Subcortical Stimulation in Brain Tumor Surgery: A Closer Look Beneath the Surface.
Brain tumor
Motor evoked potentials
Neuromonitoring
Subcortical stimulation
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
received:
25
11
2021
revised:
02
02
2022
accepted:
03
02
2022
pubmed:
13
2
2022
medline:
6
5
2022
entrez:
12
2
2022
Statut:
ppublish
Résumé
Maximizing the patient's onco-functional balance is the central tenet of brain tumor surgery. Consequently, numerous surgical adjuncts have been developed to facilitate identification of the tumor-brain interface and preservation of functional anatomy. Among these, intraoperative neurophysiologic monitoring (IONM) with direct cortical stimulation (DCS) and subcortical stimulation (SCS) remains the gold standard for real-time, functional mapping of motor and language activity. Stimulation techniques are not standardized and vary significantly across institutions, however. This is particularly true with SCS for mapping motor function. We reviewed the state of subcortical IONM and mapping techniques, including historical and predicate literature as well as new and emerging techniques. Here we discuss their evolution, clinical utility, and limitations to direct future research and application. Our evaluation of the background and current clinical use of DCS and SCS techniques and protocols and identification of current trends and limitations focuses specifically on methods of SCS, given the heterogeneity in the published literature. We suggest directions to optimize the clinical utility of these tools. Despite significant heterogeneity in published techniques, trends support use of the Taniguchi method for SCS. Novel dynamic stimulation techniques may improve accuracy. Prospective studies to define standardized guidelines are needed.
Sections du résumé
BACKGROUND
Maximizing the patient's onco-functional balance is the central tenet of brain tumor surgery. Consequently, numerous surgical adjuncts have been developed to facilitate identification of the tumor-brain interface and preservation of functional anatomy. Among these, intraoperative neurophysiologic monitoring (IONM) with direct cortical stimulation (DCS) and subcortical stimulation (SCS) remains the gold standard for real-time, functional mapping of motor and language activity. Stimulation techniques are not standardized and vary significantly across institutions, however. This is particularly true with SCS for mapping motor function.
METHODS
We reviewed the state of subcortical IONM and mapping techniques, including historical and predicate literature as well as new and emerging techniques. Here we discuss their evolution, clinical utility, and limitations to direct future research and application.
RESULTS
Our evaluation of the background and current clinical use of DCS and SCS techniques and protocols and identification of current trends and limitations focuses specifically on methods of SCS, given the heterogeneity in the published literature. We suggest directions to optimize the clinical utility of these tools.
CONCLUSIONS
Despite significant heterogeneity in published techniques, trends support use of the Taniguchi method for SCS. Novel dynamic stimulation techniques may improve accuracy. Prospective studies to define standardized guidelines are needed.
Identifiants
pubmed: 35149248
pii: S1878-8750(22)00153-X
doi: 10.1016/j.wneu.2022.02.014
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
55-63Informations de copyright
Copyright © 2022 Elsevier Inc. All rights reserved.