Intraoperative Cortical Stimulation and the Value of Negative Mapping

  • Nader SanaiEmail author
  • Mitchel S. Berger


Direct cortical stimulation has been employed in neurosurgery since 1930, first by Foerster [1], and then later, by Penfield [2–4]. In recent years, the technique of intraoperative cortical stimulation has been adopted for the identification and preservation of language function and motor pathways. Stimulation depolarizes a very focal area of cortex which, in turn, evokes certain responses. Although the mechanism of stimulation effects on language are poorly understood, the principle is based upon the depolarization of local neurons and also of passing pathways, inducing local excitation or inhibition, as well as possible diffusion to more distant areas by way of orthodromic or antidromic propagation [5]. Studies employing optical imaging of bipolar cortical stimulation in monkey and human cortex have shown precise local changes, within 2–3 mm, after the activation of cortical tissue [6, 7]. With the advent of the bipolar probe, avoidance of local diffusion and more precise mapping have been enabled with an accuracy estimated to be approximately 5 mm [6].


Cortical Stimulation Cortical Site Stimulation Mapping Awake Craniotomy Direct Cortical Stimulation 
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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Neurological SurgeryBarrow Neurological InstitutePhoenixUSA
  2. 2.Department of Neurological SurgeryUCSF School of MedicineSan FranciscoUSA

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