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Alsallom F, Simon MV. Pediatric Intraoperative Neurophysiologic Mapping and Monitoring in Brain Surgery. J Clin Neurophysiol 2024; 41:96-107. [PMID: 38306217 DOI: 10.1097/wnp.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024] Open
Abstract
SUMMARY Similar to adults, children undergoing brain surgery can significantly benefit from intraoperative neurophysiologic mapping and monitoring. Although young brains present the advantage of increased plasticity, during procedures in close proximity to eloquent regions, the risk of irreversible neurological compromise remains and can be lowered further by these techniques. More so, pathologies specific to the pediatric population, such as neurodevelopmental lesions, often result in medically refractory epilepsy. Thus, their successful surgical treatment also relies on accurate demarcation and resection of the epileptogenic zone, processes in which intraoperative electrocorticography is often employed. However, stemming from the development and maturation of the central and peripheral nervous systems as the child grows, intraoperative neurophysiologic testing in this population poses methodologic and interpretative challenges even to experienced clinical neurophysiologists. For example, it is difficult to perform awake craniotomies and language testing in the majority of pediatric patients. In addition, children may be more prone to intraoperative seizures and exhibit afterdischarges more frequently during functional mapping using electrical cortical stimulation because of high stimulation thresholds needed to depolarize immature cortex. Moreover, choice of anesthetic regimen and doses may be different in pediatric patients, as is the effect of these drugs on immature brain; these factors add additional complexity in terms of interpretation and analysis of neurophysiologic recordings. Below, we are describing the modalities commonly used during intraoperative neurophysiologic testing in pediatric brain surgery, with emphasis on age-specific clinical indications, methodology, and challenges.
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Affiliation(s)
- Faisal Alsallom
- King Fahad Medical City, KFMC Neurosciences Center, Riyadh, Saudi Arabia; and
| | - Mirela V Simon
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, U.S.A
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Broggi M, Zattra CM, Restelli F, Acerbi F, Seveso M, Devigili G, Schiariti M, Vetrano IG, Ferroli P, Broggi G. A Brief Explanation on Surgical Approaches for Treatment of Different Brain Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:689-714. [PMID: 37452959 DOI: 10.1007/978-3-031-23705-8_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The main goal of brain tumor surgery is to achieve gross total tumor resection without postoperative complications and permanent new deficits. However, when the lesion is located close or within eloquent brain areas, cranial nerves, and/or major brain vessels, it is imperative to balance the extent of resection with the risk of harming the patient, by following a so-called maximal safe resection philosophy. This view implies a shift from an approach-guided attitude, in which few standard surgical approaches are used to treat almost all intracranial tumors, to a pathology-guided one, with surgical approaches actually tailored to the specific tumor that has to be treated with specific dedicated pre- and intraoperative tools and techniques. In this chapter, the basic principles of the most commonly used neurosurgical approaches in brain tumors surgery are presented and discussed along with an overview on all available modern tools able to improve intraoperative visualization, extent of resection, and postoperative clinical outcome.
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Affiliation(s)
- Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Costanza M Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Mirella Seveso
- Neuroanesthesia and Neurointensive Care Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Grazia Devigili
- Neurological Unit 1, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Giovanni Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
- Scientific Director, Fondazione I.E.N. Milano, Italy.
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Xie T, Wu Z, Schalk G, Tong Y, Vato A, Raviv N, Guo Q, Ye H, Sheng X, Zhu X, Brunner P, Chen L. Automated intraoperative central sulcus localization and somatotopic mapping using median nerve stimulation. J Neural Eng 2022; 19. [PMID: 35785769 PMCID: PMC9534515 DOI: 10.1088/1741-2552/ac7dfd] [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: 02/18/2022] [Accepted: 07/04/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Accurate identification of functional cortical regions is essential in neurological resection. The central sulcus (CS) is an important landmark that delineates functional cortical regions. Median nerve stimulation (MNS) is a standard procedure to identify the position of the CS intraoperatively. In this paper, we introduce an automated procedure that uses MNS to rapidly localize the CS and create functional somatotopic maps. APPROACH We recorded electrocorticographic signals from 13 patients who underwent MNS in the course of an awake craniotomy. We analyzed these signals to develop an automated procedure that determines the location of the CS and that also produces functional somatotopic maps. MAIN RESULTS The comparison between our automated method and visual inspection performed by the neurosurgeon shows that our procedure has a high sensitivity (89%) in identifying the CS. Further, we found substantial concordance between the functional somatotopic maps generated by our method and passive functional mapping (92% sensitivity). SIGNIFICANCE Our automated MNS-based method can rapidly localize the CS and create functional somatotopic maps without imposing additional burden on the clinical procedure. With additional development and validation, our method may lead to a diagnostic tool that guides neurosurgeon and reduces postoperative morbidity in patients undergoing resective brain surgery.
