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Vol. 91, No. 6, 2013
Issue release date: November 2013
Section title: Clinical Study
Stereotact Funct Neurosurg 2013;91:379-385
(DOI:10.1159/000350020)

Safety and Efficacy of Motor Mapping Utilizing Short Pulse Train Direct Cortical Stimulation

Tate M.C. · Guo L.J. · McEvoy J. · Chang E.F.
aDepartment of Neurological Surgery, University of California, San Francisco, and bCalifornia Neuromonitoring Services, San Francisco, Calif., USA

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Article / Publication Details

First-Page Preview
Abstract of Clinical Study

Received: 4/27/2012 6:04:55 PM
Accepted: 1/20/2013
Published online: 10/9/2013

Number of Print Pages: 7
Number of Figures: 4
Number of Tables: 4

ISSN: 1011-6125 (Print)
eISSN: 1423-0372 (Online)

For additional information: http://www.karger.com/SFN

Abstract

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-μs 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.


  

Author Contacts

Dr. Edward F. Chang
Department of Neurological Surgery
University of California, 505 Parnassus Ave, Room M779
San Francisco, CA 94143-0112 (USA)
E-Mail changed@neurosurg.ucsf.edu

  

Article Information

Received: April 27, 2012
Accepted after revision: January 20, 2013
Published online: October 9, 2013
Number of Print Pages : 7
Number of Figures : 4, Number of Tables : 4, Number of References : 21

  

Publication Details

Stereotactic and Functional Neurosurgery

Vol. 91, No. 6, Year 2013 (Cover Date: November 2013)

Journal Editor: Roberts D.W. (Lebanon, N.H.)
ISSN: 1011-6125 (Print), eISSN: 1423-0372 (Online)

For additional information: http://www.karger.com/SFN


Article / Publication Details

First-Page Preview
Abstract of Clinical Study

Received: 4/27/2012 6:04:55 PM
Accepted: 1/20/2013
Published online: 10/9/2013

Number of Print Pages: 7
Number of Figures: 4
Number of Tables: 4

ISSN: 1011-6125 (Print)
eISSN: 1423-0372 (Online)

For additional information: http://www.karger.com/SFN


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