Direct electrical stimulation as an input gate into brain functional networks: principles, advantages and limitations

被引:155
作者
Mandonnet, Emmanuel [1 ,2 ]
Winkler, Peter A. [3 ]
Duffau, Hugues [4 ]
机构
[1] Hop Lariboisiere, Dept Neurosurg, Serv Neurochirurg, F-75010 Paris, France
[2] UPMC, INSERM, U678, F-75634 Paris 13, France
[3] Univ Munich, Dept Neurosurg, Klinikum Grosshadern, D-81377 Munich, Germany
[4] CHU Montpellier, Dept Neurosurg, Hop Gui Chauliac, F-34295 Montpellier 5, France
关键词
Brain mapping; Connectivity; Direct electrical stimulation; Neural networks; Plasticity; LOW-GRADE GLIOMAS; MOTOR CORTEX STIMULATION; INTRAOPERATIVE STIMULATION; ACCURACY LIMITATIONS; CONDUCTION APHASIA; CONSECUTIVE SERIES; LANGUAGE PATHWAYS; CELL-BODIES; SURGERY; RESECTION;
D O I
10.1007/s00701-009-0469-0
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
While the fundamental and clinical contribution of direct electrical stimulation (DES) of the brain is now well acknowledged, its advantages and limitations have not been re-evaluated for a long time. Here, we critically review exactly what DES can tell us about cerebral function. First, we show that DES is highly sensitive for detecting the cortical and axonal eloquent structures. Moreover, DES also provides a unique opportunity to study brain connectivity, since each area responsive to stimulation is in fact an input gate into a large-scale network rather than an isolated discrete functional site. DES, however, also has a limitation: its specificity is suboptimal. Indeed, DES may lead to interpretations that a structure is crucial because of the induction of a transient functional response when stimulated, whereas (1) this effect is caused by the backward spreading of the electro-stimulation along the network to an essential area and/or (2) the stimulated region can be functionally compensated owing to long-term brain plasticity mechanisms. In brief, although DES is still the gold standard for brain mapping, its combination with new methods such as perioperative neurofunctional imaging and biomathematical modeling is now mandatory, in order to clearly differentiate those networks that are actually indispensable to function from those that can be compensated.
引用
收藏
页码:185 / 193
页数:9
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