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Journal articles on the topic 'Intraoperative brain mapping'

Author: Grafiati

Published: 9 March 2023

Last updated: 10 March 2023

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1

Byrne, Richard W., Nader Sanai, Jose A. Landeiro, and Hugues Duffau. "Introduction: Advances in intraoperative brain mapping." Neurosurgical Focus 45, VideoSuppl2 (October 2018): Intro. http://dx.doi.org/10.3171/2018.10.focusvid.intro.

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Silbergeld, Daniel L. "Intraoperative transdural functional mapping." Journal of Neurosurgery 80, no. 4 (April 1994): 756–58. http://dx.doi.org/10.3171/jns.1994.80.4.0756.

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✓ During craniotomy for supratentorial intraparenchymal space-occupying lesions, with the patient either under general anesthesia or awake, a smaller durotomy designed to expose only the region of resection may be desirable because of brain swelling. Similarly, during repeat craniotomy or craniotomy following cerebral injury or infection, pial-dural adhesions increase the risk of damage to essential cortex, making a limited dural opening desirable. Intraoperative transdural somatosensory evoked potentials and transdural cortical stimulation mapping permit localization of functional cortex prior to durotomy. These techniques can be combined with intraoperative transdural ultrasonography to identify topographical landmarks and borders of mass lesions.

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Gasser, T., C. Nimsky, O. Ganslandt, E. Sandalcioglu, Y. Muragaki, N. Ozawa, H. Iseki, et al. "Intraoperative functional MRI: A novel technology for intraoperative brain-mapping." Journal of Biomechanics 39 (January 2006): S369. http://dx.doi.org/10.1016/s0021-9290(06)84481-7.

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Skrap, Miran, Dario Marin, Tamara Ius, Franco Fabbro, and Barbara Tomasino. "Brain mapping: a novel intraoperative neuropsychological approach." Journal of Neurosurgery 125, no. 4 (October 2016): 877–87. http://dx.doi.org/10.3171/2015.10.jns15740.

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OBJECTIVE Awake surgery and mapping are performed in patients with low-grade tumors infiltrating functional brain areas for which the greater the resection, the longer the patient survival. However, the extent of resection is subject to preservation of cognitive functions, and in the absence of proper feedback during mapping, the surgeon may be less prone to perform an extensive resection. The object of this study was to perform real-time continuous assessment of cognitive function during the resection of tumor tissue that could infiltrate eloquent tissue. METHODS The authors evaluated the use of new, complex real-time neuropsychological testing (RTNT) in a series of 92 patients. They reported normal scoring and decrements in patient performance as well as reversible intraoperative neuropsychological dysfunctions in tasks (for example, naming) associated with different cognitive abilities. RESULTS RTNT allowed one to obtain a more defined neuropsychological picture of the impact of surgery. The influence of this monitoring on surgical strategy was expressed as the mean extent of resection: 95% (range 73%–100%). At 1 week postsurgery, the neuropsychological scores were very similar to those detected with RTNT, revealing the validity of the RTNT technique as a predictive tool. At the follow-up, the majority of neuropsychological scores were still > 70%, indicating a decrease of < 30%. CONCLUSIONS RTNT enables continuous enriched intraoperative feedback, allowing the surgeon to increase the extent of resection. In sharp contrast to classic mapping techniques, RTNT allows testing of several cognitive functions for one brain area under surgery.

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Berger, Mitchel S., and George A. Ojemann. "Intraoperative Brain Mapping Techniques in Neuro-Oncology." Stereotactic and Functional Neurosurgery 58, no. 1-4 (1992): 153–61. http://dx.doi.org/10.1159/000098989.

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6

Gorbach, A. M., C. Kufta, J. Heiss, and E. Oldfield. "Intraoperative Functional Brain Mapping by Infrared Imaging." NeuroImage 7, no. 4 (May 1998): S63. http://dx.doi.org/10.1016/s1053-8119(18)30896-6.

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Duffau, Hugues. "Brain mapping in tumors: Intraoperative or extraoperative?" Epilepsia 54 (December 2013): 79–83. http://dx.doi.org/10.1111/epi.12449.

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Hameed, N. U. Farrukh, Zehao Zhao, Jie Zhang, Linghao Bu, Yuyao Zhou, Lei Jin, Hongmin Bai, et al. "A Novel Intraoperative Brain Mapping Integrated Task-Presentation Platform." Operative Neurosurgery 20, no. 5 (February 6, 2021): 477–83. http://dx.doi.org/10.1093/ons/opaa476.

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Abstract BACKGROUND To be efficient, intraoperative task-presentation systems must accurately present various language and cognitive tasks to patients undergoing awake surgery, and record behavioral data without compromising convenience of surgery. OBJECTIVE To present an integrated brain mapping task-presentation system we developed and evaluate its effectiveness in intraoperative task presentation. METHODS The Brain Mapping Interactive Stimulation System (Brain MISS) is a flexible task presentation system that adjusts for patient comfort, needs of the surgeon, and operating team, with multivideo recording for patients’ behavior. A total of 48 patients from 3 centers underwent intraoperative language task test during awake brain surgery with the Brain MISS. Each patient was assigned 5 questions each on picture naming, reading, and listening comprehension before and during awake surgeries. The accuracy of intraoperative stimulus-response (without electrical stimulation) was recorded. The Brain MISS was to be considered effective, if the lower limit of 95% CI of patients’ intraoperative response was ≥80% and also if the accuracy of intraoperative response of all patients was statistically higher than 80%. RESULTS All patients successfully underwent intraoperative assessment with the Brain MISS. The overall accuracy of stimulus response was 95.8% (95% CI 90.18%-100.00%), with the lower limit being higher than 80% and the response accuracy also significantly being higher than 80% in all patients (P = .006). CONCLUSION The Brain MISS is a portable and effective system for presenting and streamlining complicated language and cognitive tasks during awake surgery. It can also record standardized patient response data for neuroscientific research.

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Kin, Taichi, Masanori Yoshino, Toki Saito, Daichi Nakagawa, Masaaki Shojima, Akitake Mukasa, Masahiro Shin, et al. "Pre- and Intraoperative Brain Functional Mapping in Brain Tumor Surgery." Japanese Journal of Neurosurgery 23, no. 1 (2014): 5–11. http://dx.doi.org/10.7887/jcns.23.5.

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Miyagishima, T., A. Takahashi, S. Ishiuchi, M. Hirato, and N. Saito. "Preoperative brain mapping and intraoperative monitoring in brain tumor surgery." International Congress Series 1278 (March 2005): 113–16. http://dx.doi.org/10.1016/j.ics.2004.11.149.

