Impulse Monitoring Inc, Columbia, MD, USA.
Neurosurgery. 2011 Oct;69(4):893-8. doi: 10.1227/NEU.0b013e3182230ac3.
Traditionally, the dual-radial model, which requires high cortical stimulation intensities and may evoke intraoperative seizures, is used for mapping during resection of lesions within or near the central sulcus.
To examine the potential utility of using the multimodal tangential-radial triphasic model, which may increase the accuracy and reliability of cortical mapping at lower stimulation intensities.
We performed a retrospective review of intracranial neuromonitoring cases at the University of Virginia. The tangential-radial triphasic model used direct electrical cortical stimulation (DECS), electrocorticography, and somatosensory evoked potentials with an additional P25 peak for waveform interpretation, instead of the older dual-radial model with N20 and P30 peaks alone. The central sulcus and sensory cortex were localized by generating multiple sensory maps. DECS with 50-Hz frequency was applied. Electrocorticography was used for detection of afterdischarges.
Fifteen consecutive intracranial cases were identified. The patients consisted of 8 males and 7 females ranging in age from 12 to 74 years (median, 53 years). Fourteen patients had an intra-axial cortical mass, and 1 patient had a cortical arteriovenous malformation. The DECS thresholds ranged from 3.7 to 12 mA (median, 6.2 mA). Localization of motor and sensory cortices was accurately performed at low thresholds with bipolar DECS in all patients. Intraoperative seizures occurred in 1 patient (7%), and new permanent postoperative functional deficits occurred in 1 patient (7%).
Our mapping technique appears safe and reliable for resection near the central sulcus. The tangential-radial triphasic model allows for lower stimulation intensities, reducing the risk of intraoperative seizures.
传统的双辐射模型需要高皮质刺激强度，并可能在中央沟内或附近的病变切除过程中引发术中癫痫发作。
研究使用多模态切线辐射三相模型的潜在效用，该模型可能在较低的刺激强度下提高皮质映射的准确性和可靠性。
我们对弗吉尼亚大学的颅内神经监测病例进行了回顾性审查。切线辐射三相模型使用直接电皮质刺激（DECS）、皮质电图和体感诱发电位，外加一个 P25 峰值用于波形解释，而不是使用单独的 N20 和 P30 峰值的旧双辐射模型。通过产生多个感觉图来定位中央沟和感觉皮层。应用 50-Hz 频率的 DECS。使用皮质电图检测后放电。
确定了 15 例连续的颅内病例。患者包括 8 名男性和 7 名女性，年龄从 12 岁到 74 岁不等（中位数为 53 岁）。14 例患者有颅内轴内皮质肿块，1 例患者有皮质动静脉畸形。DECS 阈值范围为 3.7 至 12 mA（中位数为 6.2 mA）。所有患者均在低阈值下使用双极 DECS 准确地定位了运动和感觉皮层。1 例患者（7%）发生术中癫痫发作，1 例患者（7%）发生新的永久性术后功能缺陷。
我们的映射技术似乎安全可靠，适用于中央沟附近的切除。切线辐射三相模型允许更低的刺激强度，降低术中癫痫发作的风险。
