• Kohei Kanaya, Tetsuya Goto, Tetsuyoshi Horiuchi, and Kazuhiro Hongo.
• Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
• World Neurosurg. 2019 Jul 1; 127: e1044-e1050.

ObjectiveCorkscrew (CS) electrodes are usually used for transcranial electrical stimulation (TES) in the intraoperative monitoring of motor evoked potentials (MEP). Direct cranial stimulation with peg-screw (PS) electrodes can elicit MEP. The present study investigated the difference in the initial threshold between PS and CS electrodes for intraoperative MEP monitoring.MethodsWe retrospectively analyzed TES-MEP monitoring for supratentorial surgery in 72 patients. Of these 72 patients, 44 were monitored with PS and CS electrodes (PS/CS group) and 28 were monitored with CS and CS electrodes (CS/CS group). TES was used to deliver electrical stimulation by a train of 4-pulse anodal constant current stimulation. The initial threshold in each electrode was checked and analyzed.ResultsIn the PS/CS group, the initial threshold with the PS electrode was 38.3 ± 15.1 mA (mean ± standard deviation) on the affected side, and the initial threshold with the CS electrode was 51.4 ± 13.9 mA on the unaffected side. The initial threshold with the PS electrode was significantly lower than that with the CS electrode (P = 0.0001). In the CS/CS group, the initial threshold was 56.2 ± 16.5 mA on the affected side and 62.1 ± 18.6 mA on the unaffected side, with no statistically significant difference (P = 0.23).ConclusionThe initial threshold to elicit MEP was significantly lower with the PS electrode than with the CS electrode. A PS electrode can be used as a feasible stimulation electrode for TES-MEP.Copyright © 2019. Published by Elsevier Inc.

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