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Affiliation(s)
- Tao Xie
- Department of Neurosurgery, Washington University School of Medicine in Saint Louis, 660 S. Euclid Avenue, St Louis, Missouri, 63110-1010, UNITED STATES
| | - Zehan Wu
- Dept. of Neurosurgery, Huashan Hospital Fudan University, 12 Wulumuqi Middle Rd, Shanghai, 200040, CHINA
| | - Gerwin Schalk
- National Center for Adaptive Neurotechnologies, 113 Holland Avenue, Albany, New York, 12208, UNITED STATES
| | - Yusheng Tong
- Dept. of Neurosurgery, Huashan Hospital Fudan University, 12 Wulumuqi Middle Rd, Shanghai, 200040, CHINA
| | - Alessandro Vato
- National Center for Adaptive Neurotechnologies, 113 Holland Avenue, Albany, New York, 12208, UNITED STATES
| | - Nataly Raviv
- National Center for Adaptive Neurotechnologies, 113 Holland Avenue, Albany, New York, 12208, UNITED STATES
| | - Qinglong Guo
- Dept. of Neurosurgery, Huashan Hospital Fudan University, 12 Wulumuqi Middle Rd, Shanghai, 200040, CHINA
| | - Huanpeng Ye
- State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, CHINA
| | - Xinjun Sheng
- State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, CHINA
| | - Xiangyang Zhu
- State Key Laboratory of Mechanical System and Vibration , Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, CHINA
| | - Peter Brunner
- Department of Neurosurgery, Washington University School of Medicine in Saint Louis, 660 S. Euclid Avenue, St Louis, Missouri, 63110-1010, UNITED STATES
| | - Liang Chen
- Dept. of Neurosurgery, Huashan Hospital Fudan University, 12 Wulumuqi Middle Rd, Shanghai, 200040, CHINA
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Abstract
There are many recent advances in intraoperative evoked potential techniques for mapping and monitoring neural function during surgery. In particular, somatosensory evoked potential optimization speeds surgical feedback, motor evoked potentials provide selective motor system information, and new visual evoked potential methods promise reliable visual system monitoring. This chapter reviews these advances and provides a comprehensive background for understanding their context and importance.
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Affiliation(s)
| | - Charles C Dong
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Alberto Uribe
- Department of Anesthesiology, Ohio State University, Columbus, OH, United States
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Chen DF, Willie JT, Cabrera D, Bullinger KL, Karakis I. Continuous Intraoperative Neurophysiological Monitoring of the Motor Pathways Using Depth Electrodes During Surgical Resection of an Epileptogenic Lesion: A Novel Technique. Oper Neurosurg (Hagerstown) 2021; 20:E379-E385. [PMID: 33475704 DOI: 10.1093/ons/opaa463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/11/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Intraoperative neurophysiological monitoring of the motor pathways during epilepsy surgery is essential to safely achieve maximal resection of the epileptogenic zone. Motor evoked potential (MEP) recording is usually performed intermittently during resection using a handheld stimulator or continuously through an electrode array placed on the motor cortex. We present a novel variation of continuous MEP acquisition through previously implanted depth electrodes in the perirolandic cortex. CLINICAL PRESENTATION A 60-yr-old woman with a history of a left frontal meningioma (World Health Organization [WHO] grade II) treated with surgical resection and radiation presented with residual right hemiparesis and refractory epilepsy. Imaging demonstrated a perirolandic lesion with surrounding edema and mass effect in the prior surgical site, suspicious for radiation necrosis versus tumor recurrence. Presurgical electrocorticography (ECoG) with orthogonal, stereotactically implanted depth electrodes (stereoelectroencephalography [SEEG]) of the perirolandic cortex captured seizure onsets from the supplementary motor area (SMA) and primary motor cortex (PMC). The patient underwent a left frontal craniotomy for repeat resection and tissue diagnosis. Intraoperative ECoG and MEPs were obtained continuously with direct cortical stimulation through the indwelling SEEG electrodes in the PMC. Maximal resection was achieved with preservation of direct cortical MEPs and without deterioration of her baseline hemiparesis. Biopsy revealed radiation necrosis. At 30-mo follow-up, the patient had only rare seizures (Engel class IIB). CONCLUSION Intraoperative cortical MEP acquisition through implanted SEEG electrode arrays is a potentially safe and effective alternative approach to continuously monitor the motor pathways during the resection of a perirolandic epileptogenic lesion, without the need for surgical interruptions.
