Identification of motor pathways during tumor surgery facilitated by multichannel electromyographic recording

Yingling, Charles D.; Ojemann, Steven G.; Dodson, Barbara A.; Harrington, Margaret J.; Berger, Mitchel S.

doi:10.3171/jns.1999.91.6.0922

Cited by 150 publications

(79 citation statements)

References 18 publications

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“…This can be delineated accurately by electrical stimulation mapping of the hand, leg, and face area of the motor cortex, either in the awake patient 12 or with the help of multichannel electromyographic recordings. 13 If necessary, electrophysiological recordings and stimulations can be performed repeatedly during the ongoing operation, the electrical stimulation of superficial and descending motor pathways bears the potential for real time continuous monitoring. 13 53 54 As a result of different overall capabilities the cost effectiveness of functional neuronavigation and the SEP technique cannot be compared easily.…”

Section: Discussionmentioning

confidence: 99%

“…13 If necessary, electrophysiological recordings and stimulations can be performed repeatedly during the ongoing operation, the electrical stimulation of superficial and descending motor pathways bears the potential for real time continuous monitoring. 13 53 54 As a result of different overall capabilities the cost effectiveness of functional neuronavigation and the SEP technique cannot be compared easily. 21 22 The costs for the purchase and the maintenance of the equipment (the electrodiagnostic and the neuronavigational system, fMRI, or MSI) differ markedly, the costs/patient depend on the price of a single use cortical electrode on the one hand and on the price of preoperative diagnostic and functional MRI examinations on the other.…”

Section: Discussionmentioning

confidence: 99%

“…9 These non-invasive diagnostic tools not only provide excellent information for presurgical planning but their integration into neuronavigational systems allows safer and more radical surgery in and around the sensorimotor cortex. 4 8 10 Traditionally, intraoperative identification of the perirolandic gyri has been accomplished using electrophysiological techniques, either electrical stimulation mapping of exposed motor cortex [11][12][13] or recording the phase reversal of somatosensory evoked potentials (SEPs) across the central sulcus. 11 14-20 So far they have not become obsolete because the availability of functional neuronavigation is still limited, methodological problems may complicate the recording of fMRI or MSI in some cases, and its cost effectiveness is a matter for discussion.…”

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confidence: 99%

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Localisation of the sensorimotor cortex during surgery for brain tumours: feasibility and waveform patterns of somatosensory evoked potentials

Romstöck

Fahlbusch

Ganslandt

et al. 2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

118

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Objective: Intraoperative localisation of the sensorimotor cortex using the phase reversal of somatosensory evoked potentials (SEPs) is an essential tool for surgery in and around the perirolandic gyri, but unsuccessful and perplexing results have been reported. This study examines the effect of tumour masses on the waveform characteristics and feasibility of SEP compared with functional neuronavigation and electrical motor cortex mapping. Methods: In 230 patients with tumours of the sensorimotor region the SEP phase reversal of N20-P20 was recorded from the exposed cortex using a subdural grid or strip electrode. In one subgroup of 80 patients functional neuronavigation was performed with motor and sensory magnetic source imaging and in one subgroup of 40 patients the motor cortex hand area was localised by electrical stimulation mapping. Results: The intraoperative SEP method was successful in 92% of all patients, it could be shown that the success rate rather depended on the location of the lesion than on preoperative neurological deficits. In 13% of the patients with postcentral tumours no N20-P20 phase reversal was recorded but characteristic polyphasic and high amplitude waves at 25 ms and later made the identification of the postcentral gyrus possible nevertheless. Electrical mapping of the motor cortex took up to 30 minutes until a clear result was obtained. It was successful in 37 patients, but failed in three patients with precentral and central lesions. Functional neuronavigation indicating the tumour margins and the motor and sensory evoked fields was possible in all patients. Conclusion: The SEP phase reversal of N20-P20 is a simple and reliable technique, but the success rate is much lower in large central and postcentral tumours. With the use of polyphasic late waveforms the sensorimotor cortex may be localised. By contrast with motor electrical mapping it is less time consuming. Functional neuronavigation is a desirable tool for both preoperative surgical planning and intraoperative use during surgery on perirolandic tumours, but compensation for brain shift, accuracy, and cost effectiveness are still a matter for discussion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Localisation of the sensorimotor cortex during surgery for brain tumours: feasibility and waveform patterns of somatosensory evoked potentials

