Introduction. Supplementary motor area (SMA) syndrome is a symptom complex resulting from damage to the premotor cortex and it’s subcortical projection. There is no generally accepted protocol for functional mapping of SMA during neurosurgical intervention in this area.The objective of the publication is to present a review of the literature and clinical cases from practice that describes the treatment of two patients with glioblastomas in the posterior regions of the superior frontal gyrus with IOM. Given the localization of the tumor in the dominant hemisphere, one operation was performed with awakening, the other according to the protocol of total intravenous anesthesia with mapping of only motor representative areas.Clinical cases. In both cases, during intraoperative direct electrical stimulation of the cortex subjected to resection, evoked motor responses were not recorded. The modalities used made it possible to continuously evaluate the viability of the cortico‑spinal tract. During the surgery with awakening, episodes of an instantaneous termination of the initia‑ tion of speech and counter directional movements in the arm were recorded – in the subcortical projection of the SMA at a current strength of 1–2 mA. Both patients in the early postoperative period showed the development of a gross transient neurological deficit in the form of hemiparesis and sensorimotor aphasia, which was a manifestation of pos‑ tresection SMA syndrome. During the follow‑up (control) examination 6–7 months after the operation, the following was observed in the clinical picture: mild hemiparesis up to 4–5 points, impaired bimanual coordination; difficulty the ini‑ tiation of speech spontaneous speech.Conclusion. When mapping the cortex and subcortical structures, the localization of SMA can be assumed in the event of a negative motor response of the cerebral cortex using the protocol of low‑frequency 1 Hz stimulation under EcoG control. Standardization of the SMA mapping protocol would be useful in clinical practice for determining the bounda
Introduction. Transcranial electrical stimulation is a neurophysiological method that is used intraoperatively for evaluating the conduct of a nerve impulse through the cortical-spinal tract. However, the results obtained during registration of this modality do not always correlate with the neurological status of the patient after surgery. The purpose of the study is to determine the prognostic significance of motor evoked potentials in surgical interventions for the elimination of spinal stenosis at the cervical level. Materials and methods. The study analyzed the results of 20 microsurgical root decompressions at the cervical level by eliminating spinal stenosis. Surgical interventions were performed in the neurosurgical Department of National medical and surgical center named after N.I. Pirogov from august 2018 to march 2019. Intraoperatively there were used the following modalities: motor evoked potentials, 3-channel registration of somatosensory evoked potentials from the median nerves, 8-channel electroencephalography, and train-of-four monitoring. The patients were divided into 2 groups: in the 1st group was used inhalant anesthetics, in the 2nd the anesthesia was conducted according to the protocol “Total intravenous anesthesia”. Results. Within each group, in a number of cases, there was a decrease in the response amplitude (by 80 % or more), as well as a loss of motor evoked potentials. In the “Total intravenous anesthesia” group, the current stimulation forces used to obtain motor evoked potentials did not exceed 150 mA, while in the group of inhaled anesthetics, the maximum value was 300 mA, and the average value was 170 mA. In the “Total intravenous anesthesia” group, in 2 cases, a loss of response from one myotome at the decompression phase was registered without recovery during intraoperation monitoring, in 2 cases there was the amplitude loss by 80 % or more with subsequent recovery. In the “Total intravenous anesthesia” group, the results were comparable. Conclusion. During neurophysiological monitoring in surgeries at the cervical level, the loss of motor evoked potentials from one myotome, as well as a decrease the response amplitude by 80 % or more are doubtful as a criteria for predicting neurological deficit.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.