Clinical Impact of Intraoperative CCEP Monitoring in Evaluating the Dorsal Language White Matter Pathway

被引：52

作者：

Yamao, Yukihiro ^{[1
]}

Suzuki, Kengo ^{[2
]}

Kunieda, Takeharu ^{[1
,3
]}

Matsumoto, Riki ^{[4
]}

Arakawa, Yoshiki ^{[1
]}

Nakae, Takuro ^{[1
]}

Nishida, Sei ^{[1
]}

Inano, Rika ^{[1
]}

Shibata, Sumiya ^{[1
]}

Shimotake, Akihiro ^{[4
]}

Kikuchi, Takayuki ^{[1
]}

Sawamoto, Nobukatsu ^{[4
,5
]}

Mikuni, Nobuhiro ^{[2
]}

Ikeda, Akio ^{[6
]}

Fukuyama, Hidenao ^{[7
]}

Miyamoto, Susumu ^{[1
]}

机构：

[1] Kyoto Univ, Dept Neurosurg, Grad Sch Med, Kyoto, Japan

[2] Sapporo Med Univ, Sch Med, Dept Neurosurg, Sapporo, Hokkaido, Japan

[3] Ehime Univ, Grad Sch Med, Dept Neurosurg, Toon, Ehime, Japan

[4] Kyoto Univ, Dept Neurol, Grad Sch Med, Kyoto, Japan

[5] Kyoto Univ, Dept Human Hlth Sci, Grad Sch Med, Kyoto, Japan

[6] Kyoto Univ, Dept Epilepsy Movement Disorders & Physiol, Grad Sch Med, Kyoto, Japan

[7] Kyoto Univ, Human Brain Res Ctr, Grad Sch Med, Kyoto, Japan

来源：

HUMAN BRAIN MAPPING | 2017年 / 38卷 / 04期

关键词：

cortico-cortical evoked potential; subcortico-cortical evoked potential; electrical stimulation; dorsal language pathway; awake craniotomy; CORTICOCORTICAL EVOKED-POTENTIALS; MR TRACTOGRAPHY; FUNCTIONAL CONNECTIVITY; CORTICAL STIMULATION; CONDUCTION APHASIA; ARCUATE FASCICULUS; AWAKE CRANIOTOMY; TEMPORAL-LOBE; HUMAN BRAIN; NETWORK;

D O I：

10.1002/hbm.23498

中图分类号：

Q189 [神经科学];

学科分类号：

071006 ;

摘要：

In order to preserve postoperative language function, we recently proposed a new intraoperative method to monitor the integrity of the dorsal language pathway (arcuate fasciculus; AF) using cortico-cortical evoked potentials (CCEPs). Based on further investigations (20 patients, 21 CCEP investigations), including patients who were not suitable for awake surgery (five CCEP investigations) or those without preoperative neuroimaging data (eight CCEP investigations including four with untraceable tractography due to brain edema), we attempted to clarify the clinical impact of this new intraoperative method. We monitored the integrity of AF by stimulating the anterior perisylvian language area (AL) by recording CCEPs from the posterior perisylvian language area (PL) consecutively during both general anesthesia and awake condition. After tumor resection, single-pulse electrical stimuli were also applied to the floor of the removal cavity to record subcortico-cortical evoked potentials (SCEPs) at AL and PL in 12 patients (12 SCEP investigations). We demonstrated that (1) intraoperative dorsal language network monitoring was feasible even when patients were not suitable for awake surgery or without preoperative neuroimaging studies, (2) CCEP is a dynamic marker of functional connectivity or integrity of AF, and CCEP N1 amplitude could even become larger after reduction of brain edema, (3) a 50% CCEP N1 amplitude decline might be a cut-off value to prevent permanent language dysfunction due to impairment of AF, (4) a correspondence (<2.0 ms difference) of N1 onset latencies between CCEP and the sum of SCEPs indicates close proximity of the subcortical stimulus site to AF (<3.0 mm). (C) 2017 Wiley Periodicals, Inc.

引用

页码：1977 / 1991

页数：15

共 40 条

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