{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T01:56:53Z","timestamp":1774576613831,"version":"3.50.1"},"reference-count":33,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The aim of this study was to compare sensitivity and specificity between the novel threshold and amplitude criteria for motor evoked potentials (MEPs) monitoring after transcranial electrical stimulation (TES) during surgery for supratentorial lesions in the same patient cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>One hundred twenty-six patients were included. All procedures were performed under general anesthesia. Craniotomies did not expose motor cortex, so that direct mapping was less suitable. After TES, MEPs were recorded bilaterally from abductor pollicis brevis (APB), from orbicularis oris (OO), and\/or from tibialis anterior (TA). The percentage increase in the threshold level was assessed and considered significant if it exceeded by more than 20% on the affected side the percentage increase on the unaffected side. Amplitude on the affected side was measured with a stimulus intensity of 150% of the threshold level set for each muscle.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Eighteen of 126 patients showed a significant change in the threshold level as well as an amplitude reduction of more than 50% in MEPs recorded from APB, and 15 of the patients had postoperative deterioration of motor function of the arm (temporary in 8 cases and permanent in 7 [true-positive and false-negative results]). Recording from TA was performed in 66 patients; 4 developed postoperative deterioration of motor function of the leg (temporary in 3 cases and permanent in 1), and showed a significant change in the threshold level, and an amplitude reduction of more than 50% occurred in 1 patient. An amplitude reduction of more than 50% occurred in another 10 patients, without a significant change in the threshold level or postoperative deterioration. Recording from OO was performed in 61 patients; 3 developed postoperative deterioration of motor function of facial muscles (temporary in 2 cases and permanent in 1) and had a significant change in the threshold level, and 2 of the patients had an amplitude reduction of more than 50%. Another 6 patients had an amplitude reduction of more than 50% but no significant change in the threshold level or postoperative deterioration.<\/jats:p><jats:p>Sensitivity of the threshold criterion was 100% when MEPs were recorded from APB, OO, or TA, and its specificity was 97%, 100%, and 100%, respectively. Sensitivity of the amplitude criterion was 100%, 67%, and 25%, with a specificity of 97%, 90%, and 84%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The threshold criterion was comparable to the amplitude criterion with a stimulus intensity set at 150% of the threshold level regarding sensitivity and specificity when recording MEPs from APB, and superior to it when recording from TA or OO.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.4.jns172468","type":"journal-article","created":{"date-parts":[[2018,9,7]],"date-time":"2018-09-07T14:01:50Z","timestamp":1536328910000},"page":"740-749","source":"Crossref","is-referenced-by-count":16,"title":["A comparison between threshold criterion and amplitude criterion in transcranial motor evoked potentials during surgery for supratentorial lesions"],"prefix":"10.3171","volume":"131","author":[{"given":"Tammam","family":"Abboud","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and"},{"name":"Department of Neurosurgery, University Medical Center G\u00f6ttingen, G\u00f6ttingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cindy","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manfred","family":"Westphal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Martens","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg Anesthesiol","first-page":"393","article-title":"Why does threshold level change in transcranial motor-evoked potentials during surgery for supratentorial lesions?","volume":"29","author":"Abboud T","year":"2017","unstructured":"Abboud T, Huckhagel T, Stork JH, Hamel W, Schwarz C, Vettorazzi E, : Why does threshold level change in transcranial motor-evoked potentials during surgery for supratentorial lesions? J Neurosurg Anesthesiol 29:393\u2013399, 2017"},{"key":"b2","series-title":"J Neurosurg","first-page":"795","article-title":"A novel threshold criterion in transcranial motor evoked potentials during surgery for gliomas close to the motor pathway","volume":"125","author":"Abboud T","year":"2016","unstructured":"Abboud T, Schaper M, D\u00fchrsen L, Schwarz