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http://dx.doi.org/10.15324/kjcls.2022.54.2.157

Technical Considerations of Effective Direct Cortical and Subcortical Stimulation  

Lim, Sung Hyuk (Department of Neurology, Institute of Neuroscience Center, Samsung Medical Center)
Jang, Min Hwan (Department of Neurology, Institute of Neuroscience Center, Samsung Medical Center)
Publication Information
Korean Journal of Clinical Laboratory Science / v.54, no.2, 2022 , pp. 157-162 More about this Journal
Abstract
The purpose of the direct cortical and subcortical stimulation technique is to prevent false positives caused by transcranial electrical motor evoked potentials (TceMEP) in surgery on patients with brain tumors that have occurred around the motor cortex and to preserve the correct mapping of motor areas during surgery and the corticospinal tract. In addition, it reduces the trial and error that occurs during the intraoperative neurophysiological monitoring (INM) process and minimizes the test time, so that accurate information is communicated to the surgeon with quick feedback on the test results. The most important factors of this technique are, first, examination at a stimulus threshold of a certain intensity, and second, maintaining anesthesia depth at an appropriate level to prevent false positives from occurring during surgery. The third is the installation of a multi-level channel recording electrode on the opposite side of the area of operation to measure the TceMEP waveform and the response to direct cortical and subcortical stimulation in as many muscles as possible. If these conditions are maintained, it is possible to predict causes that may occur in other factors, not false positives, from the INM test.
Keywords
Corticospinal tract; Direct cortical stimulation; Direct subcortical stimulation;
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