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Somatosensory Evoked Potential Identification of Sensorimotor Cortex in Removal of Intracranial Neoplasms

Published online by Cambridge University Press:  18 September 2015

David W. Rowed ,
David A. Houlden  and
Devsur G. Basavakumar
David W. Rowed*
Affiliation:
Sunnybrook Health Science Centre, University of Toronto, Toronto.
David A. Houlden
Affiliation:
Sunnybrook Health Science Centre, University of Toronto, Toronto.
Devsur G. Basavakumar
Affiliation:
Sunnybrook Health Science Centre, University of Toronto, Toronto.
*
Division of Neurosurgery, Ste. A134, Sunnybrook Health Science Centre, 2075 Bayview Avenue, North York, Ontario, Canada M4N 3M5
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Abstract:

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Objective:

To assess the ease and reliability of routine use of somatosensory evoked potentials (SSEPs) for identification of sensorimotor cortex in brain tumour removal and to document its influence on the performance and outcome of surgery.

Methods:

SSEPs in response to contralateral median nerve stimulation were recorded from the cortical surface by means of a four lead electrode strip. Polarity reversal of short latency SSEP waves was used to identify the position of the central sulcus in 46 consecutive craniotomies for removal of metastases, gliomas, or meningiomas located in, near, or overlying sensorimotor cortex.

Results:

SSEPs were successfully recorded in 43/46 cases (94%) with demonstration of polarity reversal in 42/43 (98%). SSEP localization led to modification of 14/42 (33%) procedures, most frequently because of either displacement or involvement of sensorimotor cortex by tumour. Six patients (14%) developed new neurological deficits but none of these was attributable to incorrect identification of sensorimotor cortex.

Conclusions:

SSEP polarity reversal is a simple, reliable, accurate, and inexpensive method of localizing sensorimotor cortex under general anaesthesia. Correct identification is possible when sensorimotor cortex is displaced or when surface anatomy is obscured by tumour. Routine use of this technique should be considered in all procedures for lesions located near the central sulcus.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 24 , Issue 2 , May 1997 , pp. 116 - 120
Copyright
Copyright © Canadian Neurological Sciences Federation 1997

