Intraoperative neurophysiology of the motor system in children: a tailored approach.
BACKGROUND
Intraoperative neurophysiology has moved giant steps forward over the past 15 years thanks to the advent of techniques aimed to reliably assess the functional integrity of motor areas and pathways.
Motor evoked potentials recorded from the muscles and/or the spinal cord (D-wave) after transcranial electrical stimulation allow to preserve the integrity of descending pathways, especially the corticospinal tract (CT), during brain and spinal cord surgery. Mapping techniques allow to identify the motor cortex through direct cortical stimulation and to localize the CT at subcortical levels during brain and brainstem surgery. These techniques are extensively used in adult neurosurgery and, in their principles, can be applied to children. However, especially in younger children, the motor system is still under development, making both mapping and monitoring techniques more challenging. In this paper, we review intraoperative neurophysiological techniques commonly used in adult neurosurgery and discuss their application to pediatric neurosurgery, in the light of preliminary experience from our and other centers. The principles of development and maturation of the motor system, and especially of the CT, are reviewed focusing on clinical studies with transcranial magnetical stimulation.
Section of Neurosurgery, Department of Neurological and Visual Sciences, University Hospital, Piazzale Stefani 1, 37124 Verona, Italy. francesco.sala@univr.it
Francesco
F
Sala
Paolo
P
Manganotti
Stefan
S
Grossauer
Vincenzo
V
Tramontanto
Carlo
C
Mazza
Massimo
M
Gerosa
D000818:Animals; D001921:Brain / Q000502:physiology* / Q000601:surgery; D002648:Child; D004525:Efferent Pathways / Q000502:physiology* / Q000601:surgery; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods*; D009482:Neurophysiology / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods; D013116:Spinal Cord / Q000502:physiology* / Q000601:surgery