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Affiliation(s)
- Denise F Chen
- Department of Neurology, Emory University, Atlanta, Georgia
| | - Jon T Willie
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - David Cabrera
- Medical Department, SpecialtyCare, Brentwood, Tennessee
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Keeble H, Lavrador JP, Pereira N, Lente K, Brogna C, Gullan R, Bhangoo R, Vergani F, Ashkan K. Electromagnetic Navigation Systems and Intraoperative Neuromonitoring: Reliability and Feasibility Study. Oper Neurosurg (Hagerstown) 2021; 20:373-382. [PMID: 33432974 DOI: 10.1093/ons/opaa407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A recent influx of intraoperative technology is being used in neurosurgery, but few reports investigate the accuracy and safety of these technologies when used simultaneously. OBJECTIVE To assess the ability to use an electromagnetic navigation system alongside multimodal intraoperative neurophysiological monitoring (IONM). METHODS Single-institution prospective cohort study of patients requiring craniotomy for brain tumor resection operated using an electromagnetic navigation system (AxiEM, Medtronic®). motor evoked potentials, somatosensory evoked potentials (SSEPs), electroencephalography, and electromyography were recorded and analyzed with AxiEM on (with/without filters) and off. The neurological outcomes of the patients were recorded. RESULTS A total of 15 patients were included (8 males/7 females, mean age 52.13 yr). Even though the raw acquisition is affected by the electromagnetic field (particularly SSEPs), no significant difference was detected in the morphology, amplitude, and latency of the different monitoring modalities (AxiEM off vs on) after the appropriate software filter application. Adjustments to the frequency of SSEP stimulation and number of averages, and reductions to the low-pass filters were applied. Notch filters were used appropriately and changes to the physical setup of the IONM and electromagnetic navigation system equipment reduced noise. Postoperatively, none of the patients developed new focal deficits; 7 patients showed improvement in their motor deficit (4 recovered fully). CONCLUSION The information provided by the IONM in intracranial neurosurgery patients whilst also using electromagnetic navigation systems is reliable for monitoring, mapping, and detecting intraoperative complications, provided that the appropriate software filters and tools are applied.
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Affiliation(s)
| | - José Pedro Lavrador
- Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom
| | | | | | - Christian Brogna
- Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom
| | - Richard Gullan
- Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom
| | - Ranjeev Bhangoo
- Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom
| | - Francesco Vergani
- Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom
| | - Keyoumars Ashkan
- Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom
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Abstract
This review is intended to provide a summary of the literature pertaining to the perioperative care of neurosurgical patients and patients with neurological diseases. General topics addressed in this review include general neurosurgical considerations, stroke, neurological monitoring, and perioperative disorders of cognitive function.
