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Direct electrical bipolar electrostimulation for functional cortical and subcortical cerebral mapping in awake
J Pallud1, O Rigaux-Viode1, R Corns2
1Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
Neuro-Chirurgie
|February 7, 2017
Summary
Direct electrical brain mapping during glioma surgery precisely identifies critical functional areas. This awake mapping technique optimizes tumor resection while preserving neurological function, improving patient outcomes.
Area of Science:
- Neurosurgery
- Neuro-oncology
- Anesthesiology
Background:
- Gliomas often infiltrate eloquent brain areas, necessitating precise surgical planning.
- Individual patient anatomy and function vary, requiring personalized surgical approaches.
- Intraoperative functional mapping is crucial for optimizing the benefit-to-risk ratio in glioma surgery.
Purpose of the Study:
- To describe the rationale, indications, and practical aspects of awake intraoperative direct electrical bipolar electrostimulation for cerebral gliomas.
- To detail the asleep-awake-asleep anesthetic protocol and surgical strategy for functional mapping.
- To provide insights into operative approach, patient positioning, and resection strategies.
Main Methods:
- Utilizing direct electrical bipolar electrostimulation for cortical and subcortical mapping in awake patients.
- Employing the asleep-awake-asleep anesthetic technique during cerebral glioma resection.
- Standardized protocol involving neurosurgery and anesthesiology teams.
Main Results:
- Real-time assessment of individual cortical functional organization.
- Mapping of anatomofunctional subcortical connectivity during resection.
- Tailoring tumor resection based on individual corticosubcortical functional boundaries.
- Demonstrated as an easy, accurate, reliable, well-tolerated, and safe detection technique.
Conclusions:
- Intraoperative direct electrical bipolar electrostimulation is the gold standard for brain mapping in neuro-oncology.
- This technique enables safe and effective resection of cerebral gliomas near eloquent areas.
- It facilitates personalized surgical strategies by defining critical functional boundaries.