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Qiu, Tianming, N. U. Farrukh Hameed, Yuerong Peng, Shuheng Wang, Jinsong Wu, and Liangfu Zhou. "Functional near-infrared spectroscopy for intraoperative brain mapping." Neurophotonics 6, no. 04 (November 25, 2019): 1. http://dx.doi.org/10.1117/1.nph.6.4.045010.

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RAABE, A., D. VANDEVILLE, M. LEUTENEGGER, A. SZELENYI, E. HATTINGEN, R. GERLACH, V. SEIFERT, C. HAUGER, A. LOPEZ, and R. LEITGEB. "Laser Doppler imaging for intraoperative human brain mapping." NeuroImage 44, no. 4 (February 15, 2009): 1284–89. http://dx.doi.org/10.1016/j.neuroimage.2008.10.049.

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Duffau, Hugues, Laurent Capelle, Nicole Sichez, Dominique Denvil, Manuel Lopes, Jean‐Pierre Sichez, Ahmad Bitar, and Denis Fohanno. "Intraoperative mapping of the subcortical language pathways using direct stimulations." Brain 125, no. 1 (January 1, 2002): 199–214. http://dx.doi.org/10.1093/brain/awf016.

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Yamaguchi, Fumio. "BRMP-05. Intraoperative neural tract positioning method for the maximal safe resection of tumors." Neuro-Oncology 23, Supplement_6 (November 2, 2021): vi224. http://dx.doi.org/10.1093/neuonc/noab196.898.

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Abstract Brain mapping is a gold standard for the surgery of tumors in eloquent area. Especially subcortical mapping is an essential method for the preservation of important neural fibers conveying motor, sensory and even higher brain functions such as language control. The efforts to estimate the fiber localizations in brain white matter sometimes result in the unprecise identification that is caused by several factors including electrical heterogeneity of brain tissues. To solve this long-standing problem, NY Tract Finder (Yamaguchi Tract Finder) was invented and has been used for intraoperative brain mappings. Now this electrode and method is used in more than 30 major hospitals in Japan, China, Taiwan and Russia. The novel and unique neural fiber positioning technique and our efforts for the maximal preservation of patients’ QOL will be introduced.

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Mericle, Robert A., Erich O. Richter, Eric Eskioglu, Courtney Watkins, Laszlo Prokai, Christopher Batich, and Swadeshmukul Santra. "Preoperative endovascular brain mapping for intraoperative volumetric image guidance: preliminary concept and feasibility in animal models." Journal of Neurosurgery 104, no. 4 (April 2006): 566–73. http://dx.doi.org/10.3171/jns.2006.104.4.566.

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ObjectThe authors describe a novel concept for brain mapping in which an endovascular approach is used, and they demonstrate its feasibility in animal models. The purpose of endovascular brain mapping is to delineate clearly the nonfunctional brain parenchyma when a craniotomy is performed for resection. The nonfunctional brain will be stained with sharp visual margins, differentiating it from the functional, nonstained brain. The authors list four essential criteria for developing an ideal endovascular mapping agent, and they describe seven potential approaches for accomplishing a successful endovascular brain map.MethodsFour Sprague–Dawley rats and one New Zealand white rabbit were used to determine initial feasibility of the procedure. The animals were anesthetized, and the internal carotid artery was catheterized. Four potential brain mapping agents were infused into the right hemisphere of the five animals. Afterward, the brains were removed and each was analyzed both grossly and histologically.Fluorescein and FD&C Green No. 3 provided good visual clarity and margins, but required blood–brain barrier (BBB) manipulation. Tantalum particles enabled avoidance of BBB manipulation, but provided inadequate visual clarity, probably because of their size. A Sudan black “cocktail” provided excellent clarity and margins despite remaining in the brain capillaries.ConclusionsThis is a novel application of the endovascular approach, and has broad potential for clinical neurosurgical brain mapping. The animal models in this study establish the feasibility of the procedure. However, further study is required to demonstrate safety, minimize toxicity, investigate stain durability, and improve the characteristics of potential mapping agents. The authors are planning to conduct future studies for identification of mapping agents that do not require BBB manipulation or vascular occlusion.

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Sartorius, Carl J., and Mitchel S. Berger. "Rapid termination of intraoperative stimulation-evoked seizures with application of cold Ringer's lactate to the cortex." Journal of Neurosurgery 88, no. 2 (February 1998): 349–51. http://dx.doi.org/10.3171/jns.1998.88.2.0349.

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✓ One major risk of intraoperative stimulation mapping is the production of stimulation-evoked seizures. Cold Ringer's lactate solution was applied directly to the irritated cortex in 22 patients with stimulation-induced seizures that occurred during intraoperative brain mapping procedures. The irrigation rapidly and reliably terminated these simple partial seizures and eliminated the need for intravenously administered short-acting barbiturates with antiepileptic properties. The authors describe a practical and simple method for controlling stimulation-induced seizure activity during brain mapping procedures.

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Pouratian, Nader, Andrew F. Cannestra, Neil A. Martin, and Arthur W. Toga. "Intraoperative optical intrinsic signal imaging: a clinical tool for functional brain mapping." Neurosurgical Focus 13, no. 4 (October 2002): 1–9. http://dx.doi.org/10.3171/foc.2002.13.4.2.

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Optical imaging of intrinsic signals (OIS) is a well-established neuroimaging modality by which functional cortical activity is mapped by detecting activity-related changes in cortical light reflectance. Light reflectance changes are detected by a charged-coupled device camera that captures images of the exposed cortex both at rest and during activity. Although to date OIS has only been used for research purposes, intraoperative OIS (iOIS) holds promise as a clinical mapping tool. In general, iOIS demonstrates good spatial correlation with electrocortical stimulation mapping (ECSM) and other electrophysiological modalities. Additionally, iOIS offers high spatial resolution (in microns), does not make contact with the surface of the brain, and introduces no potentially harmful compounds. Moreover, mapping is relatively rapid. The authors review the potential contribution of iOIS to the intraoperative environment. Specifically, they review iOIS methodology, discuss signal origin, compare OIS with other functional mapping modalities, and explain its potential benefits and limitations. They propose that iOIS may, in the future, be used in conjunction with ECSM to improve the resolution and accuracy of intraoperative mapping, decrease total time of intraoperative mapping, and possibly improve neurological outcomes. Additional studies will be required to quantify the sensitivity and specificity of optical maps relative to ECSM before it can be implemented clinically.

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White, Timothy, Salvatore Zavarella, Lauren Jarchin, Dominic Nardi, Sarah Schaffer, and Michael Schulder. "Combined Brain Mapping and Compact Intraoperative MRI for Brain Tumor Resection." Stereotactic and Functional Neurosurgery 96, no. 3 (2018): 172–81. http://dx.doi.org/10.1159/000488991.

