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We hypothesize that navigated placement of stimulation electrodes yields superior potential quality for tcMEPs compared to the conventional 10\u201320 placement. We prospectively included patients undergoing elective cranial surgery with intraoperative monitoring of tcMEPs. In addition to electrode placement as per the 10\u201320 system, an electrode pair was placed at a location corresponding to the hand knob area of the primary motor cortex (M1) for every patient, localized by a navigation system during surgical setup. Twenty-five patients undergoing elective navigated surgery for intracranial tumors (<jats:italic>n<\/jats:italic>\u2009=\u200923; 92%) or vascular lesions (<jats:italic>n<\/jats:italic>\u2009=\u20092; 8%) under intraoperative monitoring of tcMEPs were included between June and August 2019 at our department. Stimulation and recording of tcMEPs was successful in every case for the navigated electrode pair, while stimulation by 10\u201320 electrodes did not yield baseline tcMEPs in two cases (8%) with anatomical displacement of the M1. While there was no significant difference between baseline amplitudes, mean potential quality decreased significantly by 88.3\u00a0\u00b5V (\u2212\u200913.5%) for the 10\u201320 electrodes (<jats:italic>p<\/jats:italic>\u2009=\u20090.004) after durotomy, unlike for the navigated electrodes (\u2212\u200928.6\u00a0\u00b5V [\u2212\u20093.1%]; <jats:italic>p<\/jats:italic>\u2009=\u20090.055). For patients with an anatomically displaced M1, the navigated tcMEPs declined significantly less after durotomy (\u2212\u20093.6% vs. 10\u201320:\u2009\u2212\u200923.3%; <jats:italic>p<\/jats:italic>\u2009=\u20090.038). Navigated placement of tcMEP electrodes accounts for interindividual anatomical variance and pathological dislocation of the M1, yielding more consistent potentials and reliable potential quality.<\/jats:p>","DOI":"10.1007\/s10143-021-01568-4","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T07:02:38Z","timestamp":1622098958000},"page":"585-593","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Improved potential quality of intraoperative transcranial motor-evoked potentials by navigated electrode placement compared to the conventional ten-twenty system"],"prefix":"10.1007","volume":"45","author":[{"given":"Arthur","family":"Wagner","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Ille","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caspar","family":"Liesenhoff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaywan","family":"Aftahy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernhard","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandro M.","family":"Krieg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,27]]},"reference":[{"key":"1568_CR1","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1097\/wnp.0000000000000316","volume":"33","author":"JN Acharya","year":"2016","unstructured":"Acharya JN, Hani A, Cheek J, Thirumala P, Tsuchida TN (2016) American Clinical Neurophysiology Society Guideline 2: guidelines for standard electrode position nomenclature. 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The study group acquired approval by the local ethics committee (Ethikkommission der Technischen Universit\u00e4t M\u00fcnchen, registration no. 214\/16\u00a0s). Every participant of this study provided written informed consent for participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Every participant of this study provided written informed consent for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"BM received honoraria, consulting fees, and research grants from Medtronic (Meerbusch, Germany), Icotec AG (Altst\u00e4tten, Switzerland), and Relievant Medsystems, Inc. (Sunnyvale, CA, USA); honoraria and research grants from Ulrich Medical (Ulm, Germany); honoraria and consulting fees from Spineart Deutschland GmbH (Frankfurt, Germany) and DePuy Synthes (West Chester, PA, USA); and royalties from Spineart Deutschland GmbH (Frankfurt, Germany). SK received honoraria from Nexstim Plc (Helsinki, Finland), Spineart Deutschland GmbH (Frankfurt, Germany), Medtronic (Meerbusch, Germany), and Carl Zeiss Meditec (Oberkochen, Germany). SK and BM received research grants and are consultants for Brainlab AG (Munich, Germany). SI is a consultant for Brainlab AG (Munich, Germany).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}