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Andrade Machado R, Meylor J. Cortico-cortical evoked potential and language mapping: A meta-analysis. Epilepsy Behav 2024; 157:109851. [PMID: 38823074 DOI: 10.1016/j.yebeh.2024.109851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/21/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE The purpose of this meta-analysis was to determine the best available evidence for the use of cortico-cortical evoked potential (CCEP) for language mapping. METHODS PubMed/Medline/Google Scholar/Cochrane and Scopus electronic databases were searched for articles using CCEP for language mapping. CCEP data was obtained including the area of the cortex generating CCEP, resection data, and post-resection language outcomes. Inclusion criteria were clinical articles reporting the use of CCEP in language regions of the brain, reporting language outcomes and whether there was final resection of the cortex, studies with more than five patients, and studies in either English or Spanish. Review articles, systematic reviews, meta-analyses, or case series with less than five patients were excluded. RESULTS Seven studies with a total of 59 patients were included in this meta-analysis. The presence of CCEPs from stimulation of Broca's area or posterior perisylvian region in the resection predicts language deficits after surgery. The diagnostic odds ratio shows values greater than 0 perioperatively (0.69-5.82) and after six months (1.38-11), supporting a high likelihood of a language deficit if the presence of CCEPs from stimulation of Broca's area or posterior perisylvian region are included in the resection and vice versa. The True Positive rate varied between 0.38 and 0.87. This effect decreases after six months to 0.61 (0.30-0.86). However, the True Negative rate increased from 0.53 (0.32-0.79) to 0.71 (0.55-0.88). CONCLUSION This meta-analysis supports the utility of CCEP to predict the probability of having long-term language deficits after surgery. .
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Affiliation(s)
| | - Jennifer Meylor
- Medical College of Wisconsin, Department of Neurology, Milwaukee, WI, USA.
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Zauli FM, Revay M, Terzaghi M, Solbiati M, Cassani CM, Cossu M, d'Orio P, Castana L, Cardinale F, Mikulan E, Sartori I. Cortical and subcortical intraoperative-monitoring of the visual pathway under general anesthesia in epilepsy surgery. Clin Neurophysiol 2024; 166:96-107. [PMID: 39142121 DOI: 10.1016/j.clinph.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 06/05/2024] [Accepted: 07/20/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE The purpose of this study was to evaluate the applicability of visual evoked potentials (VEP) for intraoperative visual pathway monitoring in epilepsy surgery of the posterior hemispheric quadrant (PHQ) and to correlate it with post-operative visual field status. METHODS VEP monitoring was performed in 16 patients (12 females, 7 children). Flash-induced VEP were recorded with strip electrodes from the banks of the calcarine cortex. Latency and amplitude of the first component of VEP (V1-lat, V1-amp) were monitored. Evaluation of the visual field was performed pre- and post-operatively in all patients. RESULTS All procedures were successfully completed without adverse events. In 10 patients the strip covered both the inferior and superior calcarine banks, while only one bank was sampled in 6 cases (inferior in 4, superior in 2). Considering one of the two calcarine banks, at the end of the resection VEP had disappeared in 4 patients, whereas a decrease >33.3% in 4 and <20% of V1-amp was recorded in 5 and in 4 cases respectively. The percentage of V1-amp reduction was significantly higher for the patients who experienced a post-operative visual field reduction (p < 0.001). Post-operative visual field deficits were found in patients presenting a reduction >33.3% of V1-amp. CONCLUSIONS VEP monitoring is possible and safe in epilepsy surgery under general anesthesia. SIGNIFICANCE Intraoperative recording of VEP from the banks of the calcarine cortex allows monitoring the integrity of post-geniculate visual pathways during PHQ resections for epilepsy and it is pivotal to prevent disabling visual field defects, including hemianopia and inferior quadrantanopia.