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Carlson, Jonathan Dennis, Kate Elizabeth McLeod, Pamela Sue McLeod, and Jamelynn Brooke Mark. "Stereotactic Accuracy and Surgical Utility of the O-Arm in Deep Brain Stimulation Surgery." Operative Neurosurgery 13, no. 1 (June 27, 2016): 96–107. http://dx.doi.org/10.1227/neu.0000000000001326.

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Abstract BACKGROUND: The stereotactic accuracy of intraoperative imaging is critical to clinical outcome, particularly in “asleep” deep brain stimulation (DBS) surgery that typically forgoes neurophysiological techniques. Different intraoperative imaging modalities and associated accuracies have been reported, including magnetic resonance imaging (MRI), computed tomography (CT), and O-arm. OBJECTIVE: To analyze intraoperative O-arm imaging accuracy and to evaluate the utility of microelectrode mapping. METHODS: O-arm images of DBS electrodes were collected during implantation in the subthalamic nucleus in patients with Parkinson disease. Images were fused to postoperative MRI and postoperative CT scans. Stereotactic coordinates for the electrode tip were measured independently. Radial distances between the images were compared. The impact of microelectrode mapping on final DBS electrode positioning was also evaluated. RESULTS: In 71 consecutive DBS electrodes, the average radial error of the electrode tip between the O-arm and MRI was 1.55 ± 0.58 mm. The average radial error between the O-arm and CT was 1.03 ± 0.61 mm. Thus, the O-arm images accurately depicted the position of the electrode. However, in 14% of cases, microelectrode mapping revised the DBS electrode position beyond the preoperative direct target in combination with accurate intraoperative imaging. CONCLUSION: Intraoperative O-arm images reliably and accurately displayed the location of the DBS electrode compared with postoperative CT and MRI images. Microelectrode mapping provided superior subnuclear resolution to imaging. Both intraoperative imaging and microelectrode mapping are effective tools that can be synergistically combined for optimal DBS electrode placement.

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McDonald, Jeffrey D., Brian W. Chong, Jeffrey D. Lewine, Greg Jones, Robert B. Burr, Paul R. McDonald, Spencer B. Koehler, Jay Tsuruda, William W. Orrison, and M. Peter Heilbrun. "Integration of preoperative and intraoperative functional brain mapping in a frameless stereotactic environment for lesions near eloquent cortex." Journal of Neurosurgery 90, no. 3 (March 1999): 591–98. http://dx.doi.org/10.3171/jns.1999.90.3.0591.

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✓ The authors present a method of incorporating preoperative noninvasive functional brain mapping data into the frameless stereotactic magnetic resonance (MR) imaging dataset used for image-guided resection of brain lesions located near eloquent cortex. They report the use of functional (f)MR imaging and magnetic source (MS) imaging for preoperative mapping of eloquent cortex in difficult cases of brain tumor resection such as those in which there are large expansive masses or in which reoperations are required and the anatomy is distorted from prior treatments. To correlate methods of preoperative and intraoperative mapping localization directly, the authors have developed techniques of importing preoperative MS and fMR imaging data into an image-guided frameless stereotactic computer workstation. The data appear as a seamless overlay on the same preoperative volumetric MR imaging dataset used for stereotactic guidance during the operation. Intraoperatively identified functional locations mapped by cortical stimulation are recorded as digitally registered points. This approach should prove useful in assessing the accuracy and reliability of various preoperative functional brain mapping techniques.

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Roux, Franck-Emmanuel, Jean-Baptiste Durand, Imène Djidjeli, Emmanuel Moyse, and Carlo Giussani. "Variability of intraoperative electrostimulation parameters in conscious individuals: language cortex." Journal of Neurosurgery 126, no. 5 (May 2017): 1641–52. http://dx.doi.org/10.3171/2016.4.jns152434.

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OBJECTIVEElectrostimulation in awake brain mapping is widely used to guide tumor removal, but methodologies can differ substantially across institutions. The authors studied electrostimulation brain mapping data to characterize the variability of the current intensity threshold across patients and the effect of its variations on the number, type, and surface area of the essential language areas detected.METHODSOver 7 years, the authors prospectively studied 100 adult patients who were undergoing intraoperative brain mapping during resection of left hemisphere tumors. In all 100 cases, the same protocol of electrostimulation brain mapping (a controlled naming task—bipolar stimulation with biphasic square wave pulses of 1-msec duration and 60-Hz trains, maximum train duration 6 sec) and electrocorticography was used to detect essential language areas.RESULTSThe minimum positive thresholds of stimulation varied from patient to patient; the mean minimum intensity required to detect interference was 4.46 mA (range 1.5–9 mA), and in a substantial proportion of sites (13.5%) interference was detected only at intensities above 6 mA. The threshold varied within a given patient for different naming areas in 22% of cases. Stimulation of the same naming area with greater intensities led to slight changes in the type of response in 19% of cases and different types of responses in 4.5%. Naming sites detected were located in subcentimeter cortical areas (50% were less than 20 mm2), but their extent varied with the intensity of stimulation. During a brain mapping session, the same intensity of stimulation reproduced the same type of interference in 94% of the cases. There was no statistically significant difference between the mean stimulation intensities required to produce interfereince in the left inferior frontal lobe (Broca's area), the supramarginal gyri, and the posterior temporal region.CONCLUSIONSIntrasubject and intersubject variations of the minimum thresholds of positive naming areas and changes in the type of response and in the size of these areas according to the intensity used may limit the interpretation of data from electrostimulation in awake brain mapping. To optimize the identification of language areas during electrostimulation brain mapping, it is important to use different intensities of stimulation at the maximum possible currents, avoiding afterdischarges. This could refine the clinical results and scientific data derived from these mapping sessions.

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Fen Yang, Tsui. "SY5.2. Intraoperative monitoring and mapping during brain tumor surgery." Clinical Neurophysiology 132, no. 8 (August 2021): e45-e46. http://dx.doi.org/10.1016/j.clinph.2021.02.044.

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Caredda, Charly, Laurent Mahieu-Williame, Raphaël Sablong, Michaël Sdika, Laure Alston, Jacques Guyotat, and Bruno Montcel. "Intraoperative quantitative functional brain mapping using an RGB camera." Neurophotonics 6, no. 04 (December 24, 2019): 1. http://dx.doi.org/10.1117/1.nph.6.4.045015.

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Sartorius, Carl J., and Gary Wright. "Intraoperative brain mapping in a community setting—Technical considerations." Surgical Neurology 47, no. 4 (April 1997): 380–88. http://dx.doi.org/10.1016/s0090-3019(96)00340-0.

