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Related Experiment Video

Updated: Jul 2, 2026

A Standardized Protocol for Functional Motor Mapping Using Navigated Transcranial Magnetic Stimulation

A Standardized Protocol for Functional Motor Mapping Using Navigated Transcranial Magnetic Stimulation

Published on: February 27, 2026

Isocitrate Dehydrogenase-1 Mutation Status and Dynamic Subcortical Motor Mapping Using Ultrasonic Aspirator

Assaf Berger^1,2, Segev Gabay¹, Ido Strauss¹

¹Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Operative Neurosurgery (Hagerstown, Md.)

|July 1, 2026

Summary

This summary is machine-generated.

Isocitrate dehydrogenase-1 (IDH1) mutation status impacts subcortical motor mapping reliability. Distance-based thresholds are more accurate for IDH1-mutant tumors, unlike IDH1-wildtype tumors, due to brain shift.

Keywords:

Brain shift Continuous subcortical cortical motor-evoked potential Corticospinal tract Diffusion tensor imaging Glioma Intraoperative monitoring

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Area of Science:

Neurosurgery
Neurophysiology
Neuro-oncology

Background:

Continuous subcortical stimulation during tumor resection offers real-time feedback.
Interpreting distance-based subcortical motor-evoked potential (scMEP) thresholds can be limited.
The influence of IDH1 mutation on scMEP thresholds relative to tumor- corticospinal tract (CST) distance is not fully understood.

Purpose of the Study:

To compare continuous dynamic cavitron ultrasonic surgical aspirator (CUSA) stimulation with stationary ball-tip stimulation.
To investigate if IDH1 mutation status alters the relationship between preoperative tumor-CST distance and intraoperative minimum scMEP thresholds.

Main Methods:

Retrospective analysis of 425 patients with intra-axial tumors near the CST.
Measurement of shortest tumor-CST distance using diffusion tensor imaging (DTI) tractography.
Recording minimum scMEP thresholds using CUSA or ball-tip stimulation in 187 patients with gross total resection.

Main Results:

Tumor-CST distance correlated with scMEP thresholds, with stronger correlation in IDH1-mutant tumors (r=0.55) than IDH1-wildtype (r=0.35).
CUSA and ball-tip stimulation showed comparable distance-to-threshold behavior (P=.24).
IDH1 mutation status significantly modified the distance-to-threshold relationship (interaction P=.03).

Conclusions:

IDH1 mutation status influences the interpretability of distance-based subcortical motor mapping.
Distance-based scMEP thresholds are more reliable in IDH1-mutant tumors.
Increased variability in IDH1-wildtype tumors may be due to brain shift, supporting biologically informed electrophysiological approaches.