C, Schmidt NO, Westphal M, : A novel threshold criterion in transcranial motor evoked potentials during surgery for gliomas close to the motor pathway. J Neurosurg 125:795\u2013802, 2016"},{"key":"b3","series-title":"World Neurosurg","first-page":"e271","article-title":"Facial nerve monitoring during cerebellopontine angle and skull base tumor surgery: a systematic review from description to current success on function prediction","volume":"80","author":"Acioly MA","year":"2013","unstructured":"Acioly MA, Liebsch M, de Aguiar PH, Tatagiba M: Facial nerve monitoring during cerebellopontine angle and skull base tumor surgery: a systematic review from description to current success on function prediction. World Neurosurg 80:e271\u2013e300, 2013"},{"key":"b4","series-title":"Acta Neurochir (Wien)","first-page":"1059","article-title":"Intraoperative continuous monitoring of evoked facial nerve electromyograms in acoustic neuroma surgery","volume":"153","author":"Amano M","year":"2011","unstructured":"Amano M, Kohno M, Nagata O, Taniguchi M, Sora S, Sato H: Intraoperative continuous monitoring of evoked facial nerve electromyograms in acoustic neuroma surgery. Acta Neurochir (Wien) 153:1059\u20131067, 2011"},{"key":"b5","series-title":"J Neurosurg","first-page":"457","article-title":"\u201cThreshold-level\u201d multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal motor tracts: description of method and comparison to somatosensory evoked potential monitoring","volume":"88","author":"Calancie B","year":"1998","unstructured":"Calancie B, Harris W, Broton JG, Alexeeva N, Green BA: \u201cThreshold-level\u201d multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal motor tracts: description of method and comparison to somatosensory evoked potential monitoring. J Neurosurg 88:457\u2013470, 1998"},{"key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"406","article-title":"Alarm criteria for motor-evoked potentials: what\u2019s wrong with the \u201cpresence-or-absence\u201d approach?","volume":"33","author":"Calancie B","year":"2008","unstructured":"Calancie B, Molano MR: Alarm criteria for motor-evoked potentials: what\u2019s wrong with the \u201cpresence-or-absence\u201d approach? Spine (Phila Pa 1976) 33:406\u2013414, 2008"},{"key":"b7","series-title":"Am J Electroneurodiagn Technol","first-page":"247","article-title":"Intraoperative neurophysiological monitoring (IONM): lessons learned from 32 case events in 2069 spine cases","volume":"51","author":"Eager M","year":"2011","unstructured":"Eager M, Shimer A, Jahangiri FR, Shen F, Arlet V: Intraoperative neurophysiological monitoring (IONM): lessons learned from 32 case events in 2069 spine cases. Am J Electroneurodiagn Technol 51:247\u2013263, 2011"},{"key":"b8","series-title":"Front Hum Neurosci","first-page":"85","article-title":"Lower motor neuron findings after upper motor neuron injury: insights from postoperative supplementary motor area syndrome","volume":"7","author":"Florman JE","year":"2013","unstructured":"Florman JE, Duffau H, Rughani AI: Lower motor neuron findings after upper motor neuron injury: insights from postoperative supplementary motor area syndrome. Front Hum Neurosci 7:85, 2013"},{"key":"b9","series-title":"Clin Neurophysiol","first-page":"648","article-title":"The use of motor evoked potential monitoring during cerebral aneurysm surgery to predict pure motor deficits due to subcortical ischemia","volume":"122","author":"Guo L","year":"2011","unstructured":"Guo L, Gelb AW: The use of motor evoked potential monitoring during cerebral aneurysm surgery to predict pure motor deficits due to subcortical ischemia. Clin Neurophysiol 122:648\u2013655, 2011"},{"key":"b10","series-title":"J Clin Neurophysiol","first-page":"129","article-title":"Does preoperative paresis influence intraoperative monitoring of the motor cortex?","volume":"20","author":"Kombos T","year":"2003","unstructured":"Kombos T, Kopetsch O, Suess O, Brock M: Does preoperative paresis influence intraoperative monitoring of the motor cortex? J Clin Neurophysiol 20:129\u2013134, 2003"},{"key":"b11","series-title":"J Clin Neurophysiol","first-page":"422","article-title":"Impact of intraoperative neurophysiological monitoring on surgery of high-grade gliomas","volume":"26","author":"Kombos T","year":"2009","unstructured":"Kombos T, Picht T, Derdilopoulos A, Suess O: Impact of intraoperative neurophysiological monitoring on surgery of high-grade gliomas. J Clin Neurophysiol 26:422\u2013425, 2009"},{"issue":"4","key":"b12","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Subcortical mapping and monitoring during insular