References

REFERENCES

1.Ojemann, G, Ojemann, J, Lettich, E, Berger, MCortical language localization in left, dominant hemisphere. J Neurosurg 1989; 71: 316–326.CrossRefGoogle ScholarPubMed
2.Woolsey, CN, Erickson, TC, Gilson, WELocalization in somatic sensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation. J Neurosurg 1979; 51: 476–506.CrossRefGoogle ScholarPubMed
3.Broughton, RJ Discussion. In: Donchin, E, Lindsley, DB, eds. Average Evoked potentials. Methods, Results and Evaluations. Washington: US Government Printing Office NASA SP-191, 1969: 79–84.Google Scholar
4.Broughton, RJSomatosensory evoked potentials in man: cortical and scalp recordings; 1967 Thesis, McGill University, Montreal, Quebec, Canada.Google Scholar
5.Broughton, RJ, Rasmussen, T, Branch, CScalp and direct cortical recordings of somatosensory evoked potentials in man. Can J Psychol 1981; 35: 136–158.CrossRefGoogle ScholarPubMed
6.Allison, T, Goff, WR, Williamson, PD, VanGuilder, JCOn the neural origin of early components of the human somatosensory evoked potential. Prog Clin Neurophysiol 1980; 7: 51–68.Google Scholar
7.Allison, T, McCarthy, G, Wood, CC, Jones, SJPotentials evoked in human and monkey cerebral cortex by stimulation of the median nerve. Brain 1991; 114: 2465–2503.CrossRefGoogle ScholarPubMed
8.Deiber, MP, Giard, MH, Mauguiere, F.Separate generators with distinct orientations for N20 and P22 somatosensory evoked potentials to finger stimulation? Electroencephalogr Clin Neurophysiol 1986; 65: 321–334.CrossRefGoogle ScholarPubMed
9.Desmedt, JE, Cheron, GNon-cephalic reference recording of early somatosensory potentials to finger stimulation in adult or aging normal man: differentiation of widespread N18 and contralateral N20 from the prerolandic P22 and N30 components. Electroencephalogr Clin Neurophysiol 1981; 52: 553–570.CrossRefGoogle ScholarPubMed
10.Desmedt, JE, Nguyen, TH, Bourguet, MBit-mapped colour imaging of human evoked potentials with reference to the N20, P22, P27 and N30 somatosensory responses. Electroencephalogr Clin Neurophysiol 1987; 68: 1–19.CrossRefGoogle Scholar
11.Goldring, SA method for surgical management of focal epilepsy, especially as it relates to children. J Neurosurg 1978; 49: 344– 356.CrossRefGoogle ScholarPubMed
12.Goldring, S, Gregorie, EMSurgical management of epilepsy using epidural recordings to localize the seizure focus. J Neurosurg 1984; 60: 457–466.CrossRefGoogle ScholarPubMed
13.Lemon, RN,van der Burg, JShort-latency peripheral inputs to thalamic neurones projecting to the motor cortex in the monkey. Exp Brain Res 1979; 36: 445–462.CrossRefGoogle Scholar
14.Lueders, H, Lesser, RP, Hahn, J, Dinner, DS, Klem, GCortical somatosensory evoked potentials in response to hand stimulation. J Neurosurg 1983; 58: 885–894.CrossRefGoogle ScholarPubMed
15.Mauguiere, F, Desmedt, JE, Courjon, J.Astereognosis and dissociated loss of frontal and parietal components of somatosensory evoked potentials in hemispheric lesions: detailed correlations with clinical signs and computerized tomographic scanning. Brain 1983; 106: 271–311.CrossRefGoogle ScholarPubMed
16.Robertson, SC, Traynelis, VC, Yamada, TTIdentification of the sensorimotor cortex with SSEP phase reversal. In: Loftus, CM, Traynelis, VC, eds. Intraoperative Monitoring Techniques in Neurosurgery. New York, St. Louis: McGraw-Hill Inc., 1994: 107–111.Google Scholar
17.Slimp, JC, Tamas, LB, Stolov, WC, Wyler, ARSomatosensory evoked potentials after removal of somatosensory cortex in man. Electroencephalogr Clin Neurophysiol 1986; 65: 111–117.CrossRefGoogle ScholarPubMed
18.Sonoo, M, Shimpo, T, Takeda, KSEP’s in two patients with localized lesions of the postcentral gyrus. Electroencephalogr Clin Neurophysiol 1991; 80: 536–546.Google Scholar
19.Yamada, T, Graff-Radford, NR, Kimura, J, Dickins, QS, Adams, HPTopographic analysis of somatosensory evoked potentials in patients with well-localized thalamic infarctions. J Neurol Sci 1985; 68: 31–46.CrossRefGoogle ScholarPubMed
20.Yamada, T, Kimura, J, Nitz, DShort latency somatosensory evoked potentials following median nerve stimulation in man. Electroencephalogr Clin Neurophysiol 1980; 48: 367–376.CrossRefGoogle ScholarPubMed
21.Ebeling, U, Schmid, UD, Ying, H, Reulen, HJSafe surgery of lesions near the motor cortex using intra-operative mapping techniques: a report on 50 patients. Acta Neurochir (Wien) 1992; 119: 23–28.CrossRefGoogle ScholarPubMed
22.Firsching, R, Klug, N, Borner, U, Sanker, PLesions of the sensorimotor region: somatosensory evoked potentials and ultrasound guided surgery. Acta Neurochir (Wien) 1992; 118: 87–90.CrossRefGoogle ScholarPubMed
23.Gregorie, EM, Goldring, SLocalization of function in the excision of lesions from the sensorimotor region. J Neurosurg 1984; 61: 1047–1054.CrossRefGoogle ScholarPubMed
24.King, RB, Schell, GRCortical localization and monitoring during cerebral operations. J Neurosurg 1987; 67: 210–219.CrossRefGoogle ScholarPubMed
25.Wood, CC, Spencer, DD, Allison, T, et al. Localization of human sensorimotor cortex during surgery by cortical surface recording of somatosensory evoked potentials. J Neurosurg 1988; 68: 99–111.CrossRefGoogle ScholarPubMed
26.Allison, T, Wood, CC, McCarthy, G, Spencer, DDCortical somatosensory evoked potentials. II. Effects of excision of somatosensory or motor cortex in humans and monkeys. Neurosurgery 1991; 66: 64–82.Google ScholarPubMed
27.Nuwer, MR, Banoczi, WR, Coughesy, TF, et al. Topographic mapping of somatosensory evoked potentials helps identify motor ortex more quickly in the operating room. Brain Topography 1992; 5: 53–58.CrossRefGoogle Scholar
28.Desmedt, JE, Ozaki, ISEPs to finger joint input lack the N20-P20 response that is evoked by tactile inputs: contrast between cortical generators in areas 3b and 2 in humans. Electroencephalogr Clin Neurophysiol 1991; 80: 513–521.CrossRefGoogle ScholarPubMed
29.Suzuki, A, Yasui, N.Intraoperative localization of the central sulcus by cortical somatosensory evoked potentials in brain tumour. J Neurosurg 1992; 76: 867–870.CrossRefGoogle Scholar
30.Berger, MS, Cohen, WA, Ojemann, GACorrelation of motor cortex brain mapping data with magnetic resonance imaging. J Neurosurg 1990; 72: 383–387.CrossRefGoogle ScholarPubMed
31.Berger, MS, Ghatan, S, Haglund, MM, Dobbins, J, Ojemann, GALow-grade gliomas associated with intractable epilepsy: seizure outcome utilizing electrocorticography during tumour resection. J Neurosurg 1993; 79: 62–69.CrossRefGoogle Scholar
32.Berger, MS, Kincaid, J, Ojemann, GA, Lettich, EBrain mapping techniques to maximize resection, safety, and seizure control in children with brain tumours. Neurosurgery 1989; 25: 786–792.CrossRefGoogle Scholar
33.Black, PM, Ronner, SFCortical mapping for defining the limits of tumour resection. Neurosurgery 1987; 20: 914–919.CrossRefGoogle Scholar
34.Cao, Y, Vikingstad, EM, Huttenlocher, PR, Towle, VL, Levin, DNFunctional magnetic resonance studies of the reorganization of the human hand sensorimotor area after unilateral brain injury in the perinatal period. Proc Natl Acad Sci 1994; 91: 9612–9616.CrossRefGoogle ScholarPubMed
35.Drake, JM, Rutka, JT, Hoffman, HJInstrumentation, technique and technology — ISG viewing wand system. Neurosurgery 1994; 34: 1094–1097.Google Scholar
36.Obana, WG, Laxer, KD, Cogen, PH, et al. Resection of dominant opercular gliosis in refractory partial epilepsy. J Neurosurg 1992; 77: 632–639.CrossRefGoogle ScholarPubMed
37.Puce, A, Constable, RT, Luby, ML, et al. Functional magnetic resonance imaging of sensory and motor cortex: comparison with electrophysiological localization. J Neurosurg 1995; 83: 262–270.CrossRefGoogle ScholarPubMed