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Axono-cortical evoked potentials as a new method of IONM for preserving the motor control network: a first study in three cases

  • Original Article - Tumor - Glioma
  • Published:
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Abstract

Background

White matter stimulation in an awake patient is currently the gold standard for identification of functional pathways. Despite the robustness and reproducibility of this method, very little is known about the electrophysiological mechanisms underlying the functional disruption. Axono-cortical evoked potentials (ACEPs) provide a reliable technique to explore these mechanisms.

Objective

To describe the shape and spatial patterns of ACEPs recorded when stimulating the white matter of the caudal part of the right superior frontal gyrus while recording in the precentral gyrus.

Methods

We report on three patients operated on under awake condition for a right superior frontal diffuse low-grade glioma. Functional sites were identified in the posterior wall of the cavity, whose 2–3-mA stimulation generated an arrest of movement. Once the resection was done, axono-cortical potentials were evoked: recording electrodes were put over the precentral gyrus, while stimulating at 1 Hz the white matter functional sites during 30–60 s. Unitary evoked potentials were averaged off-line. Waveform was visually analyzed, defining peaks and troughs, with quantitative measurements of their amplitudes and latencies. Spatial patterns of ACEPs were compared with patients’ own and HCP-derived structural connectomics.

Results

Axono-cortical evoked potentials (ACEPs) were obtained and exhibited complex shapes and spatial patterns that correlated only partially with structural connectivity patterns.

Conclusion

ACEPs is a new IONM methodology that could both contribute to elucidate the propagation of neuronal activity within a distributed network when stimulating white matter and provide a new technique for preserving motor control abilities during brain tumor resections.

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Acknowledgments

MD was supported by the CRC-chirurgie 2016 from AP-HP. EM was supported by INSERM, contrat interface 2018.

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Authors and Affiliations

  1. Parietal, Inria Saclay Ile-de-France, CEA, Université Paris-Sud, Palaiseau, France

    Demian Wasserman

  2. Frontlab, Institut du Cerveau, CNRS UMR 7225, INSERM U1127, Paris, France

    Antoni Valero-Cabré, Chloé Stengel & Emmanuel Mandonnet

  3. Institut Neuro-PSI - UMR 9197, CNRS, Université Paris-Saclay, Gif-Sur-Yvette, France

    Mélissa Dali

  4. Department of Neurosurgery, Lariboisière Hospital, APHP, 2 rue Ambroise Paré, 75010, Paris, France

    Mélissa Dali & Emmanuel Mandonnet

  5. Brain Stimulation and Systems Neuroscience, INSERM U1216, Grenoble, France

    Anthony Boyer

  6. Sherbrooke Connectivity Imaging Lab, Department of Computer Science, Faculty of Sciences, Université de Sherbrooke, Sherbrooke, Canada

    François Rheault

  7. INRIA, University of Montpellier, LIRMM, CAMIN team, Montpellier, France

    François Bonnetblanc

  8. Université de Paris, Paris, France

    Emmanuel Mandonnet

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  1. Demian Wasserman
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  2. Antoni Valero-Cabré
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  3. Mélissa Dali
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Correspondence to Emmanuel Mandonnet.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee of Lariboisière hospital and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study.

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Wasserman, D., Valero-Cabré, A., Dali, M. et al. Axono-cortical evoked potentials as a new method of IONM for preserving the motor control network: a first study in three cases. Acta Neurochir 163, 919–935 (2021). https://doi.org/10.1007/s00701-020-04636-8

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  • DOI: https://doi.org/10.1007/s00701-020-04636-8

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