{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:43:51Z","timestamp":1787067831159,"version":"build-2736575974"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2013,6]]},"abstract":"\n Object<\/jats:title>\n Resection of gliomas in or adjacent to the motor system is widely performed using intraoperative neuromonitoring (IOM). For resection of cerebral metastases in motor-eloquent regions, however, data are sparse and IOM in such cases is not yet widely described. Since recent studies have shown that cerebral metastases infiltrate surrounding brain tissue, this study was undertaken to assess the value and influence of IOM during resection of supratentorial metastases in motor-eloquent regions.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Between 2006 and 2011, the authors resected 206 consecutive supratentorial metastases, including 56 in eloquent motor areas with monitoring of monopolar direct cortically stimulated motor evoked potentials (MEPs). The authors evaluated the relationship between the monitoring data and the course of surgery, clinical data, and postoperative imaging.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Motor evoked potential monitoring was successful in 53 cases (93%). Reduction of MEP amplitude correlated better with postoperative outcomes when the threshold for significant amplitude reduction was set at 80% (only > 80% reduction was considered significant decline) than when it was set at 50% (> 50% amplitude reduction was considered significant decline). Evidence of residual tumor was seen on MR images in 28% of the cases with significant MEP reduction. No residual tumor was seen in any case of stable MEP monitoring. Moreover, preoperative motor deficit, recursive partitioning analysis Class 3, and preoperative radiotherapy were independent risk factors for a new surgery-related motor weakness (occurring in 64% of patients with and 11% of patients without radiotherapy, p > 0.01).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Continuous MEP monitoring provides reliable monitoring of the motor system and also influences the course of operation in resection of cerebral metastases. However, in establishing warning criteria, only an amplitude decline > 80% of the baseline should be considered significant.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2013.2.jns121752","type":"journal-article","created":{"date-parts":[[2013,3,22]],"date-time":"2013-03-22T10:05:25Z","timestamp":1363946725000},"page":"1269-1278","source":"Crossref","is-referenced-by-count":62,"title":["Reliability of intraoperative neurophysiological monitoring using motor evoked potentials during resection of metastases in motor-eloquent brain regions"],"prefix":"10.3171","volume":"118","author":[{"given":"Sandro M.","family":"Krieg","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Sch\u00e4ffner","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehab","family":"Shiban","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doris","family":"Droese","sequence":"additional","affiliation":[{"name":"Anesthesiology, Technische Universit\u00e4t M\u00fcnchen, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Oberm\u00fcller","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Gempt","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Meyer","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Ringel","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns121752","series-title":"Neurosurgery","first-page":"74","article-title":"Physiological basis of motor effects of a transient stimulus to cerebral cortex","volume":"20","author":"Amassian","year":"1987"},{"key":"b2-jns121752","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/s11060-009-0055-6","article-title":"The role of retreatment in the management of recurrent\/progressive brain metastases: a systematic review and evidence-based clinical practice guideline","volume":"96","author":"Ammirati","year":"2010"},{"key":"b3-jns121752","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1007\/s00701-010-0817-0","article-title":"Utility of diffusion tensor-imaged (DTI) motor fiber tracking for the resection of intracranial tumors near the corticospinal tract","volume":"153","author":"Buchmann","year":"2011"},{"key":"b4-jns121752","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1097\/00006123-199605000-00023","article-title":"Somatosensory evoked potential phase reversal and direct motor cortex stimulation during surgery in and around the central region","volume":"38","author":"Cedzich","year":"1996"},{"key":"b5-jns121752","series-title":"Adv Neurol","first-page":"201","article-title":"Intraoperative monitoring of the functional integrity of the motor pathways","volume":"63","author":"Deletis","year":"1993"},{"key":"b6-jns121752","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1136\/jnnp.2004.048520","article-title":"Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985\u201396) and with (1996\u20132003) functional mapping in the same institution","volume":"76","author":"Duffau","year":"2005"},{"key":"b7-jns121752","series-title":"J Natl Compr Canc Netw","doi-asserted-by":"publisher","first-page":"505","DOI":"10.6004\/jnccn.2008.0038","article-title":"Guidelines for the initial management of metastatic brain tumors: role of surgery, radiosurgery, and radiation therapy","volume":"6","author":"Ewend","year":"2008"},{"key":"b8-jns121752","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1016\/S0360-3016(96)00619-0","article-title":"Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials","volume":"37","author":"Gaspar","year":"1997"},{"key":"b9-jns121752","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1007\/s11060-009-0061-8","article-title":"The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline","volume":"96","author":"Kalkanis","year":"2010"},{"key":"b10-jns121752","series-title":"J Clin Neurophysiol","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1097\/WNP.0b013e3181c2c0dc","article-title":"Impact of intraoperative neurophysiological monitoring on surgery of high-grade gliomas","volume":"26","author":"Kombos","year":"2009"},{"key":"b11-jns121752","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"608","DOI":"10.3171\/jns.2001.95.4.0608","article-title":"Monitoring of intraoperative motor evoked potentials to increase the safety of surgery in and around the motor cortex","volume":"95","author":"Kombos","year":"2001"},{"key":"b12-jns121752","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1007\/s007010050034","article-title":"Intra-operative mapping of the motor cortex during surgery in and around the motor cortex","volume":"142","author":"Kombos","year":"2000"},{"key":"b13-jns121752","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1007\/s00701-011-1255-3","article-title":"Diffusion tensor imaging