Comparison between monopolar and bipolar electrical stimulation of the motor cortex
Comparison between monopolar and bipolar electrical stimulation of the motor cortex
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DOI：
10.1007/s007010050433
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发表时间：
1999-01-01
影响因子：
2.4
通讯作者：
Brock, M
中科院分区：
文献类型：
--
作者：
Kombos, T;Suess, O;Brock, M
术中神经生理学技术允许可靠的识别感觉运动区，并使其解剖和功能保护可行。单极皮层刺激最近被描述为一种新的映射技术。在本研究中，将这种方法与“传统”双极刺激技术进行了比较。在35名患者的中央区手术期间进行了运动皮层的功能标测。通过体感诱发电位（SEP）时相反转确定中央沟（CS）。首先通过具有500 Hz（7-10个脉冲）序列的单极阳极刺激进行皮层运动标测，然后进行双极刺激（60 Hz的脉冲，最大值为10 Hz）。4秒列车持续时间）。手术在全身麻醉下进行，没有肌肉松弛剂。在双极皮层刺激引起的280个运动反应中，54.28% [152]位于初级运动皮层（PMC）。37.85% [106]位于次级运动皮层（SMC）运动带外，8% [22]位于CS后。在单极皮质刺激引起的175个运动反应中，68.57% [120]位于SMC中。SMC中为23.42% [41]，CS后为8% [14]。与一般临床观点相反，皮质区域上的初级运动单位有相当多的重叠，比沿着CS的“经典”狭窄运动带要宽得多。双极皮层刺激比单极更敏感，用于映射前运动额叶皮层的运动功能。这两种方法对于绘制初级运动皮层同样敏感。
Intra-operative neurophysiological techniques allow reliable identification of the sensorimotor region and make their anatomical and functional preservation feasible. Monopolar cortical stimulation has recently been described as a new mapping technique. In the present study this method was compared to the "traditional'' technique of bipolar stimulation.Functional mapping of the motor cortex was performed in 35 patients during surgery in the central region. The central sulcus (CS) was identified by somatosensory evoked potential (SEP) phase reversal. Cortical motor mapping was first performed by monopolar anodal stimulation with a train of 500 Hz (7-10 pulses) followed by bipolar stimulation (pulses at 60 Hz with max. 4 sec train duration). Surgery was performed under general anaesthesia without muscle relaxants. Of 280 motor responses elicited by bipolar cortical stimulation, 54.28% [152] were located in the primary motor cortex (PMC). 37.85% [106] outside the motor strip in the secondary motor cortex (SMC), and 8% [22] posterior to the CS. Of 175 motor responses elicited by monopolar cortical stimulation 68.57% [120] were located in the SMC. 23.42% [41] in the SMC and 8% [14] posterior to the CS.Contrary to the general clinical view, there is considerable overlapping of primary motor units over a cortical area much broader than the "classical" narrow motor strip along the CS. Bipolar cortical stimulation is more sensitive than monopolar for mapping motor function in the premotor frontal cortex. Both methods are equally sensitive for mapping the primary motor cortex.