Romstöck

Fahlbusch

Ganslandt

et al. 2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

118

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“…The motor responses in muscle groups in the extremities were moni-tored through electromyographic recordings. 36 We defined the stimulation points from the screen shots of the anatomical images in the StealthStation stereotactic surgical navigation system (Medtronic Inc.).…”

Section: Intraoperative Electrical Stimulationsmentioning

confidence: 99%

Quantifying accuracy and precision of diffusion MR tractography of the corticospinal tract in brain tumors

Mandelli¹,

Berger

Bucci³

et al. 2014

JNS

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Object. The aim of this paper was to validate the diffusion tensor imaging (DTI) model for delineation of the corticospinal tract using cortical and subcortical white matter electrical stimulation for the location of functional motor pathways.Methods. The authors compare probabilistic versus deterministic DTI fiber tracking by reconstructing the pyramidal fiber tracts on preoperatively acquired DTI in patients with brain tumors. They determined the accuracy and precision of these 2 methods using subcortical stimulation points and the sensitivity using cortical stimulation points. The authors further explored the reliability of these methods by estimation of the potential that the found connections were due to a random chance using a novel neighborhood permutation method.Results. The probabilistic tracking method delineated tracts that were significantly closer to the stimulation points and was more sensitive than deterministic DTI fiber tracking to define the tracts directed to the motor sites. However, both techniques demonstrated poor sensitivity to finding lateral motor regions.Conclusions. This study highlights the importance of the validation and quantification of preoperative fiber tracking with the aid of electrophysiological data during the surgery. The poor sensitivity of DTI to delineate lateral motor pathways reported herein suggests that DTI fiber tracking must be used with caution and only as adjunctive data to established methods for motor mapping. (http://thejns.org/doi/abs/10.3171/2014.4.JNS131160) key Words • diffusion tensor imaging • tractography • corticospinal tract • intraoperative stimulation • brain tumor • oncologyAbbreviations used in this paper: ANNull = architectural neighborhood null; dMRI = diffusion MRI; DTI = diffusion tensor imaging; FA = fractional anisotropy; FSE = fast spin echo; IES = intraoperative electrical stimulation; PDF = probability density function; ROI = region of interest; SNR = signal-to-noise ratio; SPGR = spoiled gradient recalled.

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“…1,8,25,33 The clinical relevance of intraoperative mapping and monitoring has been demonstrated in various publications. 3,4,7,18,19,34,40,48,60 Intraoperative mapping and monitoring involving CMAPs is a valid modality for reducing iatrogenic morbidity during surgery in and around the central region as well as for intracranial aneurysms. 7,10,11,26,38,39,42,44,[49][50][51][52]62 Two methods are used for intraoperative mapping and monitoring during surgery in and around the insula.…”

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confidence: 99%

Subcortical mapping and monitoring during insular tumor surgery

Kombos

Süss²,

Vajkoczy³

2009

FOC

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Object The treatment of insular tumors is controversial. Surgical treatment is associated with a higher morbidity rate than other therapies. The present work presents a new method in which the descending motor pathways are monitored during surgery for insular tumors. Methods Intraoperative monitoring was performed in a combination of 2 techniques. The motor cortex was stimulated with a transcranial electrical stimulus. In addition, direct subcortical stimulation was performed with an electrical anodal monopolar stimulus. Compound motor action potentials (CMAPs) were recorded from target muscles. Results Fifteen patients were included in this preliminary study. Following transcranial stimulation, CMAPs were recorded in all cases. Subcortical stimulation was successful in 12 cases. Significant CMAP alterations were recorded in 5 patients. There were no false-negative results in the series. Conclusions The technique presented here is a safe method. It allows a quantitative monitoring of motor function and functional mapping of the pyramidal tract during insular surgery.

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Identification of motor pathways during tumor surgery facilitated by multichannel electromyographic recording

Abstract: Using EMG recording in addition to motor pathway mapping results in greater sensitivity, allowing the use of lower stimulation levels and facilitating detection of stimulation-induced seizure activity.

Cited by 150 publications

References 18 publications

Localisation of the sensorimotor cortex during surgery for brain tumours: feasibility and waveform patterns of somatosensory evoked potentials

Localisation of the sensorimotor cortex during surgery for brain tumours: feasibility and waveform patterns of somatosensory evoked potentials

Quantifying accuracy and precision of diffusion MR tractography of the corticospinal tract in brain tumors

Subcortical mapping and monitoring during insular tumor surgery

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