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Greve T, Stoecklein VM, Dorn F, Laskowski S, Thon N, Tonn JC, Schichor C. Introduction of intraoperative neuromonitoring does not necessarily improve overall long-term outcome in elective aneurysm clipping. J Neurosurg 2019; 132:1188-1196. [PMID: 30925469 DOI: 10.3171/2018.12.jns182177] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative neuromonitoring (IOM), particularly of somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs), evolved as standard of care in a variety of neurosurgical procedures. Case series report a positive impact of IOM for elective microsurgical clipping of unruptured intracranial aneurysms (ECUIA), whereas systematic evaluation of its predictive value is lacking. Therefore, the authors analyzed the neurological outcome of patients undergoing ECUIA before and after IOM introduction to this procedure. METHODS The dates of inclusion in the study were 2007-2014. In this period, ECUIA procedures before (n = 136, NIOM-group; 2007-2010) and after introduction of IOM (n = 138, IOM-group; 2011-2014) were included. The cutoff value for SSEP/MEP abnormality was chosen as an amplitude reduction ≥ 50%. SSEP/MEP changes were correlated with neurological outcome. IOM-undetectable deficits (bulbar, vision, ataxia) were not included in risk stratification. RESULTS There was no significant difference in sex distribution, follow-up period, subarachnoid hemorrhage risk factors, aneurysm diameter, complexity, and location. Age was higher in the IOM-group (57 vs 54 years, p = 0.012). In the IOM group, there were 18 new postoperative deficits (13.0%, 5.8% permanent), 9 hemisyndromes, 2 comas, 4 bulbar symptoms, and 3 visual deficits. In the NIOM group there were 18 new deficits (13.2%; 7.3% permanent, including 7 hemisyndromes). The groups did not significantly differ in the number or nature of postoperative deficits, nor in their recovery rate. In the IOM group, SSEPs and MEPs were available in 99% of cases. Significant changes were noted in 18 cases, 4 of which exhibited postoperative hemisyndrome, and 1 suffered from prolonged comatose state (5 true-positive cases). Twelve patients showed no new detectable deficits (false positives), however 2 of these cases showed asymptomatic infarction. Five patients with new hemisyndrome and 1 comatose patient did not show significant SSEP/MEP alterations (false negatives). Overall sensitivity of SSEP/MEP monitoring was 45.5%, specificity 89.8%, positive predictive value 27.8%, and negative predictive value 95.0%. CONCLUSIONS The assumed positive impact of introducing SSEP/MEP monitoring on overall neurological outcome in ECUIA did not reach significance. This study suggests that from a medicolegal point of view, IOM is not stringently required in all neurovascular procedures. However, future studies should carefully address high-risk patients with complex procedures who might benefit more clearly from IOM than others.
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Affiliation(s)
| | | | - Franziska Dorn
- 2Neuroradiology, Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany
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MacDonald D, Dong C, Quatrale R, Sala F, Skinner S, Soto F, Szelényi A. Recommendations of the International Society of Intraoperative Neurophysiology for intraoperative somatosensory evoked potentials. Clin Neurophysiol 2019; 130:161-179. [DOI: 10.1016/j.clinph.2018.10.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/27/2018] [Accepted: 10/21/2018] [Indexed: 11/25/2022]
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Opciones de monitorización neurofisiológica en la resección de tumoraciones cerebrales. Documento de consenso entre el Grupo de Trabajo de Neurooncología de la Sociedad Española de Neurocirugía (SENEC) y la Sociedad Española de Neurofisiología Clínica (SENFC). Neurocirugia (Astur) 2018; 29:25-38. [DOI: 10.1016/j.neucir.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 11/23/2022]
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Abalkhail TM, MacDonald DB, AlThubaiti I, AlOtaibi FA, Stigsby B, Mokeem AA, AlHamoud IA, Hassounah MI, Baz SM, AlSemari A, AlDhalaan HM, Khan S. Intraoperative direct cortical stimulation motor evoked potentials: Stimulus parameter recommendations based on rheobase and chronaxie. Clin Neurophysiol 2017; 128:2300-2308. [PMID: 29035822 DOI: 10.1016/j.clinph.2017.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/04/2017] [Accepted: 09/19/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine optimal interstimulus interval (ISI) and pulse duration (D) for direct cortical stimulation (DCS) motor evoked potentials (MEPs) based on rheobase and chronaxie derived with two techniques. METHODS In 20 patients under propofol/remifentanil anesthesia, 5-pulse DCS thenar MEP rheobase and chronaxie with 2, 3, 4 and 5ms ISI were measured by linear regression of five charge thresholds at 0.05, 0.1, 0.2, 0.5 and 1msD, and estimated from two charge thresholds at 0.1 and 1msD using simple arithmetic. Optimal parameters were defined by minimum threshold energy: the ISI with lowest rheobase2×chronaxie, and D at its chronaxie. Near-optimal was defined as threshold energy <25% above minimum. RESULTS The optimal ISI was 3 or 4 (n=7 each), 2 (n=4), or 5ms (n=2), but only 4ms was always either optimal or near-optimal. The optimal D was ∼0.2 (n=12), ∼0.1 (n=7) or ∼0.3ms (n=1). Two-point estimates closely approximated five-point measurements. CONCLUSIONS Optimal ISI/D varies, with 4ms/0.2ms being most consistently optimal or near-optimal. Two-point estimation is sufficiently accurate. SIGNIFICANCE The results endorse 4ms ISI and 0.2msD for general use. Two-point estimation could enable quick individual optimization.
