Comparison between monopolar and bipolar electrical stimulation of the motor cortex

被引:82
作者
Kombos, T [1 ]
Suess, O [1 ]
Kern, BC [1 ]
Funk, T [1 ]
Hoell, T [1 ]
Kopetsch, O [1 ]
Brock, M [1 ]
机构
[1] Free Univ Berlin, Hosp Benjamin Franklin, Dept Neurosurg, D-12200 Berlin, Germany
关键词
cortical mapping; compound motor action potentials; motor pathways; intraoperative monitoring;
D O I
10.1007/s007010050433
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Intra-operative neurophysiological techniques allow reliable identification of the sensorimotor region and make their anatomical and functional preservation feasible. Monopolar cortical stimulation has recently been described as a new mapping technique. In the present study this method was compared to the "traditional'' technique of bipolar stimulation. Functional mapping of the motor cortex was performed in 35 patients during surgery in the central region. The central sulcus (CS) was identified by somatosensory evoked potential (SEP) phase reversal. Cortical motor mapping was first performed by monopolar anodal stimulation with a train of 500 Hz (7-10 pulses) followed by bipolar stimulation (pulses at 60 Hz with max. 4 sec train duration). Surgery was performed under general anaesthesia without muscle relaxants. Of 280 motor responses elicited by bipolar cortical stimulation, 54.28% [152] were located in the primary motor cortex (PMC). 37.85% [106] outside the motor strip in the secondary motor cortex (SMC), and 8% [22] posterior to the CS. Of 175 motor responses elicited by monopolar cortical stimulation 68.57% [120] were located in the SMC. 23.42% [41] in the SMC and 8% [14] posterior to the CS. Contrary to the general clinical view, there is considerable overlapping of primary motor units over a cortical area much broader than the "classical" narrow motor strip along the CS. Bipolar cortical stimulation is more sensitive than monopolar for mapping motor function in the premotor frontal cortex. Both methods are equally sensitive for mapping the primary motor cortex.
引用
收藏
页码:1295 / 1301
页数:7
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