Intraoperative thalamocortical tract monitoring via direct cortical recordings during craniotomy.
Clin Neurophysiol
; 132(7): 1416-1432, 2021 07.
Article
em En
| MEDLINE
| ID: mdl-34023624
ABSTRACT
OBJECTIVE:
Neuromonitoring of primary motor regions allows preservation of motor strength and is frequently employed during cranial procedures. Less is known about protection of sensory function and ability to modulate movements, both of which rely on integrity of thalamocortical afferents (TCA) to fronto-parietal regions. We describe our experience with TCA monitoring and their cortical relays during brain tumor surgery.METHODOLOGY:
To study its feasibility and usefulness, continuous somatosensory evoked potentials (SSEP) recording via a subdural electrode was attempted in 32 consecutive patients.RESULTS:
Median and posterior tibial SSEP were successfully monitored in 31 and 17 patients respectively. SSEP improved lesion localization and prevented unnecessary cortical stimulation in 9 and 16 cases respectively. A threshold of ≥30% SSEP amplitude decrease influenced management in 10 patients while a decrement of ≥50 % had a sensitivity of 0.89 and specificity of 1 in detecting worsening of sensory function. Simultaneous motor evoked potentials (MEP) and SSEP monitoring were performed in 10 cases, 9 of which showed short-lived fluctuations of the former.CONCLUSION:
Direct cortical SSEP monitoring is feasible, informs management and predicts outcome.SIGNIFICANCE:
Early intervention prevents sensory deficit. Concomitant MEP fluctuations may reflect modulation of motor activity by TCA.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Tálamo
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Neoplasias Encefálicas
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Craniotomia
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Potenciais Somatossensoriais Evocados
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Monitorização Neurofisiológica Intraoperatória
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Córtex Motor
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article