Intraoperative cortico-cortical evoked potentials for the evaluation of language function during brain tumor resection: Initial experience with 13 cases

Taiichi Saito, Manabu Tamura, Yoshihiro Muragaki, Takashi Maruyama, Yuichi Kubota, Satoko Fukuchi, Masayuki Nitta, Mikhail Chernov, Saori Okamoto, Kazuhiko Sugiyama, Kaoru Kurisu, Kuniyoshi L. Sakai, Yoshikazu Okada, Hiroshi Iseki

Research output: Contribution to journalArticle

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Abstract

Methods. Intraoperative monitoring of CCEP was applied in 13 patients (mean age 34 ± 14 years) during the removal of neoplasms located within or close to language-related structures in the dominant cerebral hemisphere. For this purpose strip electrodes were positioned above the frontal language area (FLA) and temporal language area (TLA), which were identified with direct cortical stimulation and/or preliminary mapping with the use of implanted chronic subdural grid electrodes. The CCEP response was defined as the highest observed negative peak in either direction of stimulation. In 12 cases the tumor was resected during awake craniotomy.

Results. An intraoperative CCEP response was not obtained in one case because of technical problems. In the other patients it was identified from the FLA during stimulation of the TLA (7 cases) and from the TLA during stimulation of the FLA (5 cases), with a mean peak latency of 83 ± 15 msec. During tumor resection the CCEP response was unchanged in 5 cases, decreased in 4, and disappeared in 3. Postoperatively, all 7 patients with a decreased or absent CCEP response after lesion removal experienced deterioration in speech function. In contrast, in 5 cases with an unchanged intraoperative CCEP response, speaking abilities after surgery were preserved at the preoperative level, except in one patient who experienced not dysphasia, but dysarthria due to pyramidal tract injury. This difference was statistically significant (p < 0.01). The time required to recover speech function was also significantly associated with the type of intraoperative change in CCEP recordings (p < 0.01) and was, on average, 1.8 ± 1.0, 5.5 ± 1.0, and 11.0 ± 3.6 months, respectively, if the response was unchanged, was decreased, or had disappeared.

Conclusions. Monitoring CCEP is feasible during the resection of brain tumors affecting language-related cerebral structures. In the intraoperative evaluation of speech function, it can be a helpful adjunct or can be used in its direct assessment with cortical and subcortical mapping during awake craniotomy. It can also be used to predict the prognosis of language disorders after surgery and decide on the optimal resection of a neoplasm.

Object. The objective in the present study was to evaluate the usefulness of cortico-cortical evoked potentials (CCEP) monitoring for the intraoperative assessment of speech function during resection of brain tumors.

Original languageEnglish
Pages (from-to)827-838
Number of pages12
JournalJournal of Neurosurgery
Volume121
Issue number4
DOIs
Publication statusPublished - 2014 Oct 1
Externally publishedYes

Fingerprint

Evoked Potentials
Brain Neoplasms
Language
Intraoperative Monitoring
Craniotomy
Neoplasms
Electrodes
Language Disorders
Dysarthria
Pyramidal Tracts
Aptitude
Aphasia
Cerebrum
Wounds and Injuries

Keywords

  • Awake craniotomy
  • Brain tumor
  • Cortico-cortical evoked potentials
  • Diagnostic and operative techniques
  • Language function
  • Oncology
  • Surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Intraoperative cortico-cortical evoked potentials for the evaluation of language function during brain tumor resection : Initial experience with 13 cases. / Saito, Taiichi; Tamura, Manabu; Muragaki, Yoshihiro; Maruyama, Takashi; Kubota, Yuichi; Fukuchi, Satoko; Nitta, Masayuki; Chernov, Mikhail; Okamoto, Saori; Sugiyama, Kazuhiko; Kurisu, Kaoru; Sakai, Kuniyoshi L.; Okada, Yoshikazu; Iseki, Hiroshi.

In: Journal of Neurosurgery, Vol. 121, No. 4, 01.10.2014, p. 827-838.

Research output: Contribution to journalArticle

Saito, T, Tamura, M, Muragaki, Y, Maruyama, T, Kubota, Y, Fukuchi, S, Nitta, M, Chernov, M, Okamoto, S, Sugiyama, K, Kurisu, K, Sakai, KL, Okada, Y & Iseki, H 2014, 'Intraoperative cortico-cortical evoked potentials for the evaluation of language function during brain tumor resection: Initial experience with 13 cases', Journal of Neurosurgery, vol. 121, no. 4, pp. 827-838. https://doi.org/10.3171/2014.4.JNS131195
Saito, Taiichi ; Tamura, Manabu ; Muragaki, Yoshihiro ; Maruyama, Takashi ; Kubota, Yuichi ; Fukuchi, Satoko ; Nitta, Masayuki ; Chernov, Mikhail ; Okamoto, Saori ; Sugiyama, Kazuhiko ; Kurisu, Kaoru ; Sakai, Kuniyoshi L. ; Okada, Yoshikazu ; Iseki, Hiroshi. / Intraoperative cortico-cortical evoked potentials for the evaluation of language function during brain tumor resection : Initial experience with 13 cases. In: Journal of Neurosurgery. 2014 ; Vol. 121, No. 4. pp. 827-838.
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TY - JOUR

T1 - Intraoperative cortico-cortical evoked potentials for the evaluation of language function during brain tumor resection

T2 - Initial experience with 13 cases

AU - Saito, Taiichi

AU - Tamura, Manabu

AU - Muragaki, Yoshihiro

AU - Maruyama, Takashi

AU - Kubota, Yuichi

AU - Fukuchi, Satoko

AU - Nitta, Masayuki

AU - Chernov, Mikhail

AU - Okamoto, Saori

AU - Sugiyama, Kazuhiko

AU - Kurisu, Kaoru

AU - Sakai, Kuniyoshi L.

