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Related Concept Videos

Somatosensation01:33

Somatosensation

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The somatosensory system relays sensory information from the skin, mucous membranes, limbs, and joints. Somatosensation is more familiarly known as the sense of touch. A typical somatosensory pathway includes three types of long neurons: primary, secondary, and tertiary. Primary neurons have cell bodies located near the spinal cord in groups of neurons called dorsal root ganglia. The sensory neurons of ganglia innervate designated areas of skin called dermatomes.
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Direct brainstem somatosensory evoked potentials for cavernous malformations.

Scheherazade Le1, Viet Nguyen1, Leslie Lee1

  • 11Department of Neurology, Division of Neurophysiology & Intraoperative Neuromonitoring (IONM), Stanford University School of Medicine; and.

Journal of Neurosurgery
|November 5, 2021
PubMed
Summary

This study introduces a new method using direct brainstem somatosensory evoked potentials (SSEPs) for intraoperative mapping during cavernous malformation surgery. The technique helps surgeons identify safe pathways, potentially reducing postoperative sensory deficits.

Keywords:
direct brainstem somatosensory evoked potentialsfunctional brainstem mappingneuromonitoringsurgical techniquevascular disorders

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Area of Science:

  • Neurosurgery
  • Neurophysiology
  • Neurology

Background:

  • Brainstem cavernous malformations (CMs) pose surgical challenges due to hemorrhage risk and neurological deficits.
  • Aggressive natural history necessitates effective surgical resection strategies.

Purpose of the Study:

  • To report a novel intraoperative neuromonitoring technique using direct brainstem somatosensory evoked potentials (SSEPs).
  • To assess the feasibility of SSEPs for functional mapping to guide brainstem CM surgery and minimize sensory deficits.

Main Methods:

  • Intraoperative direct brainstem stimulation of somatosensory pathways in 11 patients with CMs (2013-2019).
  • Identification of critical sensory structures and safe surgical corridors.
  • Recording of SSEPs from scalp electrodes following low-intensity stimulation (0.3-3.0 mA or V).

Main Results:

  • Brainstem SSEPs were successfully recorded and reproducible in 7 out of 11 cases.
  • Direct brainstem stimulation provided reliable SSEPs when peripheral nerve stimulation failed.
  • The technique aided in identifying safe incision sites for lesion resection.

Conclusions:

  • Direct brainstem SSEP recording is feasible at low stimulation intensities.
  • This technique aids neurosurgeons in clarifying anatomy and identifying safer surgical corridors.
  • The method shows potential for reducing postoperative neurological deficits and mapping other brainstem lesions.