Intraoperative Subcortical Fiber Mapping with Subcortico-Cortical Evoked Potentials

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• 作者：Rei Enatsu ; ^{enatsur@sapmed.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Aya Kanno ; Shunya Ohtaki ; Yukinori Akiyama ; Satoko Ochi ; Nobuhiro Mikuni
• 关键词：Arcuate fasciculus ; Pyramidal tract ; Subcortical stimulation ; Subcortico-cortical evoked potential
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：86
• 期：Complete
• 页码：478-483
• 全文大小：2665 K

文摘

During brain surgery, there are difficulties associated with identifying subcortical fibers with no clear landmarks. We evaluated the usefulness of cortical evoked potentials with subcortical stimuli (subcortico-cortical evoked potential [SCEP]) in identifying subcortical fibers intraoperatively.

Methods

We used SCEP to identify the pyramidal tract in 4 patients, arcuate fasciculus in 1 patient, and both in 2 patients during surgical procedures. After resection, a 1 × 4-electrode plate was placed on the floor of the removal cavity and 1-Hz alternating electrical stimuli were delivered to this electrode. A 4 × 5 recording electrode plate was placed on the central cortical areas to map the pyramidal tract and temporoparietal cortical areas for the arcuate fasciculus. SCEPs were obtained by averaging electrocorticograms time locked to the stimulus onset.

Results

The subcortical stimulation within 15 mm of the target fiber induced cortical evoked potentials in the corresponding areas, whereas the stimulation apart from 20 mm did not. Five patients showed transient worsening of neurologic symptoms after surgery. However, all patients recovered.

Conclusions

SCEP was useful for identifying subcortical fibers and confirmed the preservation of these fibers. This technique is expected to contribute to the effectiveness and safety of resective surgery in patients with lesions close to eloquent areas.