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Kamada, Kyousuke, Satoshi Hiroshima, Hiroshi Ogawa, Naoto Kunii, Kensuke Kawai, Ryogo Anei, and Nobuhito Saito. "Pre- and Intraoperative Functional Brain Mapping and Monitoring for Brain Tumor Surgery." Japanese Journal of Neurosurgery 23, no. 4 (2014): 296–305. http://dx.doi.org/10.7887/jcns.23.296.

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Lavrador, José, Prajwal Ghimire, Christian Brogna, Luciano Furlanetti, Sabina Patel, Richard Gullan, Keyoumars Ashkan, Ranjeev Bhangoo, and Francesco Vergani. "Brain mapping for lesions in primary motor cortex: integrated surgical approach." Neuro-Oncology 21, Supplement_4 (October 2019): iv18. http://dx.doi.org/10.1093/neuonc/noz167.078.

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Abstract Background Lesions within the corticospinal tract (CST) represent significant surgical challenge with a delicate functional trade-off that should be integrated in the overall patient-centred treatment plan. Methods Patients with lesions within the CST with preoperative cortical and subcortical mapping (nTMS and tractography), intraoperative mapping and intraoperative provisional histological information (smear +- 5-ALA) were included. This independently acquired information was integrated in a decision-making process model to determine the intraoperative extent of resection. Results 10 patients (6 patients with metastatic precentral tumour; 1 patient with Grade III and 2 patients with grade IV gliomas; 1 patient with precentral vascular malformation) were included in the study. Majority of the patient had pre-operative motor deficit (60%). 50% patients underwent gross total resection and 40% patients underwent near total resection of the lesions. In only one patient, no surgical resection was possible after both pre-operative and intraoperative mapping. 70% of patients remained stable postoperatively and 20% improved from previous motor weakness. Conclusion The independently acquired anatomical (anatomical MRI) and functional (nTMS and tractography) in patients with CST lesions provide a more accurate guide for resection. The inclusion of the histological information (smear +- 5-ALA) further allows the surgical team to balance the potential functional risks within the global treatment plan. Therefore, the patient is kept at the centre of the informed decision making process.

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Puglisi, Guglielmo, Tommaso Sciortino, Marco Rossi, Antonella Leonetti, Luca Fornia, Marco Conti Nibali, Alessandra Casarotti, et al. "Preserving executive functions in nondominant frontal lobe glioma surgery: an intraoperative tool." Journal of Neurosurgery 131, no. 2 (August 2019): 474–80. http://dx.doi.org/10.3171/2018.4.jns18393.

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OBJECTIVEThe goal of surgery for gliomas is maximal tumor removal while preserving the patient’s full functional integrity. At present during frontal tumor removal, this goal is mostly achieved, although the risk of impairing the executive functions (EFs), and thus the quality of life, remains significant. The authors investigated the accuracy of an intraoperative version of the Stroop task (iST), adapted for intraoperative mapping, to detect EF-related brain sites by evaluating the impact of the iST brain mapping on preserving functional integrity following a maximal tumor resection.METHODSForty-five patients with nondominant frontal gliomas underwent awake surgery; brain mapping was used to establish the functional boundaries for the resection. In 18 patients language, praxis, and motor functions, but not EFs (control group), were mapped intraoperatively at the cortical-subcortical level. In 27 patients, in addition to language, praxis, and motor functions, EFs were mapped with the iST at the cortical-subcortical level (Stroop group). In both groups the EF performance was evaluated preoperatively, at 7 days and 3 months after surgery.RESULTSThe iST was successfully administered in all patients. Consistent interferences, such as color-word inversion/latency, were obtained by stimulating precise white matter sites below the inferior and middle frontal gyri, anterior to the insula and over the putamen, and these were used to establish the posterior functional limit of the resection. Procedures implemented with iST dramatically reduced the EF deficits at 3 months. The EOR was similar in Stroop and control groups.CONCLUSIONSBrain mapping with the iST allows identification and preservation of the frontal lobe structures involved in inhibition of automatic responses, reducing the incidence of postoperative EF deficits and enhancing the further posterior and inferior margin of tumor resection.

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Eichberg, Daniel G., and Iahn Cajigas. "Commentary: A Novel Intraoperative Brain Mapping Integrated Task-Presentation Platform." Operative Neurosurgery 20, no. 5 (February 6, 2021): E340—E341. http://dx.doi.org/10.1093/ons/opaa482.

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Hulou, M. Maher, and Farhan A. Mirza. "Commentary: A Novel Intraoperative Brain Mapping Integrated Task-Presentation Platform." Operative Neurosurgery 21, no. 2 (June 7, 2021): E160. http://dx.doi.org/10.1093/ons/opab168.

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Prat-Acín, Ricardo, Inma Galeano-Senabre, Pilar López-Ruiz, Daniel García-Sánchez, Angel Ayuso-Sacido, and Raul Espert-Tortajada. "Intraoperative brain mapping during awake surgery in symptomatic supratentorial cavernomas." Neurocirugía (English Edition) 32, no. 5 (September 2021): 217–23. http://dx.doi.org/10.1016/j.neucie.2020.07.001.

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Mueller, Wade M., and George L. Morris. "Intraoperative and Extraoperative Identification of Eloquent Brain Using Stimulation Mapping." Neurosurgery Clinics of North America 4, no. 2 (April 1993): 217–22. http://dx.doi.org/10.1016/s1042-3680(18)30588-6.

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Kyuma, Yoshikazu, Akimune Hayashi, and Satoshi Nishimura. "Intraoperative cortical mapping by direct brain stimulation under local anesthesia." Clinical Neurology and Neurosurgery 99 (July 1997): S190—S191. http://dx.doi.org/10.1016/s0303-8467(97)82155-5.

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Roser, Florian, and Marina Liebsch. "Closer to the Edge—The Value of Intraoperative Brain Mapping." World Neurosurgery 89 (May 2016): 689–91. http://dx.doi.org/10.1016/j.wneu.2015.11.104.

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Arkhipova, N. B., and M. V. Aleksandrov. "Effect of sevoflurane on high-frequency brain electrical activity." Translational Medicine 6, no. 6 (January 29, 2020): 23–28. http://dx.doi.org/10.18705/2311-4495-2019-6-6-23-28.

