• Giuseppe Maria Della Pepa, Michele Di Domenico, Giovanni Maria Ceccarelli, Benedetta Burattini, Grazia Menna, Alessandro Rapisarda, Diana Viola, Salvatore Marino, Pier Paolo Mattogno, Alessandro Olivi, and Francesco Doglietto.
• Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy.
• World Neurosurg. 2024 Aug 1; 188: 117123117-123.

BackgroundThe balance between comprehensive intraoperative neurophysiological monitoring (IONM) for both upper and lower limbs while ensuring the reliability of motor evoked potentials (MEPs) is paramount in motor area surgery. It is commonly difficult to obtain good simultaneous stimulation of both upper and lower limbs. A series of factors can bias MEP accuracy, and inappropriate stimulation intensity can result in unreliable monitoring. The presented IONM technique is based on the concurrent use of both transcranial and cortical strip electrodes to facilitate simultaneous monitoring of both upper and lower limbs at optimized stimulation intensities to increase IONM accuracy during motor area surgery.MethodsTen nonconsecutive motor area tumors were studied. Good visualization of both limbs was observed in the series at a low amperage (1.2 mA from the strip electrode and 165.3 mA from the transcranial electrode).ResultsOur analysis confirms concordance between the IONM data and postoperative outcomes. An MEP reduction >20% and >50% correlated with postoperative modified Rankin scale score changes without false-negative IONM findings.ConclusionsThe technique was demonstrated to be accurate in providing a good simultaneous neurophysiological evaluation of both upper and lower limbs with an optimized and stimulation amplitude. The technique results in a low encumbrance of electrodes in the surgical field. Our results have confirmed the "proof of concept," its reliability and feasibility.Copyright © 2024 Elsevier Inc. All rights reserved.

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