Safety and Efficacy of Motor Mapping Utilizing Short Pulse Train Direct Cortical Stimulation
Safety and Efficacy of Motor Mapping Utilizing Short Pulse Train Direct Cortical Stimulation
复制标题
DOI：
10.1159/000350020
复制
发表时间：
2013-01-01
影响因子：
1.7
通讯作者：
Chang, Edward F.
中科院分区：
文献类型：
--
作者：
Tate, Matthew C.;Guo, LanJun;Chang, Edward F.
背景/目标：颅内手术的一个主要目标是最大限度地切除，同时最大限度地减少神经系统的发病率，特别是运动功能障碍。直接皮层刺激（DCS）是一种常见的术中辅助手段，用于识别功能性运动皮层。在这项研究中，我们报告了短脉冲串DCS（直接皮层刺激运动诱发电位，dcMEP）用于颅内手术期间运动标测和监测的安全性/有效性。方法：回顾性分析29例因运动皮质附近病变而接受择期开颅手术的患者。dcMEP标测（40-120 V，500- 1，000 Hz，5-9脉冲/s，1- 3 ms刺激间期，单极，50 μ s脉冲宽度）单独进行（n = 29）或与标准DCS一起进行（n = 6）。结果指标为阳性MEP和刺激期间癫痫发作的存在。还进行了基于dcMEP的连续皮质脊髓束（CST）监测。记录刺激阈值的变化和术后新发神经功能缺损。结果：dcMEP标测成功率为96%，不受术前运动状态的影响。术中dcMEP癫痫发作率为3%，与术前癫痫发作状态无关。CST监测成功率为96%，刺激阈值的变化可预测新的永久性运动缺陷。结论：dcMEP是一种有效的方法映射运动功能，并可能被证明是有用的连续CST监测。(C)2013 S. Karger AG，巴塞尔
Background/Aims: A major goal of intracranial surgery is to maximize resection while minimizing neurological morbidity, particularly motor dysfunction. Direct cortical stimulation (DCS) is a common intraoperative adjunct used to identify functional motor cortex. In this study, we report on the safety/efficacy of short pulse train DCS (direct cortical stimulation motor-evoked potential, dcMEP) for motor mapping and monitoring during intracranial surgery. Methods: A retrospective analysis of 29 patients undergoing elective craniotomy for lesions near the motor cortex was performed. dcMEP mapping (40-120 V, 500-1,000 Hz, 5-9 pulses/s, 1- to 3-ms interstimulus interval, monopolar, 50-mu s pulse width) was performed either alone (n = 29) or in addition to standard DCS (n = 6). Outcome measures were positive MEPs and the presence of seizures during stimulation. dcMEP-based continuous corticospinal tract (CST) monitoring was also performed. Changes in stimulation threshold and new postoperative neurological deficits were recorded. Results: dcMEP mapping success was 96% and was not affected by preoperative motor status. Intraoperative seizure rates for dcMEP were 3% and were not related to preoperative seizure status. CST monitoring success rate was 96%, and changes in stimulation threshold were predictive of new permanent motor deficits. Conclusions: dcMEP is an effective method for mapping motor function and may prove useful for continuous CST monitoring. (C) 2013 S. Karger AG, Basel