• Neurochirurgie · Jun 2017

    Technical principles of direct bipolar electrostimulation for cortical and subcortical mapping in awake craniotomy.

    • J Pallud, E Mandonnet, R Corns, E Dezamis, E Parraga, M Zanello, and G Spena.
    • Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674 Paris cedex 14, France; Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France. Electronic address: johanpallud@hotmail.com.
    • Neurochirurgie. 2017 Jun 1; 63 (3): 158-163.

    IntroductionIntraoperative application of electrical current to the brain is a standard technique during brain surgery for inferring the function of the underlying brain. The purpose of intraoperative functional mapping is to reliably identify cortical areas and subcortical pathways involved in eloquent functions, especially motor, sensory, language and cognitive functions.Material And MethodsThe aim of this article is to review the rationale and the electrophysiological principles of the use of direct bipolar electrostimulation for cortical and subcortical mapping under awake conditions.ResultsDirect electrical stimulation is a window into the whole functional network that sustains a particular function. It is an accurate (spatial resolution of about 5mm) and a reproducible technique particularly adapted to clinical practice for brain resection in eloquent areas. If the procedure is rigorously applied, the sensitivity of direct electrical stimulation for the detection of cortical and subcortical eloquent areas is nearly 100%. The main disadvantage of this technique is its suboptimal specificity. Another limitation is the identification of eloquent areas during surgery, which, however, could have been functionally compensated postoperatively if removed surgically.ConclusionDirect electrical stimulation is an easy, accurate, reliable and safe invasive technique for the intraoperative detection of both cortical and subcortical functional brain connectivity for clinical purpose. In our opinion, it is the optimal technique for minimizing the risk of neurological sequelae when resecting in eloquent brain areas.Copyright © 2017 Elsevier Masson SAS. All rights reserved.

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