Subcortical Stimulation in Brain Tumor Surgery: A Closer Look Beneath the Surface

Greisman, Jacob D.; Dadario, Nicholas B.; Park, Jung; Silverstein, Justin W.; D’Amico, Randy S.

doi:10.1016/j.wneu.2022.02.014

Cited by 5 publications

(8 citation statements)

References 62 publications

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“…5,9,16 In addition, the inefficiency of swapping between suction devices and stimulation probes increases operative times and introduces a source of contaminants to the operative field. 5,9,16 Newer dynamic SCS techniques have been developed but remain limited by financial considerations and a restricted design, limiting broad adoption. [11][12][13][14][15][16] Notably, existing designs offer only a fixed suction cap size and fixed suction diameter, whereas our device is easily modifiable by implementing alternative suction sizes.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22][23] In their current form, many SCS techniques necessitate static stimulation as the surgeon must swap between resection tools and stimulation probes. 5,6,9 The discontinuity of stimulation and resection requires the surgeon to visually approximate stimulation regions and resume resection, increasing the likelihood of error. 5,9,16 In addition, the inefficiency of swapping between suction devices and stimulation probes increases operative times and introduces a source of contaminants to the operative field.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] Static IONMap techniques have been widely adopted, whereby the surgeon approximates the location of critical structures based on preoperative imaging and then tests for function using IONMap techniques such as direct cortical or subcortical stimulation (DCS and SCS, respectively). 5,8 Static techniques require repeated cycling of surgical equipment into and out of the operative field to resect and map in sequence. 9,10 However, this discontinuous process increases operative duration and risks accuracy error along with untoward injury.…”

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confidence: 99%

“…9,10 However, this discontinuous process increases operative duration and risks accuracy error along with untoward injury. 5,9,10 ABBREVIATIONS: CST, corticospinal tract; DCMEP, direct cortical motor evoked potentials; DCS, direct cortical stimulation; EOR, extent of resection; GTR, gross total resection; IONMap, intraoperative neurophysiological mapping; IONMon, intraoperative neurophysiological monitoring; SCS, subcortical stimulation; TCMEP, transcranial motor evoked potentials.…”

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confidence: 99%

“…9,10 However, this discontinuous process increases operative duration and risks accuracy error along with untoward injury. 5,9,10…”

mentioning

confidence: 99%

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Adjustable, Dynamic Subcortical Stimulation Technique for Brain Tumor Resection: A Case-Series

Silverstein

Shah

Greisman

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Subcortical stimulation (SCS) is the gold standard neuromonitoring technique for intraoperative identification of descending white matter tracts. Dynamic SCS confers several advantages over more commonly used static devices; however, current commercially available devices for dynamic SCS have not been widely adopted. METHODS: We fashioned a dynamic SCS device using a stainless-steel suction and commonly available materials and assessed its efficacy in a series of 14 patients with brain tumors. The device was used to provide continuous SCS during tumor resection. Preoperative and postoperative motor function were characterized, and preoperative and postoperative imaging were analyzed to determine extent of tumor resection and proximity to motor-eloquent structures. Inferential statistics were used to correlate study parameters. RESULTS: Fourteen patients (12 male and 2 female, median age 52.5 years) were analyzed. The lowest intraoperative SCS intensities were 10 to 15 mA (3 surgeries), 5 to 10 mA (4 surgeries), and <5 mA (2 surgeries). SCS with this device did not elicit motor evoked potentials in 5 surgeries because of distance from the corticospinal tract (CST) and served as negative controls. Three patients (21.4%) experienced new postoperative motor deficits immediately after surgery that resolved by discharge. We observed no instances of mechanical CST injury resulting in permanent postoperative motor deficits using this technique and no correlation between lower SCS intensity and the presence of new motor impairments after surgery. No patient experienced an intraoperative seizure. CONCLUSION: The novel dynamic SCS device is easily adoptable and allows accurate intraoperative identification of the CST, facilitating safe resection of tumors near motor-eloquent structures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

“…9,10 However, this discontinuous process increases operative duration and risks accuracy error along with untoward injury. 5,9,10…”

mentioning

confidence: 99%

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Adjustable, Dynamic Subcortical Stimulation Technique for Brain Tumor Resection: A Case-Series

Silverstein

Shah

Greisman

et al. 2023

Operative Neurosurgery

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Diffusion tensor imaging versus intraoperative subcortical mapping for glioma resection: a systematic review and meta-analysis

Guo

Zhang

et al. 2023

Neurosurg Rev

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Maintaining the integrity of crucial fiber tracts allows functional preservation and improved recovery in patients with glioma resection. Diffusion tensor imaging (DTI) and intraoperative subcortical mapping (ISM) are commonly required for pre- and intraoperative assessment of white matter fibers. This study investigated differences of clinical outcomes in glioma resection aided by DTI or ISM. A comprehensive literature retrieval of the PubMed and Embase databases identified several DTI or ISM studies in 2000–2022. Clinical data, including extent of resection (EOR) and postoperative neurological deficits, was collected and statistically analyzed. Heterogeneity was regressed by a random effect model and the Mann–Whitney U test was used to test statistical significance. Publication bias was assessed by Egger test. A total of 14 studies with a pooled cohort of 1837 patients were included. Patients undergoing DTI-navigated glioma surgery showed a higher rate of gross total resection (GTR) than ISM-assisted surgical resection (67.88%, [95% CI 0.55—0.79] vs. 45.73%, [95% CI 0.29—0.63], P = 0.032). The occurrence of early postoperative functional deficit (35.45%, [95% CI 0.13—0.61] vs. 35.60% [95% CI 0.20—0.53], P = 1.000), late postoperative functional deficit (6.00%, [95% CI 0.02—0.11] vs. 4.91% [95% CI 0.03—0.08], P = 1.000) and severe postoperative functional deficit (2.21%, [95% CI 0—0.08] vs. 5.93% [95% CI 0.01—0.16], P = 0.393) were similar between the DTI and ISM group, respectively. While DTI-navigation resulted in a higher rate of GTR, the occurrence of postoperative neurological deficits between DTI and ISM groups was comparable. Together, these data indicate that both techniques could safely facilitate glioma resection.

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Enhanced Recovery After Surgery (ERAS) for Cranial Tumor Resection: A Review

et al. 2022

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Subcortical Stimulation in Brain Tumor Surgery: A Closer Look Beneath the Surface

Cited by 5 publications

References 62 publications

Adjustable, Dynamic Subcortical Stimulation Technique for Brain Tumor Resection: A Case-Series

Adjustable, Dynamic Subcortical Stimulation Technique for Brain Tumor Resection: A Case-Series

Diffusion tensor imaging versus intraoperative subcortical mapping for glioma resection: a systematic review and meta-analysis

Enhanced Recovery After Surgery (ERAS) for Cranial Tumor Resection: A Review

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