A New Device for Electrical Stimulation Mapping of the Brainstem and Spinal Cord

Duffau, Hugues; Lopes, M. Beatriz S.; Jp, Sichez; Bitar, Ahmad W.; Capelle, L

doi:10.1055/s-2003-37961

Cited by 17 publications

(12 citation statements)

References 7 publications

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“…36 More recently, ESM has also been used to identify critical subcortical white matter tracts. 9,10 In our study, ESM precisely delineated eloquent areas of the cortex in all patients. Other investigators have reported that the risk of transient language deficit is 36% and that of permanent deficit 0% when resection is limited to a distance of more than 1 cm from the nearest language site; with a margin of 0.7–1.0 cm, the risks of transient and permanent language deficit were 91 and 22%, respectively, and with a margin < 0.7 cm, the risks were 100 and 43%.…”

Section: Discussionsupporting

confidence: 51%

Cortical mapping and frameless stereotactic navigation in the high-field intraoperative magnetic resonance imaging suite

Weingarten¹,

Asthagiri²,

Butman

et al. 2009

JNS

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Frameless stereotactic neuronavigation provides tracking of surgical instruments on radiographic images and orients the surgeon to tumor margins at surgery. Bipolar electrical stimulation mapping (ESM) delineates safe limits for resection of brain tumors adjacent to eloquent cortex. These standard techniques could complement the capability of intraoperative MR (iMR) imaging to evaluate for occult residual disease during surgery and promote more complete tumor removal. The use of frameless neuronavigation in the high-field iMR imaging suite requires that a few pieces of standard equipment be replaced by nonferromagnetic instruments. Specific use of ESM in a high-field iMR imaging suite has not been reported in the literature. To study whether frameless neuronavigation and electrical stimulation mapping could be successfully integrated in the high-field iMR imaging suite, the authors employed these modalities in 10 consecutive cases involving patients undergoing conscious craniotomy for primary brain tumors located in or adjacent to eloquent cortices. Equipment included a custom high-field MR imaging–compatible head holder and dynamic reference frame attachment, a standard MR imaging–compatible dynamic reference frame, a standard MR imaging machine with a table top that could be translated to a pedestal outside the 5-gauss line for the operative intervention, and standard neuronavigational and cortical stimulation equipment. Both ESM and frameless stereotactic guidance were performed outside the 5-gauss line. The presence of residual neoplasm was evaluated using iMR imaging; resection was continued until eloquent areas were encountered or iMR imaging confirmed complete removal of any residual tumor. Mapping identified essential language (5 patients), sensory (6), and motor (7) areas. The combined use of frameless stereotactic navigation, ESM, and iMR imaging resulted in complete radiographic resection in 7 cases and resection to an eloquent margin in 3 cases. Postoperative MR imaging confirmed final iMR imaging findings. No patient experienced a permanent new neurological deficit. Familiar techniques such as frameless navigation and ESM can be rapidly, inexpensively, safely, and effectively integrated into the high-field iMR imaging suite.

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Section: Discussionsupporting

confidence: 51%

Cortical mapping and frameless stereotactic navigation in the high-field intraoperative magnetic resonance imaging suite

Weingarten¹,

Asthagiri²,

Butman

et al. 2009

JNS

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“…The benefits of motor tract mapping during brainstem surgery have been described, in particular if the approach exposes the cerebral peduncle 15 37. It is important to understand the difference between mapping methods and true monitoring techniques such as EP recordings.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative preservation of corticospinal function in the brainstem

Neuloh

Bogucki

Schramm

2008

Journal of Neurology, Neurosurgery & Psychiatry

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“…The reorganization taking place in the central nervous system possibly includes both cellular and anatomical phenomena, as well modifications of synaptic efficacy within neuronal networks (22). Additionally, plastic functional reorganization involves the contralesional supplementary motor area (SMA) and premotor cortex (23) and potentially the ipsilesional primary motor cortex (24). Other clinical studies have shown the benefits of using robot-assisted therapy in patients during neurological recovery (25–36).…”

Section: Introductionmentioning

confidence: 99%

Diffusion tensor and volumetric magnetic resonance imaging using an MR-compatible hand-induced robotic device suggests training-induced neuroplasticity in patients with chronic stroke

Lazaridou

Astrakas

Mintzopoulos

et al. 2013

International Journal of Molecular Medicine

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Stroke is the third leading cause of mortality and a frequent cause of long-term adult impairment. Improved strategies to enhance motor function in individuals with chronic disability from stroke are thus required. Post-stroke therapy may improve rehabilitation and reduce long-term disability; however, objective methods for evaluating the specific impact of rehabilitation are rare. Brain imaging studies on patients with chronic stroke have shown evidence for reorganization of areas showing functional plasticity after a stroke. In this study, we hypothesized that brain mapping using a novel magnetic resonance (MR)-compatible hand device in conjunction with state-of-the-art magnetic resonance imaging (MRI) can serve as a novel biomarker for brain plasticity induced by rehabilitative motor training in patients with chronic stroke. This hypothesis is based on the premises that robotic devices, by stimulating brain plasticity, can assist in restoring movement compromised by stroke-induced pathological changes in the brain and that these changes can then be monitored by advanced MRI. We serially examined 15 healthy controls and 4 patients with chronic stroke. We employed a combination of diffusion tensor imaging (DTI) and volumetric MRI using a 3-tesla (3T) MRI system using a 12-channel Siemens Tim coil and a novel MR-compatible hand-induced robotic device. DTI data revealed that the number of fibers and the average tract length significantly increased after 8 weeks of hand training by 110% and 64%, respectively (p<0.001). New corticospinal tract (CST) fibers projecting progressively closer to the motor cortex appeared during training. Volumetric data analysis showed a statistically significant increase in the cortical thickness of the ventral postcentral gyrus areas of patients after training relative to pre-training cortical thickness (p<0.001). We suggest that rehabilitation is possible for a longer period of time after stroke than previously thought, showing that structural plasticity is possible even after 6 months due to retained neuroplasticity. Our study is an example of personalized medicine using advanced neuroimaging methods in conjunction with robotics in the molecular medicine era.

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A New Device for Electrical Stimulation Mapping of the Brainstem and Spinal Cord

Cited by 17 publications

References 7 publications

Cortical mapping and frameless stereotactic navigation in the high-field intraoperative magnetic resonance imaging suite

Cortical mapping and frameless stereotactic navigation in the high-field intraoperative magnetic resonance imaging suite

Intraoperative preservation of corticospinal function in the brainstem

Diffusion tensor and volumetric magnetic resonance imaging using an MR-compatible hand-induced robotic device suggests training-induced neuroplasticity in patients with chronic stroke

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