Effect of peripheral nerve tetanic stimulation on the inter-trial variability and accuracy of transcranial motor-evoked potential in brain surgery

•We compared post-tetanic (p-MEP) and conventional (c-MEP) motor-evoked potentials.•p-MEP showed lower inter-trial variability, higher amplitude, fewer false-positive alarm signs, and equal sensitivity.•The p-MEP technique may increase the accuracy of intraoperative MEP monitoring.

ObjectivesThe aim of this study was to evaluate and compare the advantages of post-tetanic motor-evoked potential (p-MEP) and conventional motor-evoked potential (c-MEP) in terms of MEP inter-trial variability and accuracy.Methodsc-MEP and p-MEP were quantified in subjects who underwent brain surgery. c-MEP was generated by transcranial electrical stimulation (TES). p-MEP was generated using a preconditioning process involving tetanic stimulation at the left tibial nerve followed by TES. The presence of significant MEP deterioration was monitored during major surgical process. An additional 5-8 MEP obtained after major surgical process were used to analyze amplitude parameters such as mean, standard deviation, range, coefficient of variation (CV), and range to mean ratio.ResultsWhen only irreversible MEP deteriorations were considered as positive results, the false-positive rate was identical for p-MEP and c-MEP. When total MEP deteriorations were considered as positive results, the false-positive rate of p-MEP was lower and p-MEP had higher specificity than c-MEP. The mean amplitude of p-MEP was significantly higher than that of c-MEP. The CV and range to mean ratio of p-MEP were less than those of c-MEP.ConclusionThe p-MEP technique is useful for augmenting MEP amplitude and reducing inter-trial variability.Significancep-MEP has clinical significance as a useful technique for intraoperative monitoring.