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Mandonnet V, Obaid S, Descoteaux M, St-Onge E, Devaux B, Levé C, Froelich S, Rheault F, Mandonnet E. Electrostimulation of the white matter of the posterior insula and medial operculum: perception of vibrations, heat, and pain. Pain 2024; 165:565-572. [PMID: 37862047 DOI: 10.1097/j.pain.0000000000003069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/02/2023] [Indexed: 10/21/2023]
Abstract
ABSTRACT This study aimed to characterize the sensory responses observed when electrically stimulating the white matter surrounding the posterior insula and medial operculum (PIMO). We reviewed patients operated on under awake conditions for a glioma located in the temporoparietal junction. Patients' perceptions were retrieved from operative reports. Stimulation points were registered in the Montreal Neurological Institute template. A total of 12 stimulation points in 8 patients were analyzed. Painful sensations in the contralateral leg were reported (5 sites in 5 patients) when stimulating the white matter close to the parcel OP2/3 of the Glasser atlas. Pain had diverse qualities: burning, tingling, crushing, or electric shock. More laterally, in the white matter of OP1, pain and heat sensations in the upper part of the body were described (5 sites in 2 patients). Intermingled with these sites, vibration sensations were also reported (3 sites in 2 patients). Based on the tractograms of 44 subjects from the Human Connectome Project data set, we built a template of the pathways linking the thalamus to OP2/3 and OP1. Pain sites were located in the thalamo-OP2/3 and thalamo-OP1 tracts. Heat sites were located in the thalamo-OP1 tract. In the 227 awake surgeries performed for a tumor located outside of the PIMO region, no patients ever reported pain or heat sensations when stimulating the white matter. Thus, we propose that the thalamo-PIMO connections constitute the main cortical inputs for nociception and thermoception and emphasize that preserving these fibers is of utmost importance to prevent the postoperative onset of a debilitating insulo-opercular pain syndrome.
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Affiliation(s)
- Valéry Mandonnet
- Frontlab, Paris Brain Institute, CNRS UMR 7225, INSERM U1127, Paris, France
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
- Université de Paris Cité, Paris, France
| | - Sami Obaid
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
- Department of Neurosciences, University of Montreal, Montreal, QC, Canada
- Neuroscience Research Axis, University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Lab, Department of Computer Science, Faculty of Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Imeka Solutions, Sherbrooke, QC, Canada
| | - Etienne St-Onge
- Neuroimaging and Surgical Technologies Laboratory (NIST), Montreal Neurological Institute (MNI), Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Computer Science and Engineering, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
| | - Bertrand Devaux
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
- Université de Paris Cité, Paris, France
| | - Charlotte Levé
- Department of Anesthesiology, Lariboisière Hospital, Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
- Université de Paris Cité, Paris, France
| | - François Rheault
- Sherbrooke Connectivity Imaging Lab, Department of Computer Science, Faculty of Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Emmanuel Mandonnet
- Frontlab, Paris Brain Institute, CNRS UMR 7225, INSERM U1127, Paris, France
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
- Université de Paris Cité, Paris, France
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Rossel O, Schlosser-Perrin F, Duffau H, Matsumoto R, Mandonnet E, Bonnetblanc F. Short-range axono-cortical evoked-potentials in brain tumor surgery: Waveform characteristics as markers of direct connectivity. Clin Neurophysiol 2023; 153:189-201. [PMID: 37353389 DOI: 10.1016/j.clinph.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/20/2023] [Accepted: 05/24/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE Intraoperative measurement of axono-cortical evoked potentials (ACEP) has emerged as a promising tool for studying neural connectivity. However, it is often difficult to determine if the activity recorded by cortical grids is generated by stimulated tracts or by spurious phenomena. This study aimed to identify criteria that would indicate a direct neurophysiological connection between a recording contact and a stimulated pathway. METHODS Electrical stimulation was applied to white matter fascicles within the resection cavity, while the evoked response was recorded at the cortical level in seven patients. RESULTS By analyzing the ACEP recordings, we identified a main epicenter characterized by a very early positive (or negative) evoked response occurring just after the stimulation artifact (<5 ms, |Amplitude| > 100 µV) followed by an early and large negative (or positive) monophasic evoked response (<40 ms; |Amplitude| > 300 µV). The neighboring activity had a different waveform and was attenuated compared to the hot-spot activity. CONCLUSIONS It is possible to distinguish the hotspot with direct connectivity to the stimulated site from neighboring activity using the identified criteria. SIGNIFICANCE The electrogenesis of the ACEP at the hotspot and neighboring activity is discussed.
