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J Neurol Surg A Cent Eur Neurosurg 2020; 81(02): 105-110
DOI: 10.1055/s-0039-1698384
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Continuous Dynamic Mapping to Identify the Corticospinal Tract in Motor Eloquent Brain Tumors: An Update

Kathleen Seidel 
1   Inselspital Bern University Hospital – Neurosurgery, Bern, Switzerland
,
Philippe Schucht
1   Inselspital Bern University Hospital – Neurosurgery, Bern, Switzerland
,
Jürgen Beck
1   Inselspital Bern University Hospital – Neurosurgery, Bern, Switzerland
2   University of Freiburg – Neurosurgery, Freiburg, Germany
,
Andreas Raabe
1   Inselspital Bern University Hospital – Neurosurgery, Bern, Switzerland
› Institutsangaben
Weitere Informationen

Publikationsverlauf

18. Dezember 2018

26. März 2019

Publikationsdatum:
14. Januar 2020 (online)

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Abstract

Objective We recently developed a new subcortical mapping technique based on the concept of stimulating the tissue at the site of and synchronously with resection. Our hypothesis was that instead of performing resection and mapping sequentially, a synchronized resection and mapping could potentially improve deficit rates.

Methods We report our 5-year series of patients who prospectively underwent tumor surgery adjacent to the corticospinal tract (CST) (defined as < 1 cm using diffusion tension imaging and fiber tracking) with simultaneous subcortical short train cathodal monopolar mapping, equipped with a new acoustic motor evoked potential (MEP) alarm. Continuous (temporal coverage) and dynamic (spatial coverage) mapping was realized technically by integrating the mapping probe at the tip of a new suction device. Motor function was assessed using the Medical Research Council scale (from M1 to M5) 1 day after surgery, at discharge, and at 3 months.

Results Technically, the method was successful in all 182 cases. The lowest individual motor thresholds reached during resection were > 10 mA, n = 56; 6–10 mA, n = 31; 4–5 mA, n = 37; and 1–3 mA, n = 58. At 3 months, six patients (3%) had a persisting postoperative motor deficit that was caused by direct mechanical injury in three of these patients (1.7%).

Conclusions Continuous dynamic mapping was found to be a feasible and ergonomic technique for localizing the exact site of the CST and distance to the motor fibers. This new technique may improve the safety of motor eloquent tumor surgery.

Keywords

corticospinal tract - electrical stimulation - intraoperative neuromonitoring - motor evoked potential - subcortical mapping
 