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Background. In 30 % of cases with epilepsy, it qualifies as medically intractable and requires surgical treatment. The need for improvement of epilepsy surgery effectiveness demands updating of the preoperative assessment protocols. Intraoperative wide-range electrocorticography is a novel technique for defining resection volume in focal structural epilepsy. Combined analysis of high-frequency and epileptiform activity provides additional information and allows prognosticating of surgery outcome. However, consistent evaluation of intraoperative monitoring results is only possible when general anesthetic effect on brain electrical activity is taken into account.Objective. This study was aimed at evaluation of anesthetic gas sevoflurane effect on high-frequency brain electrical activity, recorded directly from the cortex or deep brain structures.Design and methods. Eight patients were included in this study (2 females, 6 males), aged 19 to 47, with a long-term epilepsy (disease duration 15 to 38 years). Prolonged electrocorticographic monitoring was indicated to these patients, combined with eloquent zones mapping in some cases. Patients were implanted with grid electrodes on frontal and temporal cortex, and deep brain Spencer electrodes into the mesial temporal lobe. Wide-range electrocorticography was recorded during slow-wave sleep and intraoperatively under sevoflurane anesthesia. Pathological high-frequency oscillations (pHFOs) rate was counted.Results. In seven patients pHFOs were recorded extraoperatively. Pathological HFO rate varied between 13 and 30 % (mean — 19 %). Distribution of pHFO did not change due to anesthesia effects. Mean background noise amplitude was significantly decreased intraoperatively (z = 2.45; p = 0.014). This effect facilitated visual marking of pHFOs. There were no trends in comparison between extraoperative and intraoperative pHFO rate.Conclusion. Well-controlled levels of general anesthesia obtained with sevoflurane (0,9-1,1 MAC) showed minimal effect on high-frequency brain electrical activity. This allows thorough analysis of wide-range electrocorticogiaphy without waking the patient and provides more information about the extension of the epileptogenic zone and its resection rate intraoperatively.

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Kim, Stefan S., Ian E. McCutcheon, Dima Suki, Jeffrey S. Weinberg, Raymond Sawaya, Frederick F. Lang, David Ferson, Amy B. Heimberger, Franco DeMonte, and Sujit S. Prabhu. "AWAKE CRANIOTOMY FOR BRAIN TUMORS NEAR ELOQUENT CORTEX." Neurosurgery 64, no. 5 (May 1, 2009): 836–46. http://dx.doi.org/10.1227/01.neu.0000342405.80881.81.

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Abstract OBJECTIVE Intraoperative localization of cortical areas for motor and language function has been advocated to minimize postoperative neurological deficits. We report herein the results of a retrospective study of cortical mapping and subsequent clinical outcomes in a large series of patients. METHODS Patients with intracerebral tumors near and/or within eloquent cortices (n = 309) were clinically evaluated before surgery, immediately after, and 1 month and 3 months after surgery. Craniotomy was tailored to encompass tumor plus adjacent areas presumed to contain eloquent cortex. Intraoperative cortical stimulation for language, motor, and/or sensory function was performed in all patients to safely maximize surgical resection. RESULTS A gross total resection (≥95%) was obtained in 64%, and a resection of 85% or more was obtained in 77% of the procedures. Eloquent areas were identified in 65% of cases, and in that group, worsened neurological deficits were observed in 21% of patients, whereas only 9% with negative mapping sustained such deficits (P < 0.01). Intraoperative neurological deficits occurred in 64 patients (21%); of these, 25 (39%) experienced worsened neurological outcome at 1 month, whereas only 27 of 245 patients (11%) without intraoperative changes had such outcomes (P < 0.001). At 1 month, 83% overall showed improved or stable neurological status, whereas 17% had new or worse deficits; however, at 3 months, 7% of patients had a persistent neurological deficit. Extent of resection less than 95% also predicted worsening of neurological status (P < 0.025). CONCLUSION Negative mapping of eloquent areas provides a safe margin for surgical resection with a low incidence of neurological deficits. However, identification of eloquent areas not only failed to eliminate but rather increased the risk of postoperative deficits, likely indicating close proximity of functional cortex to tumor.

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Serletis, Demitre, and Mark Bernstein. "Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors." Journal of Neurosurgery 107, no. 1 (July 2007): 1–6. http://dx.doi.org/10.3171/jns-07/07/0001.

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Object The authors prospectively assessed the value of awake craniotomy used nonselectively in patients undergoing resection of supratentorial tumors. Methods The demographic features, presenting symptoms, tumor location, histological diagnosis, outcomes, and complications were documented for 610 patients who underwent awake craniotomy for supratentorial tumor resection. Intraoperative brain mapping was used in 511 cases (83.8%). Mapping identified eloquent cortex in 115 patients (22.5%) and no eloquent cortex in 396 patients (77.5%). Results Neurological deficits occurred in 89 patients (14.6%). In the subset of 511 patients in whom brain mapping was performed, 78 (15.3%) experienced postoperative neurological worsening. This phenomenon was more common in patients with preoperative neurological deficits or in those individuals in whom mapping successfully identified eloquent tissue. Twenty-five (4.9%) of the 511 patients suffered intraoperative seizures, and two of these individuals required intubation and induction of general anesthesia after generalized seizures occurred. Four (0.7%) of the 610 patients developed wound complications. Postoperative hematomas developed in seven patients (1.1%), four of whom urgently required a repeated craniotomy to allow evacuation of the clot. Two patients (0.3%) required readmission to the hospital soon after being discharged. There were three deaths (0.5%). Conclusions Awake craniotomy is safe, practical, and effective during resection of supratentorial lesions of diverse pathological range and location. It allows for intraoperative brain mapping that helps identify and protect functional cortex. It also avoids the complications inherent in the induction of general anesthesia. Awake craniotomy provides an excellent alternative to surgery of supratentorial brain lesions in patients in whom general anesthesia has been induced.

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Chang, Edward F., Aaron Clark, Justin S. Smith, Mei-Yin Polley, Susan M. Chang, Nicholas M. Barbaro, Andrew T. Parsa, Michael W. McDermott, and Mitchel S. Berger. "Functional mapping–guided resection of low-grade gliomas in eloquent areas of the brain: improvement of long-term survival." Journal of Neurosurgery 114, no. 3 (March 2011): 566–73. http://dx.doi.org/10.3171/2010.6.jns091246.

