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Recording cortico-cortical evoked potentials of the human arcuate fasciculus under general anaesthesia
Affiliation:1. Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy;2. Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy;3. Division of Neurology, Verona University Hospital, Verona, Italy;4. CIMEC – Center for Mind/Brain Sciences, University of Trento, Trento, Italy
Abstract:ObjectiveWe examined the feasibility of using cortico-cortical evoked potentials (CCEPs) to monitor the major cortical white matter tract involved in language, the arcuate fasciculus (AF), during surgery under general anaesthesia.MethodsWe prospectively recruited nine patients undergoing surgery for lesions in the left peri-sylvian cortex, for whom awake surgery was not indicated. High angular resolution diffusion imaging (HARDI) tractography was used to localise frontal and temporal AF terminations, which guided intraoperative cortical strip placement.ResultsCCEPs were successfully evoked in 5/9 patients, showing a positive potential (P1) at 12 ms and a negative component (N1) at 21 ms when stimulating from the frontal lobe and recording in the temporal lobe. CCEP responses peaked in the posterior middle temporal gyrus. No CCEPs were evoked when stimulating temporal sites and recording from frontal contacts.ConclusionFor the first time, we show that CCEPs can be evoked from the peri-sylvian cortices also in adult patients who are not candidates for awake procedures. Our results are akin to those described in the awake setting and suggest the recorded activity is conveyed by the arcuate fasciculus.SignificanceThis intraoperative approach may have promising implications in reducing deficits in patients that require surgery in language areas under general anesthesia.
Keywords:Language  Intraoperative neurophysiological monitoring  Asleep surgery  Brain tumour  CCEPs  Neurosurgery  AF"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0040"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  arcuate fasciculus  BADA"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0050"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  Batteria per l’analisi dei deficit afasici  CCEPs"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0060"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  Cortico-cortical evoked potentials  DES"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0070"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  direct electrical stimulation  DTI"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0080"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  diffusion tensor imaging  DWI"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0090"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  diffusion weighted imaging  ECoG"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0100"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  electrocorticography  EEG"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0110"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  electroencephalography  EHI"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0120"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  Edinburgh Handedness Inventory  EMG"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0130"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  electromyography  FSL"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0140"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  FMRIB Software Library  GTR"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0150"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  gross total resection  HARDI"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0160"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  high angular resolution diffusion imaging  HFF"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0170"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  high frequency filter  LFF"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0180"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  low frequency filter  HGG"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0190"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  high grade glioma  MNI"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0200"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  Montreal Neurological Institute  ROI"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0210"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  region of interest  SD"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0220"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  spherical deconvolution  STR"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0230"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  subtotal resection  TIVA"  },{"  #name"  :"  keyword"  ,"  $"  :{"  id"  :"  k0240"  },"  $$"  :[{"  #name"  :"  text"  ,"  _"  :"  total intravenous anaesthesia
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