fiber tracking using navigated brain stimulation\u2014a feasibility study","volume":"154","author":"Krieg","year":"2012"},{"key":"b14-jns121752","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"994","DOI":"10.3171\/2011.12.JNS111524","article-title":"Utility of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in eloquent motor areas. Clinical article","volume":"116","author":"Krieg","year":"2012"},{"key":"b15-jns121752","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1227\/NEU.0b013e31823f5ade","article-title":"Predictive value and safety of intraoperative neurophysiological monitoring with motor evoked potentials in glioma surgery","volume":"70","author":"Krieg","year":"2012"},{"key":"b16-jns121752","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s11060-009-0073-4","article-title":"The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline","volume":"96","author":"Linskey","year":"2010"},{"key":"b17-jns121752","series-title":"Radiat Oncol","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/1748-717X-6-48","article-title":"Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis","volume":"6","author":"Minniti","year":"2011"},{"key":"b18-jns121752","series-title":"Int J Clin Oncol","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s10147-009-0917-0","article-title":"Strategy of surgery and radiation therapy for brain metastases","volume":"14","author":"Narita","year":"2009"},{"key":"b19-jns121752","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1227\/01.NEU.0000119326.15032.00","article-title":"Motor evoked potential monitoring with supratentorial surgery","volume":"54","author":"Neuloh","year":"2004"},{"issue":"1 Suppl","key":"b20-jns121752","series-title":"Neurosurgery","first-page":"337","article-title":"Motor evoked potential monitoring with supratentorial surgery","volume":"61","author":"Neuloh","year":"2007"},{"key":"b21-jns121752","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"582","DOI":"10.3171\/jns.2007.106.4.582","article-title":"Motor tract monitoring during insular glioma surgery","volume":"106","author":"Neuloh","year":"2007"},{"key":"b22-jns121752","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"389","DOI":"10.3171\/jns.2004.100.3.0389","article-title":"Monitoring of motor evoked potentials compared with somatosensory evoked potentials and microvascular Doppler ultrasonography in cerebral aneurysm surgery","volume":"100","author":"Neuloh","year":"2004"},{"key":"b23-jns121752","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1097\/00006123-199608000-00020","article-title":"Transcranial high-frequency repetitive electrical stimulation for recording myogenic motor evoked potentials with the patient under general anesthesia","volume":"39","author":"Pechstein","year":"1996"},{"key":"b24-jns121752","series-title":"Brain","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1093\/brain\/60.4.389","article-title":"Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation","volume":"60","author":"Penfield","year":"1937"},{"key":"b25-jns121752","series-title":"Cancer","doi-asserted-by":"publisher","first-page":"2980","DOI":"10.1002\/cncr.26612","article-title":"Single brain metastasis: radiosurgery alone compared with radiosurgery plus up-front whole-brain radiotherapy","volume":"118","author":"Rades","year":"2012"},{"key":"b26-jns121752","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1016\/j.clineuro.2011.10.042","article-title":"Single brain metastasis: resection followed by whole-brain irradiation and a boost to the metastatic site compared to whole-brain irradiation plus radiosurgery","volume":"114","author":"Rades","year":"2012"},{"key":"b27-jns121752","series-title":"Cancer","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1002\/cncr.26379","article-title":"Single brain metastasis: whole-brain irradiation plus either radiosurgery or neurosurgical resection","volume":"118","author":"Rades","year":"2012"},{"key":"b28-jns121752","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1016\/j.ijrobp.2010.07.034","article-title":"Metastasis infiltration: an investigation of the postoperative brain-tumor interface","volume":"81","author":"Raore","year":"2011"},{"key":"b29-jns121752","series-title":"Can J Neurol Sci","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1017\/S0317167100021430","article-title":"Somatosensory evoked potential identification of sensorimotor cortex in removal of intracranial neoplasms","volume":"24","author":"Rowed","year":"1997"},{"issue":"2","key":"b30-jns121752","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.3171\/2009.12.FOCUS09266","article-title":"Intraoperative stimulation techniques for functional pathway preservation and glioma resection","volume":"28","author":"Sanai","year":"2010"},{"key":"b31-jns121752","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"571","DOI":"10.3171\/jns.2002.96.3.0571","article-title":"Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data","volume":"96","author":"Scheufler","year":"2002"},{"key":"b32-jns121752","series-title":"Head Face Med","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/1746-160X-2-20","article-title":"Intraoperative electrocortical stimulation of Brodman area 4: a 10-year analysis of 255 cases","volume":"2","author":"Suess","year":"2006"},{"key":"b33-jns121752","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"675","DOI":"10.3171\/jns.2006.105.5.675","article-title":"Monitoring of muscle motor evoked potentials during cerebral aneurysm surgery: intraoperative changes and postoperative outcome","volume":"105","author":"Szel\u00e9nyi","year":"2006"},{"key":"b34-jns121752","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1227\/00006123-199302000-00011","article-title":"Modification of cortical stimulation for motor evoked potentials under general anesthesia: technical description","volume":"32","author":"Taniguchi","year":"1993"},{"key":"b35-jns121752","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"439","DOI":"10.3171\/2008.11.JNS08984","article-title":"Stereotactic radiosurgery for metastatic brain tumors: a comprehensive review of complications. Clinical article","volume":"111","author":"Williams","year":"2009"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/118\/6\/article-p1269.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/118\/6\/article-p1269.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/118\/6\/article-p1269.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,14]],"date-time":"2022-08-14T13:50:28Z","timestamp":1660485028000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/118\/6\/article-p1269.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2013,6]]},"references-count":35,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2013.2.jns121752","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,6]]}}}