AU - Okada, Yoshikazu

AU - Iseki, Hiroshi

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Methods. Intraoperative monitoring of CCEP was applied in 13 patients (mean age 34 ± 14 years) during the removal of neoplasms located within or close to language-related structures in the dominant cerebral hemisphere. For this purpose strip electrodes were positioned above the frontal language area (FLA) and temporal language area (TLA), which were identified with direct cortical stimulation and/or preliminary mapping with the use of implanted chronic subdural grid electrodes. The CCEP response was defined as the highest observed negative peak in either direction of stimulation. In 12 cases the tumor was resected during awake craniotomy.Results. An intraoperative CCEP response was not obtained in one case because of technical problems. In the other patients it was identified from the FLA during stimulation of the TLA (7 cases) and from the TLA during stimulation of the FLA (5 cases), with a mean peak latency of 83 ± 15 msec. During tumor resection the CCEP response was unchanged in 5 cases, decreased in 4, and disappeared in 3. Postoperatively, all 7 patients with a decreased or absent CCEP response after lesion removal experienced deterioration in speech function. In contrast, in 5 cases with an unchanged intraoperative CCEP response, speaking abilities after surgery were preserved at the preoperative level, except in one patient who experienced not dysphasia, but dysarthria due to pyramidal tract injury. This difference was statistically significant (p < 0.01). The time required to recover speech function was also significantly associated with the type of intraoperative change in CCEP recordings (p < 0.01) and was, on average, 1.8 ± 1.0, 5.5 ± 1.0, and 11.0 ± 3.6 months, respectively, if the response was unchanged, was decreased, or had disappeared.Conclusions. Monitoring CCEP is feasible during the resection of brain tumors affecting language-related cerebral structures. In the intraoperative evaluation of speech function, it can be a helpful adjunct or can be used in its direct assessment with cortical and subcortical mapping during awake craniotomy. It can also be used to predict the prognosis of language disorders after surgery and decide on the optimal resection of a neoplasm.Object. The objective in the present study was to evaluate the usefulness of cortico-cortical evoked potentials (CCEP) monitoring for the intraoperative assessment of speech function during resection of brain tumors.

AB - Methods. Intraoperative monitoring of CCEP was applied in 13 patients (mean age 34 ± 14 years) during the removal of neoplasms located within or close to language-related structures in the dominant cerebral hemisphere. For this purpose strip electrodes were positioned above the frontal language area (FLA) and temporal language area (TLA), which were identified with direct cortical stimulation and/or preliminary mapping with the use of implanted chronic subdural grid electrodes. The CCEP response was defined as the highest observed negative peak in either direction of stimulation. In 12 cases the tumor was resected during awake craniotomy.Results. An intraoperative CCEP response was not obtained in one case because of technical problems. In the other patients it was identified from the FLA during stimulation of the TLA (7 cases) and from the TLA during stimulation of the FLA (5 cases), with a mean peak latency of 83 ± 15 msec. During tumor resection the CCEP response was unchanged in 5 cases, decreased in 4, and disappeared in 3. Postoperatively, all 7 patients with a decreased or absent CCEP response after lesion removal experienced deterioration in speech function. In contrast, in 5 cases with an unchanged intraoperative CCEP response, speaking abilities after surgery were preserved at the preoperative level, except in one patient who experienced not dysphasia, but dysarthria due to pyramidal tract injury. This difference was statistically significant (p < 0.01). The time required to recover speech function was also significantly associated with the type of intraoperative change in CCEP recordings (p < 0.01) and was, on average, 1.8 ± 1.0, 5.5 ± 1.0, and 11.0 ± 3.6 months, respectively, if the response was unchanged, was decreased, or had disappeared.Conclusions. Monitoring CCEP is feasible during the resection of brain tumors affecting language-related cerebral structures. In the intraoperative evaluation of speech function, it can be a helpful adjunct or can be used in its direct assessment with cortical and subcortical mapping during awake craniotomy. It can also be used to predict the prognosis of language disorders after surgery and decide on the optimal resection of a neoplasm.Object. The objective in the present study was to evaluate the usefulness of cortico-cortical evoked potentials (CCEP) monitoring for the intraoperative assessment of speech function during resection of brain tumors.

KW - Awake craniotomy

KW - Brain tumor

KW - Cortico-cortical evoked potentials

KW - Diagnostic and operative techniques

KW - Language function

KW - Oncology

KW - Surgery

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