Abstract:
:OBJECTIVE Transcranial motor evoked potential (tMEP) monitoring is popular in neurosurgery; however, the accuracy of tMEP can be impaired by craniotomy. Each craniotomy procedure and changes in the CSF levels affects the current spread. The aim of this study was to investigate the influence of several craniotomies on tMEP monitoring by using C3-4 transcranial electrical stimulation (TES). METHODS The authors used the finite element method to visualize the electric field in the brain, which was generated by TES, using realistic 3D head models developed from T1-weighted MR images. Surfaces of 5 layers of the head (brain, CSF, skull, subcutaneous fat, and skin layer) were separated as accurately as possible. The authors created 5 models of the head, as follows: normal head; frontotemporal craniotomy; parietal craniotomy; temporal craniotomy; and occipital craniotomy. The computer simulation was investigated by finite element methods, and clinical recordings of the stimulation threshold level of upper-extremity tMEP (UE-tMEP) during neurosurgery were also studied in 30 patients to validate the simulation study. RESULTS Bone removal during the craniotomy positively affected the generation of the electric field in the motor cortex if the motor cortex was just under the bone at the margin of the craniotomy window. This finding from the authors' simulation study was consistent with clinical reports of frontotemporal craniotomy cases. A major decrease in CSF levels during an operation had a significantly negative impact on the electric field when the motor cortex was exposed to air. The CSF surface level during neurosurgery depends on the body position and location of the craniotomy. The parietal craniotomy and temporal craniotomy were susceptible to the effect of the changing CSF level, based on the simulation study. A marked increase in the threshold following a decrease in CSF was actually recorded in clinical reports of the UE-tMEP threshold from a temporal craniotomy. However, most frontotemporal craniotomy cases were minimally affected by a small decrease in CSF. CONCLUSIONS Bone removal during a craniotomy positively affects the generation of the electric field in the motor cortex if the motor cortex is just under the bone at the margin of the craniotomy window. The CSF decrease and the shifting brain can negatively affect tMEP ignition. These changes should be minimized to maintain the original conductivity between the motor cortex and the skull, and the operation team must remember the fluctuation of the tMEP threshold.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Tomio R,Akiyama T,Toda M,Ohira T,Yoshida Kdoi
10.3171/2016.7.JNS152759subject
Has Abstractpub_date
2017-09-01 00:00:00pages
543-552issue
3eissn
0022-3085issn
1933-0693journal_volume
127pub_type
杂志文章abstract:OBJECT:This study was conducted to evaluate the value of postoperative CT scans in determining the probability of return to the operating room (OR) and the optimal time to obtain such scans to determine the effects of surgery. METHODS:Between January and December 2006 (12 months), all postoperative head CT scans obtai...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2009.11.JNS081048
更新日期:2010-11-01 00:00:00
abstract::Since the discovery of melatonin approximately 25 years ago, there has been intense study regarding the details of the structure and function of the pineal gland. This work is reviewed, with particular emphasis on those aspects of importance to human physiology and disease. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
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abstract::Forty-five children harboring brain-stem tumors were treated at the University of California, San Francisco, between 1969 and 1979. Pathological diagnoses were made in 19 patients. All patients received radiation therapy (RT). Thirteen patients received chemotherapy before, during, or immediately after RT. Twenty-four...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1981.54.6.0721
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pub_type: 杂志文章
doi:10.3171/jns.1997.87.2.0184
更新日期:1997-08-01 00:00:00
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pub_type: 历史文章,杂志文章,评审
doi:10.3171/2012.1.JNS111786
更新日期:2012-07-01 00:00:00
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doi:10.3171/2017.8.JNS171167
更新日期:2018-03-02 00:00:00
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pub_type: 杂志文章
doi:10.3171/jns.1995.83.1.0133
更新日期:1995-07-01 00:00:00
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pub_type: 杂志文章
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更新日期:2010-09-01 00:00:00
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pub_type: 杂志文章
doi:10.3171/jns.1977.47.5.0663
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journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
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pub_type: 杂志文章
doi:10.3171/2011.1.JNS101657
更新日期:2011-06-01 00:00:00
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更新日期:2011-02-01 00:00:00
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doi:10.3171/spi.2002.96.3.0309
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pub_type: 杂志文章
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2018-08-24 00:00:00
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更新日期:2019-03-08 00:00:00
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pub_type: 杂志文章
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更新日期:2004-05-01 00:00:00
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pub_type: 杂志文章
doi:10.3171/jns.1979.51.4.0429
更新日期:1979-10-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:1997-07-01 00:00:00
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pub_type: 杂志文章
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