J Pallud1, E Mandonnet2, R Corns3, E Dezamis4, E Parraga4, M Zanello4, G Spena5. 1. Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674 Paris cedex 14, France; Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France. Electronic address: johanpallud@hotmail.com. 2. Department of Neurosurgery, Lariboisière Hospital, 75475 Paris, France. 3. Department of Neurosurgery, Leeds General Infirmary, LS1 3EX Leeds, United Kingdom. 4. Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674 Paris cedex 14, France; Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France. 5. Department of Neurosurgery, Spedali Civili and University of Brescia, 25123 Brescia, Italy.
Abstract
INTRODUCTION: Intraoperative application of electrical current to the brain is a standard technique during brain surgery for inferring the function of the underlying brain. The purpose of intraoperative functional mapping is to reliably identify cortical areas and subcortical pathways involved in eloquent functions, especially motor, sensory, language and cognitive functions. MATERIAL AND METHODS: The aim of this article is to review the rationale and the electrophysiological principles of the use of direct bipolar electrostimulation for cortical and subcortical mapping under awake conditions. RESULTS: Direct electrical stimulation is a window into the whole functional network that sustains a particular function. It is an accurate (spatial resolution of about 5mm) and a reproducible technique particularly adapted to clinical practice for brain resection in eloquent areas. If the procedure is rigorously applied, the sensitivity of direct electrical stimulation for the detection of cortical and subcortical eloquent areas is nearly 100%. The main disadvantage of this technique is its suboptimal specificity. Another limitation is the identification of eloquent areas during surgery, which, however, could have been functionally compensated postoperatively if removed surgically. CONCLUSION: Direct electrical stimulation is an easy, accurate, reliable and safe invasive technique for the intraoperative detection of both cortical and subcortical functional brain connectivity for clinical purpose. In our opinion, it is the optimal technique for minimizing the risk of neurological sequelae when resecting in eloquent brain areas.
INTRODUCTION: Intraoperative application of electrical current to the brain is a standard technique during brain surgery for inferring the function of the underlying brain. The purpose of intraoperative functional mapping is to reliably identify cortical areas and subcortical pathways involved in eloquent functions, especially motor, sensory, language and cognitive functions. MATERIAL AND METHODS: The aim of this article is to review the rationale and the electrophysiological principles of the use of direct bipolar electrostimulation for cortical and subcortical mapping under awake conditions. RESULTS: Direct electrical stimulation is a window into the whole functional network that sustains a particular function. It is an accurate (spatial resolution of about 5mm) and a reproducible technique particularly adapted to clinical practice for brain resection in eloquent areas. If the procedure is rigorously applied, the sensitivity of direct electrical stimulation for the detection of cortical and subcortical eloquent areas is nearly 100%. The main disadvantage of this technique is its suboptimal specificity. Another limitation is the identification of eloquent areas during surgery, which, however, could have been functionally compensated postoperatively if removed surgically. CONCLUSION: Direct electrical stimulation is an easy, accurate, reliable and safe invasive technique for the intraoperative detection of both cortical and subcortical functional brain connectivity for clinical purpose. In our opinion, it is the optimal technique for minimizing the risk of neurological sequelae when resecting in eloquent brain areas.
Authors: Giannantonio Spena; Elena Roca; Francesco Guerrini; Pier Paolo Panciani; Lorenzo Stanzani; Andrea Salmaggi; Sabino Luzzi; Marco Fontanella Journal: J Neurooncol Date: 2019-09-24 Impact factor: 4.130
Authors: Elena Roca; Johan Pallud; Francesco Guerrini; Pier Paolo Panciani; Marco Fontanella; Giannantonio Spena Journal: Neurosurg Rev Date: 2019-12-03 Impact factor: 3.042
Authors: Hans W Axelson; Francesco Latini; Malin Jemstedt; Mats Ryttlefors; Maria Zetterling Journal: Front Oncol Date: 2022-08-12 Impact factor: 5.738