Intraoperative neurophysiology for surgery in and around the brainstem: role of brainstem mapping and corticobulbar tract motor-evoked potential monitoring.
BACKGROUND
New advancements of intraoperative neurophysiology for surgery in and around the brainstem have been described. NEUROPHYSIOLOGICAL TECHNIQUES: Brainstem mapping (BSM) is applied to locate cranial nerves and their motor nuclei (CMN) on the floor of the fourth ventricle. Corticobulbar tract (CBT) motor-evoked potential (MEP) monitoring is used to achieve on-line monitoring of the cranial motor nerves' functional integrity.


CONCLUSIONS
Each of these procedures bears a specific role: BSM can help avoid direct damage to CMNs on the fourth ventricular floor; CBT-MEP can provide simultaneous feedback on the functional integrity of the CBT and CMN during surgery, eventually leading to "tailored" modifications of the surgical procedure, based upon neurophysiological responses.


CONCLUSIONS
CBT-MEP monitoring has less restriction in terms of clinical indications, but a combination of both procedures is essential for functional preservation of CMNs during surgery in and around the brainstem.
Department of Neurosurgery, National Children's Medical Center, National Center for Child Health and Development, Tokyo, Japan. morota-n@ncchd.go.jp
Nobuhito
N
Morota
Satoshi
S
Ihara
Vedran
V
Deletis
D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D001933:Brain Stem / Q000503:physiopathology* / Q000601:surgery*; D002675:Child, Preschool; D004806:Ependymoma / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D011712:Pyramidal Tracts / Q000503:physiopathology / Q000601:surgery; D018335:Rhabdoid Tumor / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D013724:Teratoma / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery