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Intraoperative Subcortical Fiber Mapping with Subcortico-Cortical Evoked Potentials
Rei Enatsu1, Aya Kanno1, Shunya Ohtaki1
1Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
World Neurosurgery
|November 2, 2015
Summary
Subcortico-cortical evoked potentials (SCEP) effectively identify critical subcortical white matter tracts during brain surgery. This technique aids in preserving these fibers, enhancing surgical safety near eloquent brain areas.
Area of Science:
- Neurosurgery
- Neurophysiology
Background:
- Identifying subcortical white matter tracts during brain surgery is challenging due to a lack of clear anatomical landmarks.
- Accurate localization of these tracts is crucial for preventing neurological deficits.
Observation:
- Subcortico-cortical evoked potentials (SCEP) were utilized to map the pyramidal tract and arcuate fasciculus in seven patients undergoing brain surgery.
- Electrical stimulation of subcortical areas and recording of evoked potentials on the cortical surface were performed.
Findings:
- SCEP successfully identified target subcortical fibers when stimulation was within 15 mm.
- Stimulation beyond 20 mm did not elicit reliable cortical evoked potentials.
- Five patients experienced transient neurological worsening post-operatively, with complete recovery observed in all.
Implications:
- SCEP is a valuable tool for intraoperative identification and confirmation of subcortical fiber preservation.
- This technique can improve the efficacy and safety of resective surgeries in proximity to eloquent brain regions.
Keywords:
Arcuate fasciculusPyramidal tractSubcortical stimulationSubcortico-cortical evoked potential
