NEUROPHYSIOLOGY IN NEUROSURGERY SECOND EDITION https://www.elsevier.com/books-and-journals/book-companion/9780128150009/ Neurophysiology in Neurosurgery Vedran Deletis, Jay L. Shils, Francesco Sala, Kathleen Seidel, Editors Resources available: Chapter 2 - Intraoperative neurophysiology and methodologies used to monitor the functional integrity of the motor system (Video 2.1) Chapter 9 - Cortical and subcortical brain mapping (Videos 9.1, 9.2) Chapter 12 - Neurophysiological identification of long sensory and motor tracts within the spinal cord (Videos 12.1, 12.2, 12.3) Chapter 15 - Intraoperative monitoring of the vagus and laryngeal nerves with the laryngeal adductor reflex (Videos 15.1, 15,2) Chapter 16 - Bringing the masseter reflex into the operating room (Video 16.1) Chapter 24 - Surgery of the face (Video 24.1) Chapter 29 - Neurophysiological monitoring during endovascular procedures on the spine and the spinal cord (Video 29.1) Chapter 34 - Neurophysiological monitoring during neurosurgery for movement disorders (Video 34.1) Chapter 36 - Deep brain stimulation for treatment patients in vegetative state and minimally conscious state (Videos 36.1, 36.2, 36.3, 36.4, 36.5) Chapter 37 - Neuromonitoring for spinal cord stimulation placement under general anesthesia (Videos 37.1, 37.2) NEUROPHYSIOLOGY IN NEUROSURGERY A Modern Approach SECOND EDITION Edited by V D EDRAN ELETIS DepartmentofNeurosurgery,UniversityHospitalDubrava,Zagreb,Croatia AlbertEinsteinCollegeofMedicine,NewYork,NY,UnitedStates J L. S AY HILS DepartmentofAnesthesiology,RushUniversityMedicalCenter,Chicago,IL,UnitedStates F S RANCESCO ALA SectionofNeurosurgery,DepartmentofNeurosciences,BiomedicineandMovementSciences,UniversityHospital,Verona,Italy K S ATHLEEN EIDEL DepartmentofNeurosurgery,InselspitalBernUniversityHospital,Bern,Switzerland Academic Press isan imprint of Elsevier 125 London Wall, London EC2Y 5AS, UnitedKingdom 525 BStreet, Suite 1650, San Diego, CA 92101,United States 50 Hampshire Street, 5th Floor, Cambridge,MA 02139,United States TheBoulevard, LangfordLane,Kidlington, OxfordOX5 1GB,United Kingdom Copyright© 2020 Elsevier Inc. All rights reserved. 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British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library ofCongress Cataloging-in-Publication Data A catalog record for this book isavailable from the Library of Congress ISBN: 978-0-12-815000-9 For Information on all Academic Press publications visit our website at https://www.elsevier.com/books-and-journals Publisher: Nikki Levy Acquisitions Editor: Melanie Tucker EditorialProjectManager: Megan Ashdown ProductionProjectManager: Sujatha Thirugnana Sambandam Cover Designer:MatthewLimbert Typeset by MPS Limited,Chennai, India Dedication This book is dedicated to two extraordinary men, Vahe Amassian and Fred Epstein. Both of these extraordi- nary individuals changed our professional lives and made a significant impact on the fields of intraoperative neurophysiology and neurosurgery. Vahe was French-born neurophysiologist, from Armenian parents, educated in the United Kingdom, where he made part of his professional carrier as a neurophysiologist, and later on moved to the United States where he continued to work with great success and achievement. Vahe’s work on the physiology of the nervous system describing D and I waves of corticospinal neurons [1] was the basis for the development of present methodolo- gies for intraoperative monitoring of motor-evoked potentials. Vahe was actively involved throughout the devel- opment of this methodology. Vahe generously shared his enormous intellectual talent and his vast knowledge. Vahe was always an inspiration for us and our colleagues. Vahe was the quintessential great teacher and mentor youremember for life. Fred was larger than life. Growing up he battled with circumstances that made every academic achievement a hard-earned victory. He beat that, and went on to reach further. Having become an accomplished and leading pediatric neurosurgeon, he developed pioneering surgeries in the brainstem and spinal cord. In doing this he realized the potential of intraoperative neurophysiology. Thus he was a very early advocate of the utilization of intraoperative neurophysiologic