tumor surgery","volume":"27","author":"Kombos T","year":"2009","unstructured":"Kombos T, S\u00fcss O, Vajkoczy P: Subcortical mapping and monitoring during insular tumor surgery. Neurosurg Focus 27(4):E5, 2009"},{"key":"b13","series-title":"Br J Neurosurg","first-page":"48","article-title":"Significance of intraoperative motor function monitoring using transcranial electrical motor evoked potentials (MEP) in patients with spinal and cranial lesions near the motor pathways","volume":"23","author":"Krammer MJ","year":"2009","unstructured":"Krammer MJ, Wolf S, Schul DB, Gerstner W, Lumenta CB: Significance of intraoperative motor function monitoring using transcranial electrical motor evoked potentials (MEP) in patients with spinal and cranial lesions near the motor pathways. Br J Neurosurg 23:48\u201355, 2009"},{"key":"b14","series-title":"Neurophysiol Clin","first-page":"431","article-title":"Criteria for transcranial electrical motor evoked potential monitoring during spinal deformity surgery. A review and discussion of the literature","volume":"37","author":"Langeloo DD","year":"2007","unstructured":"Langeloo DD, Journ\u00e9e HL, de Kleuver M, Grotenhuis JA: Criteria for transcranial electrical motor evoked potential monitoring during spinal deformity surgery. A review and discussion of the literature. Neurophysiol Clin 37:431\u2013439, 2007"},{"key":"b15","series-title":"Spine (Phila Pa 1976)","first-page":"1043","article-title":"Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity: a study of 145 patients","volume":"28","author":"Langeloo DD","year":"2003","unstructured":"Langeloo DD, Lelivelt A, Louis Journ\u00e9e H, Slappendel R, de Kleuver M: Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity: a study of 145 patients. Spine (Phila Pa 1976) 28:1043\u20131050, 2003"},{"key":"b16","series-title":"J Korean Neurosurg Soc","first-page":"98","article-title":"Intraoperative monitoring of motor-evoked potentials for supratentorial tumor surgery","volume":"56","author":"Lee JJ","year":"2014","unstructured":"Lee JJ, Kim YI, Hong JT, Sung JH, Lee SW, Yang SH: Intraoperative monitoring of motor-evoked potentials for supratentorial tumor surgery. J Korean Neurosurg Soc 56:98\u2013102, 2014"},{"key":"b17","series-title":"Chin Med J (Engl)","first-page":"323","article-title":"Intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation for preservation of facial nerve function in patients with large acoustic neuroma","volume":"120","author":"Liu BY","year":"2007","unstructured":"Liu BY, Tian YJ, Liu W, Liu SL, Qiao H, Zhang JT, : Intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation for preservation of facial nerve function in patients with large acoustic neuroma. Chin Med J (Engl) 120:323\u2013325, 2007"},{"key":"b18","series-title":"WHO Classification of Tumours of the Central Nervous System","year":"2007","unstructured":"Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds): WHO Classification of Tumours of the Central Nervous System, ed 4. Lyon, France: International Agency for Research on Cancer, 2007"},{"key":"b19","series-title":"J Neurosurg Anesthesiol","first-page":"13","article-title":"Progressive suppression of motor evoked potentials during general anesthesia: the phenomenon of \u201canesthetic fade\u201d","volume":"17","author":"Lyon R","year":"2005","unstructured":"Lyon R, Feiner J, Lieberman JA: Progressive suppression of motor evoked potentials during general anesthesia: the phenomenon of \u201canesthetic fade\u201d. J Neurosurg Anesthesiol 17:13\u201319, 2005"},{"key":"b20","series-title":"J Clin Monit Comput","first-page":"347","article-title":"Intraoperative motor evoked potential monitoring: overview and update","volume":"20","author":"MacDonald DB","year":"2006","unstructured":"MacDonald DB: Intraoperative motor evoked potential monitoring: overview and update. J Clin Monit Comput 20:347\u2013377, 2006"},{"key":"b21","series-title":"Spine (Phila Pa 1976)","first-page":"194","article-title":"Monitoring scoliosis surgery with combined multiple pulse transcranial electric motor and cortical somatosensory-evoked potentials from the lower and upper extremities","volume":"28","author":"MacDonald DB","year":"2003","unstructured":"MacDonald DB, Al Zayed Z, Khoudeir I, Stigsby B: Monitoring scoliosis surgery with combined multiple pulse transcranial electric motor and cortical somatosensory-evoked potentials from the lower and upper extremities. Spine (Phila Pa 1976) 28:194\u2013203, 2003"},{"key":"b22","series-title":"Clin Neurophysiol","first-page":"2291","article-title":"Intraoperative motor evoked potential monitoring\u2014a position