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Affiliation(s)
| | | | - Hugues Duffau
- Département de Neurochirurgie, Centre Hospitalier Universitaire de Montpellier Gui de Chauliac, Montpellier, France
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Japan
| | - Emmanuel Mandonnet
- Département de Neurochirurgie, Centre Hospitalier Universitaire, Hôpital Lariboisière, Paris, France
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Schlosser-Perrin F, Rossel O, Duffau H, Bonnetblanc F, Mandonnet E. How far does electrical stimulation activate white matter tracts? A computational modeling study. Clin Neurophysiol 2023; 153:68-78. [PMID: 37459667 DOI: 10.1016/j.clinph.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE The aim of this study was to model how the different parameters of electrical stimulation (intensity, pulse shape, probe geometry) influence the extent of white matter activation. METHODS The electrical potentials generated by the stimulating electrodes were determined by solving Laplace equation. The temporal evolution of membrane potentials at each nodes of Ranvier of an axon was then computed by solving the coupled system of differential equations describing membrane dynamics and cable propagation. RESULTS Regions of unilateral propagation were observed for monophasic pulses delivered with a bipolar probe aligned along the tract. For biphasic pulses, the largest activation areas and depths were found with a high inter-electrode-distance (IED) bipolar probe, oriented orthogonally to the tract. The smallest activation areas and depths were found for bipolar stimulations with the probe aligned parallel to the tract and low IED. For isotropic white matter regions, the activation area and depth were three times larger than for anisotropic white matter tracts. CONCLUSIONS Bipolar probes with biphasic pulses offer the greatest versatility: an orthogonal orientation acts as two monopolars (increased sensitivity when searching for a tract), whereas a parallel orientation corresponds to a single monopolar (increased specificity). Activation is more superficial when stimulating highly anisotropic tracts. SIGNIFICANCE This knowledge is essential for interpreting the behavorial effects of stimulation and the recordings of axono-cortical evoked potentials.
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Affiliation(s)
| | | | - Hugues Duffau
- Département de Neurochirurgie, Centre Hospitalier Universitaire de Montpellier Gui de Chauliac, Montpellier, France; Team "Neuroplasticity, Stem Cells and Glial Tumors", Institute of Functional Genomics, INSERM U-1191, University of Montpellier, 34090 Montpellier, France; Université de Montpellier, Montpellier, France
| | | | - Emmanuel Mandonnet
- Frontlab, Paris Brain Institute, CNRS UMR 7225, INSERM U1127, Paris, France; Department of Neurosurgery, Lariboisière Hospital, Paris, France; Université de Paris Cité, Paris, France.
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Landers MJ, Baene WD, Rutten GJ, Mandonnet E. The third branch of the superior longitudinal system. J Neurosurg Sci 2022; 65:548-559. [PMID: 35128918 DOI: 10.23736/s0390-5616.21.05423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
One of the major associative fiber pathways in the brain is the superior longitudinal system. This review discusses the current knowledge gained from studies on the third branch of the superior longitudinal system (SLS) regarding its anatomy, functional role in healthy individuals, results from lesion-symptom mapping studies and intraoperative electrostimulation studies. The results of these studies clearly indicate that the third branch of the SLS is a distinct pathway, as seen both from a functional and anatomical perspective. The third branch of the SLS should be distinguished from the long segment of the arcuate fasciculus, that courses along its trajectory but seems implicated in different functions. Moreover, these studies also provide substantial evidence that the right and left third branch of the SLS have different functional roles. Finally, a hypothesis for an integrated anatomo-functional model is proposed, that describes three subcomponents of the third branch of the superior longitudinal system.
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Affiliation(s)
- Maud J Landers
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.,Department of Cognitive Neuropsychology, University of Tilburg, Tilburg, the Netherlands
| | - Wouter de Baene
- Department of Cognitive Neuropsychology, University of Tilburg, Tilburg, the Netherlands
| | - Geert J Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.,Department of Cognitive Neuropsychology, University of Tilburg, Tilburg, the Netherlands
| | - Emmanuel Mandonnet
- University of Paris, Paris, France - .,Frontlab, Institut du Cerveau (ICM), CNRS UMR 7225, INSERM U1127, Paris, France.,Service of Neurosurgery, Lariboisière Hospital, Paris, France
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