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Affiliation(s)
- Tariq M Abalkhail
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center (KFSH), Saudi Arabia
| | - David B MacDonald
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center (KFSH), Saudi Arabia.
| | - Ibrahim AlThubaiti
- Section of Neurosurgery, Department of Neurosciences, KFSH, Saudi Arabia
| | - Faisal A AlOtaibi
- Section of Neurosurgery, Department of Neurosciences, KFSH, Saudi Arabia
| | - Bent Stigsby
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center (KFSH), Saudi Arabia
| | - Amal A Mokeem
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center (KFSH), Saudi Arabia
| | - Iftetah A AlHamoud
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center (KFSH), Saudi Arabia
| | - Maher I Hassounah
- Section of Neurosurgery, Department of Neurosciences, KFSH, Saudi Arabia
| | - Salah M Baz
- Section of Neurology, Department of Neurosciences, KFSH, Saudi Arabia
| | | | - Hesham M AlDhalaan
- Section of Pediatric Neurology, Department of Neurosciences, KFSH, Saudi Arabia
| | - Sameena Khan
- Section of Pediatric Neurology, Department of Neurosciences, KFSH, Saudi Arabia
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Karakis I, Leeman-Markowski BA, Leveroni CL, Kilbride RD, Cash SS, Eskandar EN, Simon MV. Intra-stimulation discharges: An overlooked cortical electrographic entity triggered by direct electrical stimulation. Clin Neurophysiol 2015; 126:882-8. [DOI: 10.1016/j.clinph.2014.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/28/2014] [Accepted: 08/14/2014] [Indexed: 11/17/2022]
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Radmanesh A, Zamani AA, Whalen S, Tie Y, Suarez RO, Golby AJ. Comparison of seeding methods for visualization of the corticospinal tracts using single tensor tractography. Clin Neurol Neurosurg 2014; 129:44-9. [PMID: 25532134 DOI: 10.1016/j.clineuro.2014.11.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/24/2014] [Accepted: 11/28/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To compare five different seeding methods to delineate hand, foot, and lip components of the corticospinal tract (CST) using single tensor tractography. METHODS We studied five healthy subjects and 10 brain tumor patients. For each subject, we used five different seeding methods, from (1) cerebral peduncle (CP), (2) posterior limb of the internal capsule (PLIC), (3) white matter subjacent to functional MRI activations (fMRI), (4) whole brain and then selecting the fibers that pass through both fMRI and CP (WBF-CP), and (5) whole brain and then selecting the fibers that pass through both fMRI and PLIC (WBF-PLIC). Two blinded neuroradiologists rated delineations as anatomically successful or unsuccessful tractography. The proportions of successful trials from different methods were compared by Fisher's exact test. RESULTS To delineate hand motor tract, seeding through fMRI activation areas was more effective than through CP (p<0.01), but not significantly different from PLIC (p>0.1). WBF-CP delineated hand motor tracts in a larger proportion of trials than CP alone (p<0.05). Similarly, WBF-PLIC depicted hand motor tracts in a larger proportion of trials than PLIC alone (p<0.01). Foot motor tracts were delineated in all trials by either PLIC or whole brain seeding (WBF-CP and WBF-PLIC). Seeding from CP or fMRI activation resulted in foot motor tract visualization in 87% of the trials (95% confidence interval: 60-98%). The lip motor tracts were delineated only by WBF-PLIC and in 36% of trials (95% confidence interval: 11-69%). CONCLUSIONS Whole brain seeding and then selecting the tracts that pass through two anatomically relevant ROIs can delineate more plausible hand and lip motor tracts than seeding from a single ROI. Foot motor tracts can be successfully delineated regardless of the seeding method used.
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Affiliation(s)
- Alireza Radmanesh
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston 02115, USA.
| | - Amir A Zamani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston 02115, USA
| | - Stephen Whalen
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston 02115, USA
| | - Yanmei Tie
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston 02115, USA
| | - Ralph O Suarez
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston 02115, USA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston 02115, USA
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