statement by the American Society of Neurophysiological Monitoring","volume":"124","author":"MacDonald DB","year":"2013","unstructured":"MacDonald DB, Skinner S, Shils J, Yingling C: Intraoperative motor evoked potential monitoring\u2014a position statement by the American Society of Neurophysiological Monitoring. Clin Neurophysiol 124:2291\u20132316, 2013"},{"issue":"1 Suppl","key":"b23","series-title":"Neurosurgery","first-page":"337","article-title":"Motor evoked potential monitoring with supratentorial surgery","volume":"61","author":"Neuloh G","year":"2007","unstructured":"Neuloh G, Pechstein U, Cedzich C, Schramm J: Motor evoked potential monitoring with supratentorial surgery. Neurosurgery 61 (1 Suppl):337\u2013348, 2007"},{"key":"b24","series-title":"Adv Tech Stand Neurosurg","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/978-3-7091-0558-0_5","article-title":"Motor evoked potential monitoring for the surgery of brain tumours and vascular malformations","volume":"29","author":"Neuloh G","year":"2004","unstructured":"Neuloh G, Schramm J: Motor evoked potential monitoring for the surgery of brain tumours and vascular malformations. Adv Tech Stand Neurosurg 29:171\u2013228, 2004"},{"key":"b25","series-title":"Neurophysiol Clin","first-page":"383","article-title":"Stroke prevention during surgery for deep-seated gliomas","volume":"37","author":"Neuloh G","year":"2007","unstructured":"Neuloh G, Simon M, Schramm J: Stroke prevention during surgery for deep-seated gliomas. Neurophysiol Clin 37:383\u2013389, 2007"},{"key":"b26","series-title":"Clin Neurophysiol","first-page":"1271","article-title":"Variability in amplitude and stimulation threshold values in motor evoked potential (MEP) monitoring during the resection of brain lesions","volume":"126","author":"Okamoto E","year":"2015","unstructured":"Okamoto E, Ishikawa E, Yamamoto T, Matsuda M, Nakai K, Matsushita A, : Variability in amplitude and stimulation threshold values in motor evoked potential (MEP) monitoring during the resection of brain lesions. Clin Neurophysiol 126:1271\u20131278, 2015"},{"key":"b27","series-title":"Front Hum Neurosci","first-page":"960","article-title":"Insights from the supplementary motor area syndrome in balancing movement initiation and inhibition","volume":"8","author":"Potgieser ARE","year":"2014","unstructured":"Potgieser ARE, de Jong BM, Wagemakers M, Hoving EW, Groen RJM: Insights from the supplementary motor area syndrome in balancing movement initiation and inhibition. Front Hum Neurosci 8:960, 2014"},{"key":"b28","series-title":"Neurosurgery","first-page":"982","article-title":"Changes in transcranial motor evoked potentials during intramedullary spinal cord tumor resection correlate with postoperative motor function","volume":"56","author":"Qui\u00f1ones-Hinojosa A","year":"2005","unstructured":"Qui\u00f1ones-Hinojosa A, Lyon R, Zada G, Lamborn KR, Gupta N, Parsa AT, : Changes in transcranial motor evoked potentials during intramedullary spinal cord tumor resection correlate with postoperative motor function. Neurosurgery 56:982\u2013993, 2005"},{"key":"b29","series-title":"Neurosurgery","first-page":"302","article-title":"Intraoperative motor evoked potential alteration in intracranial tumor surgery and its relation to signal alteration in postoperative magnetic resonance imaging","volume":"67","author":"Szel\u00e9nyi A","year":"2010","unstructured":"Szel\u00e9nyi A, Hattingen E, Weidauer S, Seifert V, Ziemann U: Intraoperative motor evoked potential alteration in intracranial tumor surgery and its relation to signal alteration in postoperative magnetic resonance imaging. Neurosurgery 67:302\u2013313, 2010"},{"key":"b30","series-title":"Neurophysiol Clin","first-page":"391","article-title":"Transcranial and direct cortical stimulation for motor evoked potential monitoring in intracerebral aneurysm surgery","volume":"37","author":"Szel\u00e9nyi A","year":"2007","unstructured":"Szel\u00e9nyi A, Langer D, Beck J, Raabe A, Flamm ES, Seifert V, : Transcranial and direct cortical stimulation for motor evoked potential monitoring in intracerebral aneurysm surgery. Neurophysiol Clin 37:391\u2013398, 2007"},{"key":"b31","series-title":"J Neurooncol","first-page":"417","article-title":"Surgical treatment of high-grade gliomas in motor areas. The impact of different supportive technologies: a 171-patient series","volume":"100","author":"Talacchi A","year":"2010","unstructured":"Talacchi A, Turazzi S, Locatelli F, Sala F, Beltramello A, Alessandrini F, : Surgical treatment of high-grade gliomas in motor areas. 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