Risk factors for intraoperative seizures during asleep motor evoked potential monitoring in supratentorial surgery.
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OBJECTIVE: Intraoperative-seizures(IOS) following direct electrical stimulation(DES) affects intraoperative neurophysiological monitoring(IONM) and may lead to stop surgical resection. We analyzed IOS risk factors during asleep brain surgery. METHODS: We reviewed 232 consecutive patients who underwent surgery for supratentorial brain lesions with IONM, that consisted in motor evoked potentials monitoring and mapping, elicited by DES using the train-of-five technique. Preoperative history of seizures, paresis, use of anti-seizure medications(ASM), stimulated cortical regions, histology, and motor performance were evaluated. IOS was defined as clinical seizure or an after-discharge. RESULTS: IOS occurred in 35 patients (15.1 %). IOS risk increased with higher stimulation intensities, younger age, cavernomas, and a history of seizures, especially in patients without ASM at the time of surgery. IOS did not significantly impact the extent of resection or clinical outcome, but prolonged hospital stays. CONCLUSION: Our findings suggest that lower stimulation intensities are advisable when operating on patients with specific risk factors for IOS. SIGNIFICANCE: We observed a significant increase in IOS risk with stimulation above 20 mA, thresholds being lower in high-risk patients. Tailored stimulation can reduce the risk of IOS. This study presents a large series on IOS risk factors during asleep surgeries and provides a review of these factors.