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Affiliation(s)
- Flavia Maria Zauli
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy; Department of Philosophy "P. Martinetti", Università degli Studi di Milano, Milan, Italy; ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| | - Martina Revay
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy; Department of Medicine, Università di Parma, Parma, Italy.
| | - Michele Terzaghi
- Sleep Medicine Centre, IRCCS Mondino Foundation, Via Mondino, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Michela Solbiati
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy; ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Chiara Maria Cassani
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy; Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy; Department of School of Advanced Studies, University of Camerino, Italy
| | - Massimo Cossu
- Department of Neurosurgery, Giannina Gaslini Pediatric Hospital, Genoa, Italy
| | - Piergiorgio d'Orio
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy; Department of Medicine, Università di Parma, Parma, Italy
| | - Laura Castana
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| | - Francesco Cardinale
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy; Department of Medicine, Università di Parma, Parma, Italy
| | - Ezequiel Mikulan
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy; Department of Health sciences, Università degli Studi di Milano, Milan, Italy
| | - Ivana Sartori
- ASST GOM Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
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Giampiccolo D, Matsumoto R. Mapping cortico-cortical evoked potentials to glioma grading and language outcome. Clin Neurophysiol 2024; 161:244-245. [PMID: 38538419 DOI: 10.1016/j.clinph.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Davide Giampiccolo
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Department of Neurosurgery, Institute of Neuroscience, Cleveland Clinic London, Grosvenor Place, London, UK.
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan; Epilepsy Center & Center for Cognitive and Memory Disorders, Kobe University Hospital, Kobe, Japan.
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d'Orio P, Squarza S, Revay M, Cardinale F, Castana L, Sartori I, Tassi L, Lo Russo G, Cossu M. Neurological morbidity of surgery for suprasylvian operculoinsular epilepsy. Epilepsia 2024; 65:402-413. [PMID: 38041557 DOI: 10.1111/epi.17844] [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: 07/24/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE The objective of this study was to identify risk factors associated with surgery-related neurological morbidity in patients with drug-resistant epilepsy undergoing suprasylvian operculoinsular resections. As secondary outcomes, we also analyzed the risk factors for ischemic lesion (IL) of corona radiata and seizure recurrence. METHODS A retrospective analysis was conducted on a cohort of patients who underwent suprasylvian operculoinsular resections for drug-resistant epilepsy. The association of several presurgical, surgical, and postsurgical factors with both primary (persistent neurological deficits) and secondary (structural abnormalities on postoperative magnetic resonance imaging [MRI] and seizure recurrence) postoperative outcomes was investigated with univariate and multivariate statistical analysis. RESULTS The study included a total of 65 patients; 46.2% of patients exhibited postoperative neurological deficits, but only 12.3% experienced persistent deficits. On postoperative MRI, IL in the corona radiata and corticospinal tract Wallerian degeneration (CSTWd) were seen in 68% and 29% of cases, respectively. Only CSTWd was significantly associated with persistent neurological deficits (relative risk [RR] = 2.6). Combined operculoinsular resection (RR = 3.62) and surgery performed on the left hemisphere (RR = .37) were independently associated with IL in the corona radiata. Variables independently associated with CSTWd were the presence of malacic components in the IL (RR = 1.96), right central operculum resection (RR = 1.79), and increasing age at surgery (RR = 1.03). Sixty-two patients had a postoperative follow-up > 12 months (median = 56, interquartile range = 30.75-73.5), and 62.9% were in Engel class I at last outpatient control. The risk of seizure recurrence was reduced by selective opercular resection (RR = .25) and increased by the histological diagnosis of aspecific gliosis (RR = 1.39). SIGNIFICANCE This study provides insights into the risk factors associated with surgery-related neurological morbidity, as well as further evidence on the postoperative occurrence of subcortical injury and seizure recurrence in epileptic patients undergoing suprasylvian operculoinsular resections. The findings highlighted in this study may be useful to better understand the processes supporting the increased surgical risk in the operculoinsular region.
