Turkish Neurosurgery
Multimodal Intraoperative Neurophysiologic Monitoring in the Neurosurgical Oncology
Sema Brandmeier2, Emine Taşkıran1, Fatihhan Bölükbaşı3, Ramazan Sarı3, İlhan Elmacı3
1Cerrahpaşa Faculty of Medicine, Neurosurgery, Istanbul,
2Istanbul University, Experimental Medicine Institute, Department of Neuroscience, Istanbul,
3Memorial Health Group, Neurosurgery Clinics, Istanbul,
DOI: 10.5137/1019-5149.JTN.19177-16.1

Aim:Neurosurgical oncology that is performed for lesions located in critical areas like the sensorimotor area has additional risk because it may cause serious neurological deficiencies. Some intraoperative neuromonitoring (IONM) modalities can effectively help the surgeons to maximize resections of this kind of lesions with or without an acceptable neurological deficiency. Our aim was to share our IONM experiences with patients who underwent intracranial lesion surgery in critical areas between September 2013 and January 2015.Material and Methods:Included in this retrospective review were 31 patients who underwent brain surgery for resection of lesions located in areas with high risk to eloquent structures. Demographic characteristics, lesion localizations, lesion pathologies, surgery, IONM recordings, pre- and postoperative neurological examinations were reviewed.Results:Five of the 31 patients had lesions in the cerebellopontine angle and 26 patients had lesions close to the critical neurologic locasions. Transcranial motor evoked potential and somatosensory evoked potential was performed in 27, electroencephalography in 31, auditory evoked potentials in 8, visual evoked potentials in 2, and triggered electromyography in 8 patients, central sulcus determination and brain mapping in 17 patients. Motor evoked potential changes occurred in 2 patients intraoperatively. One had right hemiparesia lasting 3 days while the other had monoparesia which improved within 2 months. Permenant neurologic deficit was not observed. Conclusion:Intraoperative neuromonitoring helps the surgeons to maximize resection of lesions in or close to eloquent areas of the brain. Using only one modality is not sufficient, whereas combination of modalities is required to maximize outcome.