Academic Journal
Anatomical and Temporal Blind Spots Explain the High False-Negative Rate of Motor Evoked Potential Monitoring in Glioma Surgery: A Single-Center Analysis of 106 Consecutive Patients.
| Τίτλος: | Anatomical and Temporal Blind Spots Explain the High False-Negative Rate of Motor Evoked Potential Monitoring in Glioma Surgery: A Single-Center Analysis of 106 Consecutive Patients. |
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| Συγγραφείς: | Zhou H; Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China; Department of Radiology, The Affiliated Jinyang Hospital of Guizhou Medical University, Guiyang, Guizhou, China., Liu X; Department of Radiology, The Affiliated Jinyang Hospital of Guizhou Medical University, Guiyang, Guizhou, China., Luo W; Department of Radiology, The Affiliated Jinyang Hospital of Guizhou Medical University, Guiyang, Guizhou, China., Liao X; Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China. Electronic address: xinliao1010@hotmail.com. |
| Πηγή: | World neurosurgery [World Neurosurg] 2026 Sep; Vol. 213, pp. 125204. Date of Electronic Publication: 2026 Jul 23. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: United States NLM ID: 101528275 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-8769 (Electronic) Linking ISSN: 18788750 NLM ISO Abbreviation: World Neurosurg Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: New York : Elsevier |
| Ιατρικοί όροι (MeSH): | Glioma*/surgery , Glioma*/physiopathology , Evoked Potentials, Motor*/physiology , Brain Neoplasms*/surgery , Brain Neoplasms*/physiopathology , Brain Neoplasms*/diagnostic imaging , Intraoperative Neurophysiological Monitoring*/methods, Humans ; Female ; Male ; Retrospective Studies ; Middle Aged ; Adult ; False Negative Reactions ; Aged ; Magnetic Resonance Imaging ; Young Adult ; Sensitivity and Specificity |
| Περίληψη: | Background: Intraoperative motor evoked potential (MEP) monitoring is standard during glioma surgery, yet its diagnostic performance in cohorts enriched for deep-seated tumors remains poorly characterized. Methods: We retrospectively analyzed 106 consecutive patients undergoing MEP-monitored glioma resection. False-negative cases were systematically reviewed to classify monitoring failure as anatomical blind spots (basal ganglia injury, supplementary motor area (SMA)/parietal involvement, thalamic injury) or temporal blind spots (delayed hemorrhage). Preoperative MRI variables were compared between false-negative and true-positive cases. Results: Twenty-five patients (24%) developed new-onset motor deficits at the time of hospital discharge. MEP sensitivity was 28% (95% CI: 12%-49%), and specificity was 95% (95% CI: 88%-99%), with a false-negative rate of 72% (18/25). Systematic review attributed 89% of false-negative events to anatomical blind spots: basal ganglia injury (n = 9), SMA/parietal involvement (n = 4), and thalamic injury (n = 3); 2 cases (11%) resulted from delayed postoperative hemorrhage. No preoperative magnetic resonance imaging (MRI) variable significantly differentiated false-negative from true-positive cases (all P > 0.05). Conclusions: These metrics apply to a selectively monitored cohort enriched for deep-seated lesions and should not be generalized to unselected glioma populations. The low sensitivity most plausibly reflects the high proportion of basal ganglia-involving tumors rather than undetected corticospinal tract injury, though this remains inferential without tractographic confirmation. Patients with deep-seated tumors should be counseled that stable MEP does not reliably predict the absence of motor deterioration at discharge from non-corticospinal structures. These findings quantify a specific monitoring gap and underscore the need for supplementary strategies targeting non-corticospinal motor circuits. (Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved.) |
| Contributed Indexing: | Keywords: Basal ganglia; Corticospinal tract; False-negative rate; Glioma surgery; Intraoperative neurophysiological monitoring; Motor evoked potentials |
| Entry Date(s): | Date Created: 20260723 Date Completed: 20260917 Latest Revision: 20260917 |
| Update Code: | 20260918 |
| DOI: | 10.1016/j.wneu.2026.125204 |
| PMID: | 42492850 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1878-8769 |
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| DOI: | 10.1016/j.wneu.2026.125204 |