techniques to make complex operations in critical areas safer, better, and possi- bleat all. Asa world-renowned neurosurgeon he said, “Monitoring is themostinteresting thing we do here!” Fred had an amazing ability to see forest, when most of us only saw trees. And that applied to his vision of intraoperative neurophysiology. Following this vision he was instrumental in many of intraoperative neurophy- siology’sdevelopments and this bookis testament to thefact that he was right. Vedran Deletis and Karl Kothbauer Reference [1] Patton HD, Amassian VE. Single and multiple unit analysis of the cortical state of pyramidal tract activation. J Neurophysiol 1954;17:345(cid:1)63. Contents List of contributors xiii 3.2 History 35 Preface xvii 3.3 Methodology 35 3.4 Warningcriteria 45 Intraoperative neurophysiological 3.5 Corticalsomatosensoryevokedpotentialmapping 47 monitoring—why we need it and a personal 3.6 Futuredirections 48 perspective of its development xix 3.7 Conclusion 48 JOHANNESSCHRAMMANDAZIZEBOSTRO¨M References 49 I 4. Neurophysiology of the visual system: basics INTRODUCTION TO and intraoperative neurophysiology techniques 53 INTRAOPERATIVE KUNIHIKOKODAMAANDTETSUYAGOTO NEUROPHYSIOLOGY 4.1 Introduction 53 4.2 Historicalreview 53 4.3 Neurophysiologyofthevisualpathway 54 1. Animal and human motor system 4.4 Recordingofintraoperativeflashvisualevokedpotentials 55 4.5 Results 58 neurophysiology related to intraoperative 4.6 Opticnerveactionpotentialsandevokedpotentials 62 monitoring 3 4.7 Monitoringandmappingtheposteriorvisualpathway 63 VAHEE.AMASSIAN 4.8 Conclusion 64 References 64 1.1 Introduction 3 1.2 Corticospinalresponses 4 1.3 Muscleresponses 12 5. Neurophysiology of the auditory system: References 14 basics and ION techniques 65 AAGER.MØLLER 2. Intraoperative neurophysiology and methodologies used to monitor the functional 5.1 Theauditorynerve 65 5.2 Historyofrecordingsoftheauditorybrainstemresponse 65 integrity of the motor system 17 5.3 Generationoffar-field-evokedpotentials 67 VEDRANDELETIS 5.4 Intraoperativeneurophysiologicalmonitoringofthe auditorybrainstemresponse 67 2.1 Intraoperativemonitoringofthemotorsystem:abrief 5.5 Detectionofsignsofhearinglossfrommanipulations history 17 oftheauditorynerve 72 2.2 Newmethodologies 19 5.6 Recordingdirectlyfromtheexposedauditorynerve 72 2.3 Methodologicalaspectsoftranscranialelectrical 5.7 Recordingoftheresponsefromthecochlearnucleus 73 stimulationduringgeneralanesthesia 19 5.8 Whattoreporttothesurgeon? 75 2.4 RecordingofMEPsoverthespinalcord(epiduraland 5.9 Theneuralgeneratorsoftheauditorybrainstemresponse 77 subduralspaces)usingsingle-pulsestimulation 5.10 Useofauditorybrainstemresponseinmonitoringto technique 22 detectchangesinthefunctionofthebrainstem 82 2.5 Recordingofmotor-evokedpotentialsinlimbmuscles References 84 elicitedbyamultipulsestimulatingtechnique 27 2.6 Conclusion 32 References 33 6. Intraoperative neurophysiological monitoring of the sacral nervous system 87 3. Monitoring somatosensory evoked potentials 35 DAVIDB.VODUSˇEKANDVEDRANDELETIS DAVIDB.MACDONALD 6.1 Introduction 87 3.1 Introduction 35 6.2 Functionalanatomy 88 vii viii Contents 6.3 Clinicalneurophysiologicaltestsindiagnostics 89 10. Corticobulbar motor evoked potentials in 6.4 Intraoperativeclinicalneurophysiology 90 skull base surgery 137 6.5 DiscussionandConclusion 96 ISABELFERNA´NDEZ-CONEJERO References 98 Furtherreading 99 10.1 Introduction 137 10.2 Methodology 139 7. Neurophysiology of language and cognitive 10.3 Anesthesiaregime 141 10.4 Facialcorticobulbarmotorevokedpotentials 141 mapping 101 10.5 Vagalcorticobulbarmotorevokedpotentials 144 LORENZOBELLO,MARCOROSSI,MARCOCONTINIBALI, 10.6 Limitationsofcorticobulbarmotorevokedpotentials 147 TOMMASOSCIORTINO,GUGLIELMOPUGLISI,ANTONELLALEONETTI, 10.7 Conclusion 148 LUCAFORNIA,LORENZOGAYANDMARCORIVA References 148 7.1 Introduction 101 7.2 Languagemapping 102 11. Brain stem mapping 151 7.3 Advancedmapping:cognitivemapping 109 7.4 Conclusion 109 NOBUHITOMOROTA,VEDRANDELETISANDFREDEPSTEIN References 110 11.1 Introduction 151 11.2 Methodologyofbrainstemmapping 154 8. Effects of subthreshold stimuli on the 11.3 Resultsofbrainstemmapping 155 excitability of axonal membrane 113 11.4 Surgicalimplicationsofbrainstemmapping 158 11.5 