Experimental study of medullary trigeminal evoked potentials: development of a new method of intraoperative monitoring of the medulla oblongata

OBJECT: The goal of this study was to develop a new method of intraoperative monitoring of functions located in the lateral portion of the medulla oblongata. Based on the fact that the spinal trigeminal nucleus and tract are located in the lateral portion of the medulla oblongata, the authors intended to investigate the efficacy of trigeminal evoked potentials (TEPs) in intraoperative monitoring for assessing functions of the medulla oblongata. METHODS: Trigeminal evoked potentials induced by electrical stimulation of the infraorbital nerve were recorded from the dorsolateral portion of the medulla oblongata (M-TEP) and the cerebral sensory cortex (C-TEP) in dogs. When the lateral one-sixth portion of the medulla was cut, the amplitude of the M-TEP decreased markedly, but the amplitude of the C-TEP and the somatosensory evoked potential (SSEP) did not decrease. When the lateral one-third portion of the medulla was cut, the amplitude of the SSEP decreased, but that of the C-TEP showed no change. When the medulla was retracted, the amplitude of the M-TEP was more sensitive than that of SSEP. Pathological examinations revealed that retraction force less than 10 g and a reduction in the amplitude of the M-TEP less than 50% were safe. CONCLUSIONS: These results suggest that M-TEPs obtained from the dorsolateral portion of the medulla oblongata by electrical stimulation of the trigeminal nerve are clinically applicable as a new means of intraoperative monitoring of the functions of the medulla oblongata.