Recording cortico-cortical evoked potentials of the human arcuate fasciculus under general anaesthesia

Giampiccolo, Davide; Parmigiani, Sara; Basaldella, Federica; Russo, Simone; Pigorini, Andrea; Rosanova, Mario; Cattaneo, Luigi; Sala, Francesco

doi:10.1016/j.clinph.2021.03.044

Cited by 19 publications

(10 citation statements)

References 38 publications

(83 reference statements)

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“…Therefore, this is one of the first works addressing its usefulness in an group patients under general anesthesia with most of them not awake. Giampiccolo et al [20], recently described the usefulness of CCEP monitoring in patients under general anesthesia with results very similar to those obtained in this study.…”

Section: Discussionsupporting

confidence: 90%

“…On the other hand, it is well recognized that macroscopic electrodes at the cortical surface behave differently than microscopic intracerebral electrodes and therefore the theoretical limit needs to be better defined [30]. On the other hand, it has been estimated that a charge density of the same magnitude (1269 µC/cm 2 ) for the paradigm used during awake craniotomy [20] is not safer than in anesthetized patients. Nevertheless, the possibility of cortical electrical injury must be considered and, consequently, the patients should be followed after surgery (e.g., by means of periodic EEG examination).…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative Cortico-Cortical Evoked Potentials for Monitoring Language Function during Brain Tumor Resection in Anesthetized Patients

Vega-Zelaya¹,

Pulido²,

Sola³

et al. 2023

J. Integr. Neurosci.

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Background: Cortico-cortical evoked potentials (CCEPs) have been used to map the frontal (FLA) and parietal (PLA) cortical regions related to language function. However, they have usually been employed as a complementary method during sleep-awake surgery. Methods: Five male and two female patients received surgery for tumors located near language areas. Six patients received general anesthesia and the sleep-awake method was used for patients with tumors located near the cortical language areas. We performed motor and somatosensory mapping with CCEPs to identify language areas and we monitored responses during surgery based on the mapping results. Electrocorticography was performed throughout the surgery. Single pulses of 1 ms duration at 5-20 mA were delivered by direct cortical stimulation using one grid at one region (e.g., FLA) and then recording using a second gird at another area (i.e., PLA). Next, reversed stimulation (from PLA to FLA) was performed. The charge density for electrical stimulation was computed. Sensibility, specificity, predictive positive values, and predicted negative values were also computed for warning alterations of CCEPs. Results: Gross tumor resection was achieved in four cases. The first postsurgical day showed language alterations in three patients, but one year later six patients remained asymptomatic and one patient showed the same symptomatology as previously. Seizures were observed in two patients that were easily jugulated. CCEPs predicted warning events with high sensibility and specificity. Postsurgical language deficits were mostly transitory. Although the latency between frontal and parietal regions showed symmetry, the amplitude and the relationship between amplitude and latency were different for FLA than for PLA. The charge density elicited by CCEPs ranged from 442 to 1768 µC/cm 2 . Conclusions: CCEPs have proven to be a reliable neurophysiological technique for mapping and monitoring the regions associated with language function in a small group of anesthetized patients. The high correlation between warning events and postsurgical outcomes suggested a high sensitivity and specificity and CCEPs can be used systematically in patients under general anesthesia. Nevertheless, the small number of studied patients suggests considering these results cautiously.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Intraoperative Cortico-Cortical Evoked Potentials for Monitoring Language Function during Brain Tumor Resection in Anesthetized Patients

Vega-Zelaya¹,

Pulido²,

Sola³

et al. 2023

J. Integr. Neurosci.

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“…Historically, studies using this technique have been conducted with the patient awake either intraoperatively or in an epilepsy monitoring unit ( Prime et al, 2018 ; Yamao et al, 2021 ). Some interest recently, however, has been in utilizing CCEPs intraoperatively for asleep language mapping ( Yamao et al, 2014 ; Giampiccolo et al, 2021b ).…”

Section: Brain Mapping Techniquesmentioning

confidence: 99%

Large-scale brain networks and intra-axial tumor surgery: a narrative review of functional mapping techniques, critical needs, and scientific opportunities

Boerger

Pahapill

Butts

et al. 2023

Front. Hum. Neurosci.