  • References

  • 1 Chang EF, Clark A, Smith JS. , et al. Functional mapping-guided resection of low-grade gliomas in eloquent areas of the brain: improvement of long-term survival. Clinical article. J Neurosurg 2011; 114 (03) 566-573
    CrossrefPubMedGoogle Scholar
  • 2 De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol 2012; 30 (20) 2559-2565
    CrossrefPubMedGoogle Scholar
  • 3 Raabe A, Beck J, Schucht P, Seidel K. Continuous dynamic mapping of the corticospinal tract during surgery of motor eloquent brain tumors: evaluation of a new method. J Neurosurg 2014; 120 (05) 1015-1024
    CrossrefPubMedGoogle Scholar
  • 4 Bello L, Riva M, Fava E. , et al. Tailoring neurophysiological strategies with clinical context enhances resection and safety and expands indications in gliomas involving motor pathways. Neuro Oncol 2014; 16 (08) 1110-1128
    CrossrefPubMedGoogle Scholar
  • 5 Sala F, Lanteri P. Brain surgery in motor areas: the invaluable assistance of intraoperative neurophysiological monitoring. J Neurosurg Sci 2003; 47 (02) 79-88
    PubMedGoogle Scholar
  • 6 Seidel K, Beck J, Stieglitz L, Schucht P, Raabe A. The warning-sign hierarchy between quantitative subcortical motor mapping and continuous motor evoked potential monitoring during resection of supratentorial brain tumors. J Neurosurg 2013; 118 (02) 287-296
    CrossrefPubMedGoogle Scholar
  • 7 Smith JS, Chang EF, Lamborn KR. , et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 2008; 26 (08) 1338-1345
    CrossrefPubMedGoogle Scholar
  • 8 Stummer W, Reulen HJ, Meinel T. , et al; ALA-Glioma Study Group. Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery 2008; 62 (03) 564-576 ; discussion 564–576
    CrossrefPubMedGoogle Scholar
  • 9 Senft C, Bink A, Franz K, Vatter H, Gasser T, Seifert V. Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol 2011; 12 (11) 997-1003
    CrossrefPubMedGoogle Scholar
  • 10 Sanai N, Snyder LA, Honea NJ. , et al. Intraoperative confocal microscopy in the visualization of 5-aminolevulinic acid fluorescence in low-grade gliomas. J Neurosurg 2011; 115 (04) 740-748
    CrossrefPubMedGoogle Scholar
  • 11 McGirt MJ, Chaichana KL, Gathinji M. , et al. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 2009; 110 (01) 156-162
    CrossrefPubMedGoogle Scholar
  • 12 McGirt MJ, Chaichana KL, Attenello FJ. , et al. Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery 2008; 63 (04) 700-707 ; author reply 707–708
    CrossrefPubMedGoogle Scholar
  • 13 Lacroix M, Abi-Said D, Fourney DR. , et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 2001; 95 (02) 190-198
    CrossrefPubMedGoogle Scholar
  • 14 Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ. ; ALA-Glioma Study Group. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 2006; 7 (05) 392-401
    CrossrefPubMedGoogle Scholar
  • 15 Jakola AS, Myrmel KS, Kloster R. , et al. Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. JAMA 2012; 308 (18) 1881-1888
    CrossrefPubMedGoogle Scholar
  • 16 Sanai N, Polley MY, McDermott MW, Parsa AT, Berger MS. An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 2011; 115 (01) 3-8
    CrossrefPubMedGoogle Scholar
  • 17 Schucht P, Knittel S, Slotboom J. , et al. 5-ALA complete resections go beyond MR contrast enhancement: shift corrected volumetric analysis of the extent of resection in surgery for glioblastoma. Acta Neurochir (Wien) 2014; 156 (02) 305-312 ; discussion 312
    CrossrefPubMedGoogle Scholar
  • 18 Salvati M, Pichierri A, Piccirilli M. , et al. Extent of tumor removal and molecular markers in cerebral glioblastoma: a combined prognostic factors study in a surgical series of 105 patients. J Neurosurg 2012; 117 (02) 204-211
    CrossrefPubMedGoogle Scholar
  • 19 Schucht P, Seidel K, Beck J. , et al. Intraoperative monopolar mapping during 5-ALA-guided resections of glioblastomas adjacent to motor eloquent areas: evaluation of resection rates and neurological outcome. Neurosurg Focus 2014; 37 (06) E16
    PubMedGoogle Scholar
  • 20 Seidel K, Beck J, Stieglitz L, Schucht P, Raabe A. Low-threshold monopolar motor mapping for resection of primary motor cortex tumors. Neurosurgery 2012; 71 (1 Suppl Operative ): 104-114 ; discussion 114–115
    PubMedGoogle Scholar
  • 21 Seidel K, Beck J, Stieglitz L. , et al. The warning-sign hierarchy between quantitative subcortical motor mapping and continuous motor evoked potential monitoring during resection of supratentorial brain tumors. J Neurosurg 2013; 118 (02) 287-296
    CrossrefPubMedGoogle Scholar
  • 22 Deletis V, Fernández-Conejero I. Intraoperative monitoring and mapping of the functional integrity of the brainstem. J Clin Neurol 2016; 12 (03) 262-273
    CrossrefPubMedGoogle Scholar
