Intraoperative motor evoked potentials (MEP) improvement predicts functional outcomes in intracranial surgery

• Improvement in intraoperative Motor Evoked Potentials during intracranial surgery. • The patient experienced enhanced postoperative neurological strength outcome. • Literature paucity of such correlation related to brain tumors and cranial surgery Transcranial Motor Evoked Potentials (TcMEPs) evaluate the functional integrity of corticospinal tracts during neurosurgical procedures. Intraoperative MEP improvements tend to correlate with better postoperative neurological outcomes, in spinal surgeries. Literature is limited on intraoperative MEP improvements and postoperative outcomes in intracranial surgeries. In this case report, we present a thalamic cyst fenestration in the setting of a pilocytic astrocytoma. Immediately post thalamic cyst fenestration, MEPs improved with stable stimulation parameters, anesthesia, and systemic factors. The postoperative motor exam showed an improvement. Intraoperative MEP improvement post thalamic cyst fenestration could be associated with better postoperative outcomes. Intraoperative MEP improvement in intracranial surgeries can help predict postoperative outcomes.