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Published on: March 31, 2016
Cortico-cortical and subcortico-cortical evoked potentials during general anesthesia
Caterina Mollica1, Colette Boëx2, Karl Schaller2
1Department of Neurosurgery, University Hospitals of Geneva (HUG), Geneva, Switzerland.
Summary
Cortico-cortical evoked potentials (CCEPs) and subcortico-cortical evoked potentials (SCEPs) are feasible for monitoring brain pathways during general anesthesia. These techniques help preserve neurological function by assessing tract integrity and proximity during neurosurgery.
Area of Science:
- Neurosurgery
- Neurophysiology
- Medical Technology
Background:
- Gross total and supramarginal resections in brain tumor surgery aim to maximize survival while preserving neurological function.
- Cortico-cortical evoked potentials (CCEPs) were developed for intraoperative mapping of language pathways during awake surgery but are now being adapted for asleep procedures.
- The application of CCEPs and subcortico-cortical evoked potentials (SCEPs) during general anesthesia requires further investigation.
Purpose of the Study:
- To review the current literature on the use of CCEPs and SCEPs in brain surgery performed under general anesthesia.
- To assess the feasibility and roles of CCEPs and SCEPs in monitoring eloquent cognitive functions during neurosurgery.
- To evaluate the effectiveness of these techniques in maintaining neurological integrity.
Main Methods:
- A systematic literature review was conducted following PRISMA guidelines.
- Searches were performed in PubMed, Cochrane Library, Web of Science, and Google Scholar for studies published up to March 2025.
- Studies involving CCEPs and SCEPs during general anesthesia for brain surgery were included and analyzed.
Main Results:
- The review identified 19 relevant studies, with most focusing on language pathways (arcuate fasciculus) and some on visual pathways.
- Both CCEPs and SCEPs were investigated, with fifteen studies reporting CCEPs and seven reporting SCEPs.
- Single electrical pulse stimulation (SPES) was commonly used, with recordings typically made from subdural electrodes. N1 peak latencies were site-dependent, and N2 peaks were not detected under general anesthesia.
Conclusions:
- CCEPs and SCEPs are feasible and valuable tools for neurosurgery performed under general anesthesia.
- CCEPs are effective for monitoring the integrity of neural tracts, while SCEPs aid in detecting their proximity to surgical sites.
- These evoked potential techniques show significant promise for safeguarding eloquent cognitive functions at risk during neurosurgical procedures.
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