  • 23 Taniguchi M, Cedzich C, Schramm J. Modification of cortical stimulation for motor evoked potentials under general anesthesia: technical description. Neurosurgery 1993; 32 (02) 219-226
    CrossrefPubMedGoogle Scholar
  • 24 Deletis V, Rodi Z, Amassian VE. Neurophysiological mechanisms underlying motor evoked potentials in anesthetized humans. Part 2. Relationship between epidurally and muscle recorded MEPs in man. Clin Neurophysiol 2001; 112 (03) 445-452
    CrossrefPubMedGoogle Scholar
  • 25 Szelényi A, Senft C, Jardan M. , et al. Intra-operative subcortical electrical stimulation: a comparison of two methods. Clin Neurophysiol 2011; 122 (07) 1470-1475
    CrossrefPubMedGoogle Scholar
  • 26 Macdonald DB, Skinner S, Shils J, Yingling C. ; American Society of Neurophysiological Monitoring. Intraoperative motor evoked potential monitoring—a position statement by the American Society of Neurophysiological Monitoring. Clin Neurophysiol 2013; 124 (12) 2291-2316
    CrossrefPubMedGoogle Scholar
  • 27 Deletis V, Isgum V, Amassian VE. Neurophysiological mechanisms underlying motor evoked potentials in anesthetized humans. Part 1. Recovery time of corticospinal tract direct waves elicited by pairs of transcranial electrical stimuli. Clin Neurophysiol 2001; 112 (03) 438-444
    CrossrefPubMedGoogle Scholar
  • 28 Kombos T, Suess O, Kern BC. , et al. Comparison between monopolar and bipolar electrical stimulation of the motor cortex. Acta Neurochir (Wien) 1999; 141 (12) 1295-1301
    CrossrefPubMedGoogle Scholar
  • 29 Suess O, Kombos T, Hoell T, Baur S, Pietilae T, Brock M. A new cortical electrode for neuronavigation-guided intraoperative neurophysiological monitoring: technical note. Acta Neurochir (Wien) 2000; 142 (03) 329-332
    CrossrefPubMedGoogle Scholar
  • 30 Landazuri P, Eccher M. Simultaneous direct cortical motor evoked potential monitoring and subcortical mapping for motor pathway preservation during brain tumor surgery: is it useful?. J Clin Neurophysiol 2013; 30 (06) 623-625
    CrossrefPubMedGoogle Scholar
  • 31 Kamada K, Todo T, Ota T. , et al. The motor-evoked potential threshold evaluated by tractography and electrical stimulation. J Neurosurg 2009; 111 (04) 785-795
    CrossrefPubMedGoogle Scholar
  • 32 Maesawa S, Fujii M, Nakahara N, Watanabe T, Wakabayashi T, Yoshida J. Intraoperative tractography and motor evoked potential (MEP) monitoring in surgery for gliomas around the corticospinal tract. World Neurosurg 2010; 74 (01) 153-161
    CrossrefPubMedGoogle Scholar
  • 33 Nossek E, Korn A, Shahar T. , et al. Intraoperative mapping and monitoring of the corticospinal tracts with neurophysiological assessment and 3-dimensional ultrasonography-based navigation. Clinical article. J Neurosurg 2011; 114 (03) 738-746
    CrossrefPubMedGoogle Scholar
  • 34 Prabhu SS, Gasco J, Tummala S, Weinberg JS, Rao G. Intraoperative magnetic resonance imaging-guided tractography with integrated monopolar subcortical functional mapping for resection of brain tumors. Clinical article. J Neurosurg 2011; 114 (03) 719-726
    CrossrefPubMedGoogle Scholar
  • 35 Ohue S, Kohno S, Inoue A. , et al. Accuracy of diffusion tensor magnetic resonance imaging-based tractography for surgery of gliomas near the pyramidal tract: a significant correlation between subcortical electrical stimulation and postoperative tractography. Neurosurgery 2012; 70 (02) 283-293 ; discussion 294
    CrossrefPubMedGoogle Scholar
  • 36 Shiban E, Krieg SM, Haller B. , et al. Intraoperative subcortical motor evoked potential stimulation: how close is the corticospinal tract?. J Neurosurg 2015; 123 (03) 711-720
    CrossrefPubMedGoogle Scholar
  • 37 Schucht P, Seidel K, Murek M. , et al. Low-threshold monopolar motor mapping for resection of lesions in motor eloquent areas in children and adolescents. J Neurosurg Pediatr 2014; 13 (05) 572-578
    CrossrefPubMedGoogle Scholar
  • 38 Plans G, Fernández-Conejero I, Rifà-Ros X, Fernández-Coello A, Rosselló A, Gabarrós A. Evaluation of the high-frequency monopolar stimulation technique for mapping and monitoring the corticospinal tract in patients with supratentorial gliomas. a proposal for intraoperative management based on neurophysiological data analysis in a series of 92 patients. Neurosurgery 2017; 81 (04) 585-594
    PubMedGoogle Scholar
  • 39 Sanmillan JL, Fernández-Coello A, Fernández-Conejero I, Plans G, Gabarrós A. Functional approach using intraoperative brain mapping and neurophysiological monitoring for the surgical treatment of brain metastases in the central region. J Neurosurg 2017; 126 (03) 698-707
    CrossrefPubMedGoogle Scholar
  • 40 Moiyadi A, Velayutham P, Shetty P. , et al. Combined motor evoked potential monitoring and subcortical dynamic mapping in motor eloquent tumors allows safer and extended resections. World Neurosurg 2018; 120: e259-e268
    CrossrefPubMedGoogle Scholar