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J Neurosurg Pediatr. 2019 Mar 15:1-9. doi: 10.3171/2019.1.PEDS18674. [Epub ahead of print]

Feasibility of intraoperative monitoring of motor evoked potentials obtained through transcranial electrical stimulation in infants younger than 3 months.

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Departments of1Rehabilitation Medicine.
2Anesthesiology and Pain Medicine, and.
3Neurosurgery, Seoul National University College of Medicine and Seoul National University Hospital; and.
4Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.


OBJECTIVEThis study aimed to investigate the feasibility and safety of intraoperative motor evoked potential (MEP) monitoring in infants less than 3 months of age.METHODSThe authors investigated 25 cases in which infants younger than 3 months (mean age 72.8 days, range 39-87) underwent neurosurgery between 2014 and 2017. Myogenic MEPs were obtained through transcranial electrical stimulation. In all cases, surgery was performed under total intravenous anesthesia, maintained with remifentanil and propofol.RESULTSMEPs were documented in 24 infants, the sole exception being 1 infant who was lethargic and had 4-limb weakness before surgery. The mean stimulation intensity maintained during monitoring was 596 ± 154 V (range 290-900 V). In 19 of 24 infants MEP signals remained at ≥ 50% of the baseline amplitude throughout the operation. Among 5 cases with a decrease in intraoperative MEP amplitude, the MEP signal was recovered in one during surgery, and in the other case a neurological examination could not be performed after surgery. In the other 3 cases, 2 infants had relevant postoperative weakness and the other did not show postoperative neurological deficits. Postoperative weakness was not observed in any of the 20 infants who had no deterioration (n = 19) or only temporary deterioration (n = 1) in MEP signal during surgery.CONCLUSIONSTranscranial electrical MEPs could be implemented during neurosurgery in infants between 1 and 3 months of age. Intraoperative MEP monitoring may be a safe adjunct for neurosurgical procedures in these very young patients.


AH = abductor hallucis; APB = abductor pollicis brevis; BB = biceps brachii; EAS = external anal sphincter; GCM = medial head of the gastrocnemius; IOM = intraoperative monitoring; MEP = motor evoked potential; PMA = postmenstrual age; SSEP = somatosensory evoked potential; TA = tibialis anterior; TES = transcranial electrical stimulation; TIVA = total intravenous anesthesia; VM = vastus medialis; brain tumor; infants; intraoperative monitoring; motor evoked potential; surgical technique; tethered cord syndrome


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