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Object Low-grade gliomas (LGGs) frequently infiltrate highly functional or “eloquent” brain areas. Given the lack of long-term survival data, the prognostic significance of eloquent brain tumor location and the role of functional mapping during resective surgery in presumed eloquent brain regions are unknown. Methods We performed a retrospective analysis of 281 cases involving adults who underwent resection of a supratentorial LGG at a brain tumor referral center. Preoperative MR images were evaluated blindly for involvement of eloquent brain areas, including the sensorimotor and language cortices, and specific subcortical structures. For high-risk tumors located in presumed eloquent brain areas, long-term survival estimates were evaluated for patients who underwent intraoperative functional mapping with electrocortical stimulation and for those who did not. Results One hundred and seventy-four patients (62%) had high-risk LGGs that were located in presumed eloquent areas. Adjusting for other known prognostic factors, patients with tumors in areas presumed to be eloquent had worse overall and progression-free survival (OS, hazard ratio [HR] 6.1, 95% CI 2.6–14.1; PFS, HR 1.9, 95% CI 1.2–2.9; Cox proportional hazards). Confirmation of tumor overlapping functional areas during intraoperative mapping was strongly associated with shorter survival (OS, HR 9.6, 95% CI 3.6–25.9). In contrast, when mapping revealed that tumor spared true eloquent areas, patients had significantly longer survival, nearly comparable to patients with tumors that clearly involved only noneloquent areas, as demonstrated by preoperative imaging (OS, HR 2.9, 95% CI 1.0–8.5). Conclusions Presumed eloquent location of LGGs is an important but modifiable risk factor predicting disease progression and death. Delineation of true functional and nonfunctional areas by intraoperative mapping in high-risk patients to maximize tumor resection can dramatically improve long-term survival.

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Rosengarth, Katharina, Delin Pai, Frank Dodoo-Schittko, Katharina Hense, Teele Tamm, Christian Ott, Ralf Lürding, et al. "A Novel Language Paradigm for Intraoperative Language Mapping: Feasibility and Evaluation." Journal of Clinical Medicine 10, no. 4 (February 8, 2021): 655. http://dx.doi.org/10.3390/jcm10040655.

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(1) Background—Mapping language using direct cortical stimulation (DCS) during an awake craniotomy is difficult without using more than one language paradigm that particularly follows the demand of DCS by not exceeding the assessment time of 4 s to prevent intraoperative complications. We designed an intraoperative language paradigm by combining classical picture naming and verb generation, which safely engaged highly relevant language functions. (2) Methods—An evaluation study investigated whether a single trial of the language task could be performed in less than 4 s in 30 healthy subjects and whether the suggested language paradigm sufficiently pictured the cortical language network using functional magnetic resonance imaging (fMRI) in 12 healthy subjects. In a feasibility study, 24 brain tumor patients conducted the language task during an awake craniotomy. The patients’ neuropsychological outcomes were monitored before and after surgery. (3) Results—The fMRI results in healthy subjects showed activations in a language-associated network around the (left) sylvian fissure. Single language trials could be performed within 4 s. Intraoperatively, all tumor patients showed DCS-induced language errors while conducting the novel language task. Postoperatively, mild neuropsychological impairments appeared compared to the presurgical assessment. (4) Conclusions—These data support the use of a novel language paradigm that safely monitors highly relevant language functions intraoperatively, which can consequently minimize negative postoperative neuropsychological outcomes.

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Giussani, Carlo, Frank-Emmanuel Roux, Jeffrey Ojemann, Erik Pietro Sganzerla, David Pirillo, and Costanza Papagno. "Is Preoperative Functional Magnetic Resonance Imaging Reliable for Language Areas Mapping in Brain Tumor Surgery? Review of Language Functional Magnetic Resonance Imaging and Direct Cortical Stimulation Correlation Studies." Neurosurgery 66, no. 1 (January 1, 2010): 113–20. http://dx.doi.org/10.1227/01.neu.0000360392.15450.c9.

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Abstract OBJECTIVE Language functional magnetic resonance imaging (fMRI) has been used extensively in the past decade for both clinical and research purposes. Its integration in the preoperative imaging assessment of brain lesions involving eloquent areas is progressively more diffused in neurosurgical practice. Nevertheless, the reliability of language fMRI is unclear. To understand the reliability of preoperative language fMRI in patients operated on for brain tumors, the surgical studies that compared language fMRI with direct cortical stimulation (DCS) were reviewed. METHODS Articles comparing language fMRI with DCS of language areas were reviewed with attention to the lesion pathology, the magnetic field, the language tasks used pre- and intraoperatively, and the validation modalities adopted to establish the reliability of language fMRI. We tried to explore the effectiveness of language fMRI in gliomas. RESULTS Nine language brain mapping studies compared the findings of fMRI with those of DCS. The studies are not homogeneous for tumor types, magnetic fields, pre- and intraoperative language tasks, intraoperative matching criteria, and results. Sensitivity and specificity were calculated in 5 studies (respectively ranging from 59% to 100% and from 0% to 97%). CONCLUSION The contradictory results of these studies do not allow consideration of language fMRI as an alternative tool to DCS in brain lesions located in language areas, especially in gliomas because of the pattern of growth of these tumors. However, language fMRI conducted with high magnet fields is a promising brain mapping tool that must be validated by DCS in methodological robust studies.

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Dmitriev, A. Yu, M. V. Sinkin, and V. G. Dashyan. "Intraoperative neuromonitoring in surgery of supratentorial brain tumors. Part 1. Assessment of motor conductivity." Russian journal of neurosurgery 24, no. 2 (June 13, 2022): 105–12. http://dx.doi.org/10.17650/1683-3295-2022-24-2-105-112.

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Monitoring of motor evoked potentials in surgery of supratentorial tumors estimates integrity of cortical motor centers and subcortical pathways. Violation of motor evoked potentials takes place in mechanical injury or ischemia of motor neurons. Decrease of amplitude of motor evoked potentials more than 50 % is predictor of permanent neurological deficit.Cortical mapping gives a possibility to discover eloquent brain areas before their resection. To reveal motor centers activating stimulation is applied, to find out speech or sensory areas – the inhibiting one. Positive brain mapping allows to exclude technical fault in selection of stimulation threshold but it demands a wide craniotomy. Negative mapping is more widespread, gives opportunity to use tailored craniotomy that reduces surgical injury and duration of operation. One of the most valuable factors in cortical and subcortical brain mapping is the stimulation threshold. With monopolar «train» stimulation current 1 mA spreads into approximately 1 mm. The safe value of current intensity during tumor resection in eloquent areas is 3–5 mA.Monopolar stimulation demands less time for location of eloquent brain areas, it is as accurate as the bipolar mapping and more rarely leads to intraoperative seizures. Combination of monopolar stimulator with aspirator gives opportunity to continuously allocate pyramidal tract in tumor resection.

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Natalizi, Federica, Federica Piras, Daniela Vecchio, Gianfranco Spalletta, and Fabrizio Piras. "Preoperative Navigated Transcranial Magnetic Stimulation: New Insight for Brain Tumor-Related Language Mapping." Journal of Personalized Medicine 12, no. 10 (September 27, 2022): 1589. http://dx.doi.org/10.3390/jpm12101589.