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Affiliation(s)
- Piergiorgio d'Orio
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Silvia Squarza
- Neuroradiology Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Martina Revay
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Francesco Cardinale
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Laura Castana
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ivana Sartori
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Lo Russo
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Cossu
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
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De Benedictis A, de Palma L, Rossi-Espagnet MC, Marras CE. Connectome-based approaches in pediatric epilepsy surgery: "State-of-the art" and future perspectives. Epilepsy Behav 2023; 149:109523. [PMID: 37944286 DOI: 10.1016/j.yebeh.2023.109523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Modern epilepsy science has overcome the traditional interpretation of a strict region-specific origin of epilepsy, highlighting the involvement of wider patterns of altered neuronal circuits. In selected cases, surgery may constitute a valuable option to achieve both seizure freedom and neurocognitive improvement. Although epilepsy is now considered as a brain network disease, the most relevant literature concerning the "connectome-based" epilepsy surgery mainly refers to adults, with a limited number of studies dedicated to the pediatric population. In this review, the Authors summarized the main current available knowledge on the relevance of WM surgical anatomy in epilepsy surgery, the post-surgical modifications of brain structural connectivity and the related clinical impact of such modifications within the pediatric context. In the last part, possible implications and future perspectives of this approach have been discussed, especially concerning the optimization of surgical strategies and the predictive value of the epilepsy network analysis for planning tailored approaches, with the final aim of improving case selection, presurgical planning, intraoperative management, and postoperative results.
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Affiliation(s)
| | - Luca de Palma
- Epilepsy and Movement Disorders Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Cornblath EJ, Lucas A, Armstrong C, Greenblatt AS, Stein JM, Hadar PN, Raghupathi R, Marsh E, Litt B, Davis KA, Conrad EC. Quantifying trial-by-trial variability during cortico-cortical evoked potential mapping of epileptogenic tissue. Epilepsia 2023; 64:1021-1034. [PMID: 36728906 PMCID: PMC10480141 DOI: 10.1111/epi.17528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Measuring cortico-cortical evoked potentials (CCEPs) is a promising tool for mapping epileptic networks, but it is not known how variability in brain state and stimulation technique might impact the use of CCEPs for epilepsy localization. We test the hypotheses that (1) CCEPs demonstrate systematic variability across trials and (2) CCEP amplitudes depend on the timing of stimulation with respect to endogenous, low-frequency oscillations. METHODS We studied 11 patients who underwent CCEP mapping after stereo-electroencephalography electrode implantation for surgical evaluation of drug-resistant epilepsy. Evoked potentials were measured from all electrodes after each pulse of a 30 s, 1 Hz bipolar stimulation train. We quantified monotonic trends, phase dependence, and standard deviation (SD) of N1 (15-50 ms post-stimulation) and N2 (50-300 ms post-stimulation) amplitudes across the 30 stimulation trials for each patient. We used linear regression to quantify the relationship between measures of CCEP variability and the clinical seizure-onset zone (SOZ) or interictal spike rates. RESULTS We found that N1 and N2 waveforms exhibited both positive and negative monotonic trends in amplitude across trials. SOZ electrodes and electrodes with high interictal spike rates had lower N1 and N2 amplitudes with higher SD across trials. Monotonic trends of N1 and N2 amplitude were more positive when stimulating from an area with higher interictal spike rate. We also found intermittent synchronization of trial-level N1 amplitude with low-frequency phase in the hippocampus, which did not localize the SOZ. SIGNIFICANCE These findings suggest that standard approaches for CCEP mapping, which involve computing a trial-averaged response over a .2-1 Hz stimulation train, may be masking inter-trial variability that localizes to epileptogenic tissue. We also found that CCEP N1 amplitudes synchronize with ongoing low-frequency oscillations in the hippocampus. Further targeted experiments are needed to determine whether phase-locked stimulation could have a role in localizing epileptogenic tissue.
