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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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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.
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
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  Data: 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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  Data: <searchLink fieldCode="AU" term="%22Zhou+H%22">Zhou H</searchLink>; 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.<br /><searchLink fieldCode="AU" term="%22Liu+X%22">Liu X</searchLink>; Department of Radiology, The Affiliated Jinyang Hospital of Guizhou Medical University, Guiyang, Guizhou, China.<br /><searchLink fieldCode="AU" term="%22Luo+W%22">Luo W</searchLink>; Department of Radiology, The Affiliated Jinyang Hospital of Guizhou Medical University, Guiyang, Guizhou, China.<br /><searchLink fieldCode="AU" term="%22Liao+X%22">Liao X</searchLink>; Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China. Electronic address: xinliao1010@hotmail.com.
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  Data: <searchLink fieldCode="MM" term="%22Glioma%22">Glioma*</searchLink>/<searchLink fieldCode="MM" term="%22Glioma+surgery%22">surgery</searchLink> <br /><searchLink fieldCode="MM" term="%22Glioma%22">Glioma*</searchLink>/<searchLink fieldCode="MM" term="%22Glioma+physiopathology%22">physiopathology</searchLink> <br /><searchLink fieldCode="MM" term="%22Evoked+Potentials%2C+Motor%22">Evoked Potentials, Motor*</searchLink>/<searchLink fieldCode="MM" term="%22Evoked+Potentials%2C+Motor+physiology%22">physiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Brain+Neoplasms%22">Brain Neoplasms*</searchLink>/<searchLink fieldCode="MM" term="%22Brain+Neoplasms+surgery%22">surgery</searchLink> <br /><searchLink fieldCode="MM" term="%22Brain+Neoplasms%22">Brain Neoplasms*</searchLink>/<searchLink fieldCode="MM" term="%22Brain+Neoplasms+physiopathology%22">physiopathology</searchLink> <br /><searchLink fieldCode="MM" term="%22Brain+Neoplasms%22">Brain Neoplasms*</searchLink>/<searchLink fieldCode="MM" term="%22Brain+Neoplasms+diagnostic+imaging%22">diagnostic imaging</searchLink> <br /><searchLink fieldCode="MM" term="%22Intraoperative+Neurophysiological+Monitoring%22">Intraoperative Neurophysiological Monitoring*</searchLink>/<searchLink fieldCode="MM" term="%22Intraoperative+Neurophysiological+Monitoring+methods%22">methods</searchLink><br /><searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Retrospective+Studies%22">Retrospective Studies</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink> ; <searchLink fieldCode="MH" term="%22False+Negative+Reactions%22">False Negative Reactions</searchLink> ; <searchLink fieldCode="MH" term="%22Aged%22">Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Magnetic+Resonance+Imaging%22">Magnetic Resonance Imaging</searchLink> ; <searchLink fieldCode="MH" term="%22Young+Adult%22">Young Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Sensitivity+and+Specificity%22">Sensitivity and Specificity</searchLink>
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  Data: 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.<br />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.<br />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).<br />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.<br /> (Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved.)
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  Data: <i>Keywords: </i>Basal ganglia; Corticospinal tract; False-negative rate; Glioma surgery; Intraoperative neurophysiological monitoring; Motor evoked potentials
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      – TitleFull: 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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