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Preoperative brain mapping methods are particularly important in modern neuro-oncology when a tumor affects eloquent language areas since damage to parts of the language circuits can cause significant impairments in daily life. This narrative review examines the literature regarding preoperative and intraoperative language mapping using repetitive navigated transcranial magnetic stimulation (rnTMS) with or without direct electrical stimulation (DES) in adult patients with tumors in eloquent language areas. The literature shows that rnTMS is accurate in detecting preexisting language disorders and positive intraoperative mapping regions. In terms of the region extent and clinical outcomes, rnTMS has been shown to be accurate in identifying positive sites to guide resection, reducing surgery duration and craniotomy size and thus improving clinical outcomes. Before incorporating rnTMS into the neurosurgical workflow, the refinement of protocols and a consensus within the neuro-oncology community are required.

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Ellis, David G., Matthew L. White, Satoru Hayasaka, David E. Warren, Tony W. Wilson, and Michele R. Aizenberg. "Accuracy analysis of fMRI and MEG activations determined by intraoperative mapping." Neurosurgical Focus 48, no. 2 (February 2020): E13. http://dx.doi.org/10.3171/2019.11.focus19784.

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OBJECTIVEBy looking at how the accuracy of preoperative brain mapping methods vary according to differences in the distance from the activation clusters used for the analysis, the present study aimed to elucidate how preoperative functional neuroimaging may be used in such a way that maximizes the mapping accuracy.METHODSThe eloquent function of 19 patients with a brain tumor or cavernoma was mapped prior to resection with both functional MRI (fMRI) and magnetoencephalography (MEG). The mapping results were then validated using direct cortical stimulation mapping performed immediately after craniotomy and prior to resection. The subset of patients with equivalent MEG and fMRI tasks performed for motor (n = 14) and language (n = 12) were evaluated as both individual and combined predictions. Furthermore, the distance resulting in the maximum accuracy, as evaluated by the J statistic, was determined by plotting the sensitivities and specificities against a linearly increasing distance threshold.RESULTSfMRI showed a maximum mapping accuracy at 5 mm for both motor and language mapping. MEG showed a maximum mapping accuracy at 40 mm for motor and 15 mm for language mapping. At the standard 10-mm distance used in the literature, MEG showed a greater specificity than fMRI for both motor and language mapping but a lower sensitivity for motor mapping. Combining MEG and fMRI showed a maximum accuracy at 15 mm and 5 mm—MEG and fMRI distances, respectively—for motor mapping and at a 10-mm distance for both MEG and fMRI for language mapping. For motor mapping, combining MEG and fMRI at the optimal distances resulted in a greater accuracy than the maximum accuracy of the individual predictions.CONCLUSIONSThis study demonstrates that the accuracy of language and motor mapping for both fMRI and MEG is heavily dependent on the distance threshold used in the analysis. Furthermore, combining MEG and fMRI showed the potential for increased motor mapping accuracy compared to when using the modalities separately.Clinical trial registration no.: NCT01535430 (clinicaltrials.gov)

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Kirsch, Heidi E., Zhao Zhu, Susanne Honma, Anne Findlay, Mitchel S. Berger, and Srikantan S. Nagarajan. "Predicting the location of mouth motor cortex in patients with brain tumors by using somatosensory evoked field measurements." Journal of Neurosurgery 107, no. 3 (September 2007): 481–87. http://dx.doi.org/10.3171/jns-07/09/0481.

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Object Before resective brain surgery, localization of the functional regions is necessary to minimize postoperative deficits. The face area has been relatively difficult to map noninvasively by using functional imaging techniques. Preoperative localization of face somatosensory cortex with magnetoencephalography (MEG) may allow the surgeon to predict the location of mouth motor areas. Methods The authors compared the location of face somatosensory cortex obtained with somatosensory evoked fields during preoperative MEG with the mouth motor areas identified during intraoperative electrocortical stimulation (ECS) mapping in 13 patients undergoing resection of brain tumor. Results In this group of patients, ECS mouth motor sites were usually anterior and lateral to MEG localizations of lip somatosensory cortex. The consistent quantitative relationship between results of these two mapping procedures allows the practitioner to predict the location of mouth motor cortex based on noninvasive preoperative MEG measurements. Conclusions Based on this result, the authors suggest that somatosensory mapping using MEG can be used to guide intraoperative mapping and neurosurgical planning.

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Roux, Franck-Emmanuel, Kader Boulanouar, Jean-Albert Lotterie, Mehdi Mejdoubi, James P. LeSage, and Isabelle Berry. "Language Functional Magnetic Resonance Imaging in Preoperative Assessment of Language Areas: Correlation with Direct Cortical Stimulation." Neurosurgery 52, no. 6 (June 1, 2003): 1335–47. http://dx.doi.org/10.1227/01.neu.0000064803.05077.40.

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Abstract OBJECTIVE The aim of this study was to analyze the usefulness of preoperative language functional magnetic resonance imaging (fMRI), by correlating fMRI data with intraoperative cortical stimulation results for patients with brain tumors. METHODS Naming and verb generation tasks were used, separately or in combination, for 14 right-handed patients with tumors in the left hemisphere. fMRI data obtained were analyzed with SPM software, with two standard analysis thresholds (P < 0.005 and then P < 0.05). The fMRI data were then registered in a frameless stereotactic neuronavigational device and correlated with direct brain mapping results. We used a statistical model with the fMRI information as a predictor, spatially correlating each intraoperatively mapped cortical site with fMRI data integrated in the neuronavigational system (site-by-site correlation). Eight patients were also studied with language fMRI postoperatively, with the same acquisition protocol. RESULTS We observed high variability in signal extents and locations among patients with both tasks. The activated areas were located mainly in the left hemisphere in the middle and inferior frontal gyri (F2 and F3), the superior and middle temporal gyri (T1 and T2), and the supramarginal and angular gyri. A total of 426 cortical sites were tested for each task among the 14 patients. In frontal and temporoparietal areas, poor sensitivity of the fMRI technique was observed for the naming and verb generation tasks (22 and 36%, respectively) with P < 0.005 as the analysis threshold. Although not perfect, the specificity of the fMRI technique was good in all conditions (97% for the naming task and 98% for the verb generation task). Better correlation (sensitivity, 59%; specificity, 97%) was achieved by combining the two fMRI tasks. Variation of the analysis threshold to P < 0.05 increased the sensitivity to 66% while decreasing the specificity to 91%. Postoperative fMRI data (for the cortical brain areas studied intraoperatively) were in accordance with brain mapping results for six of eight patients. Complete agreement between pre- and postoperative fMRI studies and direct brain mapping results was observed for only three of eight patients. CONCLUSION With the paradigms and analysis thresholds used in this study, language fMRI data obtained with naming or verb generation tasks, before and after surgery, were imperfectly correlated with intraoperative brain mapping results. A better correlation could be obtained by combining the fMRI tasks. The overall results of this study demonstrated that language fMRI could not be used to make critical surgical decisions in the absence of direct brain mapping. Other acquisition protocols are required for evaluation of the potential role of language fMRI in the accurate detection of essential cortical language areas.

