Direct Cortical Motor Evoked Potentials Versus Transcranial Motor Evoked Potentials for the Detection of Cortical Ischemia During Supratentorial Craniotomy: Case Report

Curēus
Justin W SilversteinJason A Ellis

Abstract

Transcranial motor evoked potential (TCMEP) and direct cortical motor evoked potential (DCMEP) paradigms have historically been used contemporaneously or independently for supratentorial craniotomies. DCMEP provides focal stimulation to the cortical surface, whereas TCMEP stimulation is more variable and may be activating structures deeper than those at risk during a supratentorial craniotomy. We present the case report for a 65-year-old female who underwent a supratentorial craniotomy for the clipping of a right-sided unruptured middle cerebral artery (MCA) aneurysm. DCMEP recordings of the upper extremity degraded after the parent vessel was temporarily occluded with a clip. The recordings returned once the clip was released. The DCMEP lower extremity recordings did not deviate from their established baseline. TCMEP recordings (upper and lower extremities) also did not deviate from their established baselines. The permanent clip was placed without incident, and the patient awoke neurologically intact. This case study demonstrates the specificity and sensitivity of DCMEP vs. TCMEP. DCMEP activates the corticospinal tract more superficially; therefore, it was evident by the loss of the upper extremity DCMEPs without the loss of...Continue Reading

Citations

Jul 3, 2021·Cancers·Evridiki AsimakidouKathleen Seidel
Nov 17, 2021·The Neurodiagnostic Journal·Nicholas B DadarioRandy S DAmico

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