• Laurèl Rauschenbach, Alejandro N Santos, Thiemo F Dinger, Annika Herten, Marvi Darkwah Oppong, Börge Schmidt, Mehdi Chihi, Johannes Haubold, Ramazan Jabbarli, Karsten H Wrede, Ulrich Sure, and Philipp Dammann.
• Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany. Electronic address: laurel.rauschenbach@uk-essen.de.
• World Neurosurg. 2021 Dec 1; 156: e359-e373.

ObjectiveTo evaluate the predictive value of intraoperative neuromonitoring (IONM) in brainstem cavernous malformation (BSCM) surgery.MethodsSurgically treated patients with BSCM were included. All patients received IONM consisting of motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs). Neurologic examination was conducted preoperatively and at discharge and follow-up >3 months after BSCM removal. Demographic, radiographic, and clinical features were assessed. Study end points were new motor or somatosensory deficits and functional disability.ResultsA total of 62 patients were included. MEP decrease was associated with new motor deficits at discharge (P = 0.022), and SSEP decrease was associated with new somatosensory deficits at discharge (P < 0.001) and follow-up (P < 0.001). Sensitivity and specificity values for MEPs (discharge: 31% and 93%; follow-up: 33% and 91%) and SSEPs (discharge: 82% and 80%; follow-up: 85% and 79%) were calculated, respectively. Receiver operating characteristic analyses with area under the curve (AUC) metrics revealed acceptable performance of MEPs (AUC, 0.75; P = 0.022) and SSEPs (AUC, 0.72; P = 0.004) in predicting early deficits. Intraoperative decrease of MEPs (P = 0.047) and SSEPs (P = 0.017) was associated with early functional disability. Surgery-related subdural air accumulation impaired IONM reliability in predicting early (P = 0.048) and long-term (P = 0.013) deficits.ConclusionsEstablished IONM warning criteria may be valid for BSCM removal. However, surgical approaches in the sitting position significantly limit the predictive value of IONM, to some extent because of intraoperative pneumocephalus.Copyright © 2021 Elsevier Inc. All rights reserved.

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