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Related Experiment Video

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Identifying subcortical connectivity during brain tumor surgery: a multimodal study.

Fabien Almairac1,2, Petru Isan3,4,5, Marie Onno3

  • 1Neurosurgery Department, Pasteur 2 Hospital, University Hospital of Nice, 30 Avenue de La Voie Romaine, 06000, Nice, France. almairac.f@chu-nice.fr.

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|February 25, 2023
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Summary

Direct electrical stimulation (DES) is key for safe brain tumor removal. This study shows combining evoked potentials (EPs) with tractography can identify white matter tracts, aiding surgeons when DES isn't possible.

Keywords:
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Area of Science:

  • Neurosurgery
  • Neurophysiology
  • Medical Imaging

Background:

  • Bipolar direct electrical stimulation (DES) is the gold standard for mapping brain structures during awake craniotomy to maximize safe tumor resection.
  • Limitations exist for DES applicability in all patients, necessitating alternative intraoperative tools for subcortical connectivity identification.
  • Understanding the electrophysiological effects of stimulation on neural pathways is crucial for refining surgical techniques.

Purpose of the Study:

  • To evaluate the combined use of evoked potentials (EPs) and tractography for identifying white matter (WM) tracts functionally connected to DES sites.
  • To explore the electrophysiological characteristics of subcortical evoked potentials (SCEPs) elicited by bipolar stimulation.
  • To correlate electrophysiological, structural, and functional data for potential intraoperative applications.

Main Methods:

  • A pilot study included 12 patients undergoing awake craniotomy for brain tumor removal with pre-operative dMRI-based tractography.
  • Subcortical evoked potentials (SCEPs) were recorded during low-frequency (2 Hz) bipolar stimulation of identified functional white matter sites.
  • Electrophysiological parameters (delay, amplitude, propagation speed) and tractography metrics (streamline counts, lengths, fractional anisotropy) were analyzed and correlated.

Main Results:

  • SCEPs were successfully triggered in 11 out of 12 patients, indicating feasibility of the technique.
  • Stimulated fibers constituted a subpart of the total tract length, suggesting selective stimulation of specific neural pathways.
  • Significant correlations were found between electrophysiological and structural measures of the white matter tracts.

Conclusions:

  • The combination of evoked potentials and tractography shows promise as an intraoperative tool for identifying functionally relevant white matter tracts.
  • This approach may help surgeons achieve maximal safe tumor resection, especially in cases where standard DES is not feasible.
  • Findings suggest bipolar stimulation has a selective effect on brain networks, providing valuable insights into neural pathway engagement.