title: Comparison of effectiveness between cork-screw and peg-screw electrodes for transcranial motor evoked potential monitoring using the finite element method.
abstract: BACKGROUND
  Intraoperative monitoring of motor evoked potentials by transcranial electric stimulation is popular in neurosurgery for monitoring motor function preservation. Some authors have reported that the peg-screw electrodes screwed into the skull can more effectively conduct current to the brain compared to subdermal cork-screw electrodes screwed into the skin. The aim of this study was to investigate the influence of electrode design on transcranial motor evoked potential monitoring. We estimated differences in effectiveness between the cork-screw electrode, peg-screw electrode, and cortical electrode to produce electric fields in the brain.
  
  
  METHODS
  We used the finite element method to visualize electric fields in the brain generated by transcranial electric stimulation using realistic three-dimensional head models developed from T1-weighted images. Surfaces from five layers of the head were separated as accurately as possible. We created the "cork-screws model," "1 peg-screw model," "peg-screws model," and "cortical electrode model".
  
  
  RESULTS
  Electric fields in the brain radially diffused from the brain surface at a maximum just below the electrodes in coronal sections. The coronal sections and surface views of the brain showed higher electric field distributions under the peg-screw compared to the cork-screw. An extremely high electric field was observed under cortical electrodes.
  
  
  CONCLUSIONS
  Our main finding was that the intensity of electric fields in the brain are higher in the peg-screw model than the cork-screw model.
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, Shinjuku, Tokyo.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tomio
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, Shinjuku, Tokyo.
authors.forename: Takenori
authors.initials: T
authors.lastname: Akiyama
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, Shinjuku, Tokyo.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ohira
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, Shinjuku, Tokyo.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Yoshida
keywords: Finite element method; screw; transcranial electric stimulation; transcranial motor evoked potential