Intra-operative micro-electrode recording in functional neurosurgery: Past, present, future

Area of Science:

• Neurosurgery
• Neurology
• Medical Technology

Background:

• Functional neurosurgery has evolved significantly over 75 years, with Micro-electrode recording (MER) playing a crucial role.
• Advancements in intra-operative MRI have raised questions about the continued utility of MER.

Purpose of the Study:

• To critically review current controversies surrounding the utility of MER in functional neurosurgery.
• To discuss the evolution of neuroimaging and its impact on deep brain stimulation.
• To review technical advances and future directions in the field.

Main Methods:

• Comprehensive review of the English literature.
• Simplified explanation of the Micro-electrode recording (MER) technique.
• Summary of results from existing meta-analyses on MER controversies.

Main Results:

• MER remains useful for addressing brain shift, mapping new targets, ablative surgeries, and in centers lacking intra-operative imaging.
• While functional neurosurgery is generally safe, MER carries risks like hemorrhage and infection.
• Improved MRI modalities enhance target delineation, potentially reducing MER's routine use.

Conclusions:

• MER's importance as a routine procedure may decrease, but it may persist as a gold standard in functional neurosurgery.
• Prospective studies to definitively determine MER's utility are currently challenging.
• MER's role is context-dependent, especially in centers with limited advanced imaging capabilities.