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Intraoperative neurophysiology for surgery in and around the brainstem: role of brainstem mapping and corticobulbar tract motor-evoked potential monitoring

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Abstract

Introduction

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.

Discussion

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.

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Acknowledgment

The authors are grateful to Dr. Paolo Rizzo for the assistance with manuscript preparation.

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Authors and Affiliations

  1. Department of Neurosurgery, National Children’s Medical Center, National Center for Child Health and Development, Tokyo, Japan

    Nobuhito Morota & Satoshi Ihara

  2. Division of Intraoperative Neurophysiology, St. Luke’s/Roosevelt Hospital, New York, NY, USA

    Vedran Deletis

Authors
  1. Nobuhito Morota
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  2. Satoshi Ihara
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  3. Vedran Deletis
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Correspondence to Nobuhito Morota.

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Morota, N., Ihara, S. & Deletis, V. Intraoperative neurophysiology for surgery in and around the brainstem: role of brainstem mapping and corticobulbar tract motor-evoked potential monitoring. Childs Nerv Syst 26, 513–521 (2010). https://doi.org/10.1007/s00381-009-1080-7

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  • DOI: https://doi.org/10.1007/s00381-009-1080-7

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