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Affiliation(s)
- Eli J. Cornblath
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alfredo Lucas
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Bioengineering, School of Engineering & Applied Science, Philadelphia, Pennsylvania, USA
| | - Caren Armstrong
- Pediatric Epilepsy Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam S. Greenblatt
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joel M. Stein
- Department of Radiology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Peter N. Hadar
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ramya Raghupathi
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Eric Marsh
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Pediatric Epilepsy Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Brian Litt
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kathryn A. Davis
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Erin C. Conrad
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Johnson GW, Doss DJ, Englot DJ. Network dysfunction in pre and postsurgical epilepsy: connectomics as a tool and not a destination. Curr Opin Neurol 2022; 35:196-201. [PMID: 34799514 PMCID: PMC8891078 DOI: 10.1097/wco.0000000000001008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Patients with focal drug-resistant epilepsy (DRE) sometimes continue to have seizures after surgery. Recently, there is increasing interest in using advanced network analyses (connectomics) to better understand this problem. Connectomics has changed the way researchers and clinicians view DRE, but it must be applied carefully in a hypothesis-driven manner to avoid spurious results. This review will focus on studies published in the last 18 months that have thoughtfully used connectomics to advance our fundamental understanding of network dysfunction in DRE - hopefully for the eventual direct benefit to patient care. RECENT FINDINGS Impactful recent findings have centered on using patient-specific differences in network dysfunction to predict surgical outcome. These works span functional and structural connectivity and include the modalities of functional and diffusion magnetic resonance imaging (MRI) and electrophysiology. Using functional MRI, many groups have described an increased functional segregation outside of the surgical resection zone in patients who fail surgery. Using electrophysiology, groups have reported network characteristics of resected tissue that suggest whether a patient will respond favorably to surgery. SUMMARY If we can develop accurate models to outline functional and structural network characteristics that predict failure of standard surgical approaches, then we can not only improve current clinical decision-making; we can also begin developing alternative treatments including network approaches to improve surgical success rates.
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Affiliation(s)
- Graham W. Johnson
- Department of Biomedical Engineering at Vanderbilt University
- Vanderbilt University Institute of Imaging Science at Vanderbilt University Medical Center
| | - Derek J. Doss
- Department of Biomedical Engineering at Vanderbilt University
- Vanderbilt University Institute of Imaging Science at Vanderbilt University Medical Center
| | - Dario J. Englot
- Department of Biomedical Engineering at Vanderbilt University
- Vanderbilt University Institute of Imaging Science at Vanderbilt University Medical Center
- Department of Neurological Surgery
- Department of Neurology
- Department of Radiology and Radiological Sciences at Vanderbilt University Medical Center
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Giampiccolo D, Nunes S, Cattaneo L, Sala F. Functional Approaches to the Surgery of Brain Gliomas. Adv Tech Stand Neurosurg 2022; 45:35-96. [PMID: 35976447 DOI: 10.1007/978-3-030-99166-1_2] [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] [Indexed: 06/15/2023]
Abstract
In the surgery of gliomas, recent years have witnessed unprecedented theoretical and technical development, which extensively increased indication to surgery. On one hand, it has been solidly demonstrated the impact of gross total resection on life expectancy. On the other hand, the paradigm shift from classical cortical localization of brain function towards connectomics caused by the resurgence of awake surgery and the advent of tractography has permitted safer surgeries focused on subcortical white matter tracts preservation and allowed for surgical resections within regions, such as Broca's area or the primary motor cortex, which were previously deemed inoperable. Furthermore, new asleep electrophysiological techniques have been developed whenever awake surgery is not an option, such as operating in situations of poor compliance (including paediatric patients) or pre-existing neurological deficits. One such strategy is the use of intraoperative neurophysiological monitoring (IONM), enabling the identification and preservation of functionally defined, but anatomically ambiguous, cortico-subcortical structures through mapping and monitoring techniques. These advances tie in with novel challenges, specifically risk prediction and the impact of neuroplasticity, the indication for tumour resection beyond visible borders, or supratotal resection, and most of all, a reappraisal of the importance of the right hemisphere from early psychosurgery to mapping and preservation of social behaviour, executive control, and decision making.Here we review current advances and future perspectives in a functional approach to glioma surgery.
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Affiliation(s)
- Davide Giampiccolo
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, University of Verona, Verona, Italy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Institute of Neurosciences, Cleveland Clinic London, London, UK
| | - Sonia Nunes
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, University of Verona, Verona, Italy
| | - Luigi Cattaneo
- Center for Mind and Brain Sciences (CIMeC) and Center for Medical Sciences (CISMed), University of Trento, Trento, Italy
| | - Francesco Sala
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, University of Verona, Verona, Italy.
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Galloway G. Use of CCEPs of the arcuate fasciculus under general anesthesia for language evaluation. Clin Neurophysiol 2021; 132:1957-1958. [PMID: 34099408 DOI: 10.1016/j.clinph.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Gloria Galloway
- Neurology Department of Neurology, 395 W 12th Avenue 7th Floor, Columbus, OH 43210, USA.
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