Staub-Bartelt Franziska, Rapp Marion, Sabel Michael
Department of Neurosurgery, University Hospital Duesseldorf, 40225 Düsseldorf, Germany.
Brain Sci. 2023 Sep 25;13(10):1366. doi: 10.3390/brainsci13101366.
Patients with eloquently located cerebral lesions require surgery that usually employs mapping and monitoring techniques for the preservation of motor and language function. However, in many cases, mapping only might be sufficient, reducing the need for technical and personnel logistics. Here, we report our experiences using a device that can be operated by the surgeon independently, providing mapping techniques but omitting monitoring techniques.
For monopolar and bipolar cortical/subcortical stimulation, pre-set programs were available and intraoperatively used-two enabling EMG real-time tracking of eight muscles for monopolar (cortical/subcortical) mapping, and two programs for 60 Hz stimulation, one with EMG and one without. Motor mapping was performed under continuous observation of the screened EMG signal and acoustic feedback by the surgeon. For the 60 Hz stimulation, a standard bipolar stimulation probe was connected through a second port. The preoperative application of the subdermal EMG needles, as well as the intraoperative handling of the device, were performed by the surgeons independently. Postoperatively, an evaluation of the autonomous handling and feasibility of the device for the chosen test parameters was conducted.
From 04/19-09/21, 136 procedures in patients with eloquently located cerebral lesions were performed by using the "mapping-only" device. Mapping was performed in 82% of the monopolar cases and in 42% of the bipolar cases. Regarding the setup and sufficiency for the cortical/subcortical mapping, the device was evaluated as independently usable for motor and language mapping in 129 procedures (95%). Gross total resection was achieved, or functional limit throughout resection was reached, in 79% of the patients. 13 patients postoperatively suffered from a new neurological deficit. At the 3-6-month follow-up, three patients showed persistent deficit (2%). All of them had language disturbances. The setup time for the device was less than 7 min.
The device was evaluated as sufficient in over 90% of cases concerning monopolar and bipolar mapping, and the setup and handling was sufficient in all patients. With the present data we show that in well-selected cases, a very simple system providing mapping only is sufficient to achieve gross total resection with the preservation of functionality.
脑功能区明确的脑损伤患者需要进行手术，通常采用定位和监测技术来保留运动和语言功能。然而，在许多情况下，仅进行定位可能就足够了，从而减少了对技术和人员安排的需求。在此，我们报告使用一种可由外科医生独立操作的设备的经验，该设备提供定位技术但省略了监测技术。
对于单极和双极皮质/皮质下刺激，有预设程序可供术中使用——两个程序用于单极（皮质/皮质下）定位时对八块肌肉进行肌电图实时跟踪，还有两个用于60赫兹刺激的程序，一个带有肌电图，一个不带。运动定位在外科医生持续观察筛选出的肌电图信号和声反馈的情况下进行。对于60赫兹刺激，通过第二个端口连接一个标准双极刺激探头。皮下肌电图针的术前应用以及设备的术中操作均由外科医生独立完成。术后，对设备在所选测试参数下的自主操作和可行性进行了评估。
从2019年4月至2021年9月，使用“仅定位”设备对136例脑功能区明确的脑损伤患者进行了手术。在82%的单极病例和42%的双极病例中进行了定位。关于皮质/皮质下定位的设置和充分性，在129例手术（95%）中，该设备被评估为可独立用于运动和语言定位。79%的患者实现了全切除或在整个切除过程中达到了功能极限。13例患者术后出现了新的神经功能缺损。在3至6个月的随访中，3例患者出现持续缺损（2%）。他们均有语言障碍。设备的设置时间少于7分钟。
在超过90%的单极和双极定位病例中，该设备被评估为足够，并且在所有患者中设置和操作都足够。根据目前的数据，我们表明在精心挑选的病例中，一个非常简单的仅提供定位的系统足以在保留功能的情况下实现全切除。