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Berger, Mitchel S., Joseph Kincaid, George A. Ojemann, and Ettore Lettich. "Brain Mapping Techniques to Maximize Resection, Safety, and Seizure Control in Children with Brain Tumors." Neurosurgery 25, no. 5 (November 1, 1989): 786–92. http://dx.doi.org/10.1227/00006123-198911000-00015.

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Abstract Intraoperative brain mapping techniques were used to localize language cortex, sensorimotor pathways, and seizure foci in children with supratentorial brain tumors. The methods of direct cortical and subcortical stimulation, in addition to electrocorticography, enabled us to maximize tumor resection, minimize morbidity, and eradicate epileptogenic zones which were always adjacent to, but not involving, the tumor nidus. Language localization was found to be quite variable in the children tested and anatomically unpredictable based on the preoperative neurological or radiological examination. Physiological mapping techniques, therefore, appear to be safe, reliable, and very useful for operations on tumors located within or adjacent to eloquent brain regions in the pediatric population.

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Maknojia, Sanam, Fred Tam, Sunit Das, Tom Schweizer, and Simon J. Graham. "Visualization of Brain Shift Corrected Functional Magnetic Resonance Imaging Data for Intraoperative Brain Mapping." World Neurosurgery: X 2 (April 2019): 100021. http://dx.doi.org/10.1016/j.wnsx.2019.100021.

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Nossek, Erez, Akiva Korn, Tal Shahar, Andrew A. Kanner, Hillary Yaffe, Daniel Marcovici, Carmit Ben-Harosh, et al. "Intraoperative mapping and monitoring of the corticospinal tracts with neurophysiological assessment and 3-dimensional ultrasonography-based navigation." Journal of Neurosurgery 114, no. 3 (March 2011): 738–46. http://dx.doi.org/10.3171/2010.8.jns10639.

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Object Preserving motor function is a major challenge in surgery for intraaxial brain tumors. Navigation systems are unreliable in predicting the location of the corticospinal tracts (CSTs) because of brain shift and the inability of current intraoperative systems to produce reliable diffusion tensor imaging data. The authors describe their experience with elaborate neurophysiological assessment and tractography-based navigation, corrected in real time by 3D intraoperative ultrasonography (IOUS) to identify motor pathways during subcortical tumor resection. Methods A retrospective analysis was conducted in 55 patients undergoing resection of tumors located within or in proximity to the CSTs at the authors' institution between November 2007 and June 2009. Corticospinal tract tractography was coregistered to surgical navigation-derived images in 42 patients. Direct cortical-stimulated motor evoked potentials (dcMEPs) and subcortical-stimulated MEPs (scrtMEPs) were recorded intraoperatively to assess function and estimate the distance from the CSTs. Intraoperative ultrasonography updated the navigation imaging and estimated resection proximity to the CSTs. Preoperative clinical motor function was compared with postoperative outcome at several time points and correlated with incidences of intraoperative dcMEP alarm and low scrtMEP values. Results The threshold level needed to elicit scrtMEPs was plotted against the distance to the CSTs based on diffusion tensor imaging tractography after brain shift compensation with 3D IOUS, generating a trend line that demonstrated a linear order between these variables, and a relationship of 0.97 mA for every 1 mm of brain tissue distance from the CSTs. Clinically, 39 (71%) of 55 patients had no postoperative deficits, and 9 of the remaining 16 improved to baseline function within 1 month. Seven patients had varying degrees of permanent motor deficits. Subcortical stimulation was applied in 45 of the procedures. The status of 32 patients did not deteriorate postoperatively (stable or improved motor status): 27 of them (84%) displayed minimum scrtMEP thresholds > 7 mA. Six patients who experienced postoperative deterioration quickly recovered (within 5 days) and displayed minimum scrtMEP thresholds > 6.8 mA. Five of the 7 patients who had late (> 5 days postoperatively) or no recovery had minimal scrtMEP thresholds < 3 mA. An scrtMEP threshold of 3 mA was found to be the cutoff point below which irreversible disruption of CST integrity may be anticipated (sensitivity 83%, specificity 95%). Conclusions Combining elaborate neurophysiological assessment, tractography-based neuronavigation, and updated IOUS images provided accurate localization of the CSTs and enabled the safe resection of tumors approximating these tracts. This is the first attempt to evaluate the distance from the CSTs using the threshold of subcortical monopolar stimulation with real-time IOUS for the correction of brain shift. The linear correlation between the distance to the CSTs and the threshold of subcortical stimulation producing a motor response provides an intraoperative technique to better preserve motor function.

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Mamani, Rocio, Javier A. Jacobo, Sonia Mejia, Santiago Nuñez-Velasco, Jorge Aragon-Arreola, and Sergio Moreno. "Analysis of Intraoperative Seizures During Bipolar Brain Mapping in Eloquent Areas." Clinical Neurology and Neurosurgery 199 (December 2020): 106304. http://dx.doi.org/10.1016/j.clineuro.2020.106304.

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Mazzoni, M., E. Sisillo, L. Salvi, M. Zucchetti, C. Solinas, and G. Susini. "Intraoperative quantitative eeg and topographic brain mapping monitoring in cardiac surgery." Journal of Cardiothoracic and Vascular Anesthesia 8, no. 5 (October 1994): 65. http://dx.doi.org/10.1016/1053-0770(94)90374-3.

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Aleksandrov, M. V., I. A. Kostenko, O. A. Toporkova, R. V. Nazarov, M. M. Tastanbekov, and V. S. Chernyj. "Intraoperative neurophysiological mapping: the effect of general anaesthetic impact on brain cortex affectability." Medical alphabet, no. 32 (January 13, 2021): 34–38. http://dx.doi.org/10.33667/2078-5631-2020-32-34-38.

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Neuron irritation lies at the heart of intraoperative motor mapping and varies with the general anaesthetic type and dose. Basing on the analysis of 63 cases (male/female 25/38, aged 21–69) of brain tumors (glial tumors, metastasis, cavernous angiomas) the study explores the role of propofol and sevoflurane in the affectability of cortex neurons during the intraoperative neurophysiological mapping. The study has clearly demonstrated that the liminal current strength is notably higher when inhalation anaesthesia (sevoflurane) is used, than in the case of TIVA (propofol). The propofol activity in the doses causing brain activity depression results in a sharp increase in the excitability threshold. In contrast, sevoflurane causes a steady dose-related rise in the liminal current strength during the motor area galvanic stimulation due to the suppression of affectability and conduction in the nervous system.

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