neuron recruit tcmep monitor general anesthesia twenti patient underw thorac andor lumbar spinal surgeri tcmep monitor tripl stimul techniqu tst appli unilater upper arm intraop total intraven anesthesia employ train four stimuli deliv maxim intens interpuls interv ms tst respons record abductor digiti minimi muscl negat peak amplitud area measur compar tst test two collis transcrani proxim distal peripher stimul control respons two collis two proxim one distal peripher stimul highest degre superimposit tst test control respons chosen sever trial per patient averag ratio testcontrol rang amplitud rang area activ approxim motor unit target muscl detect tcmep monitor therefor chang evok potenti must interpret cautious assess segment motor function tcmep monitor

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