• Theodoros Kombos, Olaf Süss, and Peter Vajkoczy.
• Neurosurgical Clinic, Charité-Universitätsmedizin, 12200 Berlin, Germany. theodoros.kombos@charite.de
• Neurosurg Focus. 2009 Oct 1;27(4):E5.

ObjectThe treatment of insular tumors is controversial. Surgical treatment is associated with a higher morbidity rate than other therapies. The present work presents a new method in which the descending motor pathways are monitored during surgery for insular tumors.MethodsIntraoperative monitoring was performed in a combination of 2 techniques. The motor cortex was stimulated with a transcranial electrical stimulus. In addition, direct subcortical stimulation was performed with an electrical anodal monopolar stimulus. Compound motor action potentials (CMAPs) were recorded from target muscles.ResultsFifteen patients were included in this preliminary study. Following transcranial stimulation, CMAPs were recorded in all cases. Subcortical stimulation was successful in 12 cases. Significant CMAP alterations were recorded in 5 patients. There were no false-negative results in the series.ConclusionsThe technique presented here is a safe method. It allows a quantitative monitoring of motor function and functional mapping of the pyramidal tract during insular surgery.

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