Yamao Yukihiro, Matsumoto Riki, Kikuchi Takayuki, Yoshida Kazumichi, Kunieda Takeharu, Miyamoto Susumu
Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan.
Front Hum Neurosci. 2021 Feb 18;15:635453. doi: 10.3389/fnhum.2021.635453. eCollection 2021.
To preserve postoperative brain function, it is important for neurosurgeons to fully understand the brain's structure, vasculature, and function. Intraoperative high-frequency electrical stimulation during awake craniotomy is the gold standard for mapping the function of the cortices and white matter; however, this method can only map the "focal" functions and cannot monitor large-scale cortical networks in real-time. Recently, an electrophysiological method using cortico-cortical evoked potentials (CCEPs) induced by single-pulse electrical cortical stimulation has been developed in an extraoperative setting. By using the CCEP connectivity pattern intraoperatively, mapping and real-time monitoring of the dorsal language pathway is available. This intraoperative CCEP method also allows for mapping of the frontal aslant tract, another language pathway, and detection of connectivity between the primary and supplementary motor areas in the frontal lobe network. Intraoperative CCEP mapping has also demonstrated connectivity between the frontal and temporal lobes, likely the ventral language pathway. Establishing intraoperative electrophysiological monitoring is clinically useful for preserving brain function, even under general anesthesia. This CCEP technique demonstrates potential clinical applications for mapping and monitoring large-scale cortical networks.
为了保留术后脑功能，神经外科医生充分了解大脑的结构、血管系统和功能非常重要。清醒开颅手术期间的术中高频电刺激是绘制皮质和白质功能的金标准；然而，这种方法只能绘制“局部”功能，无法实时监测大规模皮质网络。最近，一种在手术室外使用单脉冲皮层电刺激诱发的皮质-皮质诱发电位（CCEP）的电生理方法已经被开发出来。通过术中使用CCEP连接模式，可以对背侧语言通路进行映射和实时监测。这种术中CCEP方法还可以绘制另一条语言通路——额斜束，并检测额叶网络中初级运动区和辅助运动区之间的连接。术中CCEP映射还显示了额叶和颞叶之间的连接，可能是腹侧语言通路。建立术中电生理监测即使在全身麻醉下对保留脑功能也具有临床实用性。这种CCEP技术展示了在映射和监测大规模皮质网络方面的潜在临床应用。