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In recent years, a paradigm shift in neuroscience has been occurring from “localizationism,” or the idea that the brain is organized into separately functioning modules, toward “connectomics,” or the idea that interconnected nodes form networks as the underlying substrates of behavior and thought. Accordingly, our understanding of mechanisms of neurological function, dysfunction, and recovery has evolved to include connections, disconnections, and reconnections. Brain tumors provide a unique opportunity to probe large-scale neural networks with focal and sometimes reversible lesions, allowing neuroscientists the unique opportunity to directly test newly formed hypotheses about underlying brain structural-functional relationships and network properties. Moreover, if a more complete model of neurological dysfunction is to be defined as a “disconnectome,” potential avenues for recovery might be mapped through a “reconnectome.” Such insight may open the door to novel therapeutic approaches where previous attempts have failed. In this review, we briefly delve into the most clinically relevant neural networks and brain mapping techniques, and we examine how they are being applied to modern neurosurgical brain tumor practices. We then explore how brain tumors might teach us more about mechanisms of global brain dysfunction and recovery through pre- and postoperative longitudinal connectomic and behavioral analyses.

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“…These concern, for example: (i) methodology for the assessment of brain networks, effects of the pathological process, and cerebral plasticity, based on a qualitative and quantitative longitudinal and multimodal approach; (ii) the accuracy of neurophysiological techniques, especially for the intraoperative cortical and subcortical monitoring, especially of higher-level functions, such as language. To this regard, the application of emerging methods, such as corticocortical evoked potentials, in patients that cannot undergo awake procedures, will extend the feasibility of intraoperative monitoring of language circuits also to the pediatric population (Yamao et al, 1977;Matsumoto et al, 2004;Giampiccolo et al, 2021); (iii) the application of machine learning (ML) technology, based on the identification of specific structural WM biomarkers for the computation of reliable probabilistic atlases based on different convergent factors, such as the presurgical lesion characteristics, the relationships between the lesion type and the local and global network, the functional interactions and outflows, and the possible clinical deficits; (iv) the development of model-based approaches, based on computation of brain network models by integrating data from reference atlases with anatomofunctional connectivity data coming from patient-specific imaging, and electrophysiological recordings (e.g., EEG patterns identified by stereo-EEG recordings). As already described in both the adult and pediatric epilepsy literature, the combined use of brain network model representation (the so-called "virtual epilepsy brain models") with ML De Benedictis et al 10.3389/fnana.2023.1242757 Frontiers in Neuroanatomy 16 frontiersin.org and artificial intelligence methods would allow to approximate the extent and the organization of the epileptogenic zone (EZ), intended as the site of beginning and of the primary organization of epileptic seizures.…”

Section: Conclusion and Future Perspectivesmentioning

confidence: 99%

Structural networking of the developing brain: from maturation to neurosurgical implications

De Benedictis,

Rossi-Espagnet,

de Palma

et al. 2023

Front. Neuroanat.

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Modern neuroscience agrees that neurological processing emerges from the multimodal interaction among multiple cortical and subcortical neuronal hubs, connected at short and long distance by white matter, to form a largely integrated and dynamic network, called the brain “connectome.” The final architecture of these circuits results from a complex, continuous, and highly protracted development process of several axonal pathways that constitute the anatomical substrate of neuronal interactions. Awareness of the network organization of the central nervous system is crucial not only to understand the basis of children’s neurological development, but also it may be of special interest to improve the quality of neurosurgical treatments of many pediatric diseases. Although there are a flourishing number of neuroimaging studies of the connectome, a comprehensive vision linking this research to neurosurgical practice is still lacking in the current pediatric literature. The goal of this review is to contribute to bridging this gap. In the first part, we summarize the main current knowledge concerning brain network maturation and its involvement in different aspects of normal neurocognitive development as well as in the pathophysiology of specific diseases. The final section is devoted to identifying possible implications of this knowledge in the neurosurgical field, especially in epilepsy and tumor surgery, and to discuss promising perspectives for future investigations.

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Recording cortico-cortical evoked potentials of the human arcuate fasciculus under general anaesthesia

Cited by 19 publications

References 38 publications

Intraoperative Cortico-Cortical Evoked Potentials for Monitoring Language Function during Brain Tumor Resection in Anesthetized Patients

Intraoperative Cortico-Cortical Evoked Potentials for Monitoring Language Function during Brain Tumor Resection in Anesthetized Patients

Large-scale brain networks and intra-axial tumor surgery: a narrative review of functional mapping techniques, critical needs, and scientific opportunities

Structural networking of the developing brain: from maturation to neurosurgical implications

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