Clinicallimitationsofbrainstemmapping 158 JAVIERURRIZA 11.6 Representativecaseofbrainstemmapping 158 11.7 Clinicalapplicationofbrainstemmapping 159 8.1 Introduction 113 11.8 Conclusion 161 8.2 Methodology 113 References 161 8.3 Results 115 8.4 Discussion 115 8.5 Conclusion 116 12. Neurophysiological identification of long References 117 sensory and motor tracts within the spinal cord 163 II VEDRANDELETISANDKATHLEENSEIDEL 12.1 Introduction 163 INTRAOPERATIVE 12.2 Dorsalcolumnmapping 163 NEUROPHYSIOLOGY: 12.3 Corticospinaltractmapping 167 NEUROPHYSIOLOGIC 12.4 Conclusion 174 References 174 PERSPECTIVE 13. Electromyographic monitoring for pedicle screw placements 177 9. Cortical and subcortical brain mapping 121 RICHARDJ.TOLEIKIS KATHLEENSEIDELANDANDREASRAABE 13.1 Introduction 177 9.1 Introduction 121 13.2 Monitoringpediclescrewplacements 178 9.2 Brainmappingandanesthesia 121 13.3 Conclusion 189 9.3 Recordinganddocumentation 122 References 190 9.4 Physicalbackground 124 9.5 Choiceofstimulationparadigm 124 9.6 Choiceofstimulationprobe 126 14. Clinical and neurophysiologic features of the pure 9.7 Subcorticalmappinganddistancetothecorticospinal motor deficit syndrome caused by selective upper tract 126 motor neuron lesion: contribution to a new 9.8 Continuoussubcorticalmapping 128 9.9 Possiblepitfalls 130 neurological entity 195 9.10 Caseillustrations 131 BEATRIZARRANZARRANZ 9.11 Summaryandconclusion 131 Acknowledgment 132 14.1 Introduction 195 References 132 14.2 Underlyingpathologyofpuremotordeficit 195 ix Contents 14.3 Diagnosis 196 18.5 Physiologyandelectromyographiccharacteristicsof 14.4 Methodologies 199 posteriorroot-musclereflexes 242 14.5 Topographyofthecorticospinaltractand 18.6 Examplesofintraoperativemonitoringapplications 247 corticobulbartractlesionsproducingpuremotordeficit 199 18.7 Conclusion 250 14.6 Prognosis 203 References 251 14.7 Conclusion 204 IV References 204 Furtherreading 204 INTRAOPERATIVE III NEUROPHYSIOLOGY: SURGICAL PERSPECTIVE NEUROPHYSIOLOGY OF BRAINSTEM AND SPINAL CORD REFLEXES 19. Functional approach to brain tumor surgery: awake setting 257 15. Intraoperative monitoring of the vagus and LORENZOBELLO,MARCOROSSI,MARCOCONTINIBALI, laryngeal nerves with the laryngeal adductor TOMMASOSCIORTINO,MARCORIVAANDFEDERICOPESSINA reflex 209 19.1 Introduction 257 MARIAJ.TE´LLEZ,SEDATULKATANANDCATHERINEF.SINCLAIR 19.2 Rationaleofsurgicaltreatment 257 19.3 Theconceptoffunctionalneuro-oncology:resection 15.1 Introduction 209 accordingtofunctionalboundaries 257 15.2 History 210 19.4 Preoperativeworkup 258 15.3 Methodology 212 19.5 Decisionforsurgery 261 15.4 Examples 218 19.6 Intraoperativesetup 261 15.5 Conclusion 220 19.7 Surgicaltime 263 References 220 19.8 Howtomanageintraoperativecomplications 265 19.9 Functionalresultsofsurgery 266 16. Bringing the masseter reflex into the 19.10 Conclusion 266 operating room 223 References 266 MARIAJ.TE´LLEZANDSEDATULKATAN Furtherreading 269 16.1 Introduction 223 20. Surgery of brain tumors asleep 271 16.2 History 223 16.3 Methodology 224 DAVIDEGIAMPICCOLO,CRISTIANOPARISI, 16.4 Examples 227 VINCENZOTRAMONTANOANDFRANCESCOSALA 16.5 Conclusion 227 20.1 Introduction 271 References 227 20.2 Corticalmapping 272 20.3 Monitoring 275 17. Blink reflex 229 20.4 Subcorticalmapping 276 ISABELFERNA´NDEZ-CONEJEROANDVEDRANDELETIS 20.5 Conclusion 280 References 280 17.1 Introduction 229 17.2 Methodology 230 17.3 Anestheticconsiderations 231 21. Surgery and intraoperative neurophysiological 17.4 Clinicalassessment/results 231 monitoring for aneurysm clipping 283 17.5 Practicalapplications 231 ANDREASZELE´NYIANDGEORGNEULOH 17.6 Summary 236 References 237 21.1 Introduction 283 21.2 Somatosensory-evokedpotentials 283 18. The posterior root-muscle reflex 239 21.3 Motor-evokedpotentials 284 21.4 Earlyauditory-evokedpotentials 285 KARENMINASSIAN,BRIGITTAFREUNDLAND 21.5 Visual-evokedpotentials 286 URSULAS.HOFSTOETTER 21.6 Generalremarksforsafetyconsiderationsand 18.1 Introduction 239 anesthesia 287 18.2 History 239 21.7 IntraoperativeNeuromonitoring(ION)andsurgical 18.3 Anatomyoftheposteriorroots 240 workflow 287 18.4 Methodologiesforevokingposteriorroot-muscle 21.8 Surgicalaspectsincerebrovascularsurgery 288 reflexes 241 21.9 Vascularterritoriesandrecommendedrecordings 288