A review of monopolar motor mapping and a comprehensive guide to continuous dynamic motor mapping for resection of motor eloquent brain tumors.

Schucht, Philippe; Seidel, Kathleen; Jilch, Astrid; Beck, Jürgen; Raabe, Andreas (2017). A review of monopolar motor mapping and a comprehensive guide to continuous dynamic motor mapping for resection of motor eloquent brain tumors. Neurochirurgie, 63(3), pp. 175-180. Elsevier Masson SAS 10.1016/j.neuchi.2017.01.007

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Monopolar mapping of motor function differs from the most commonly used method of intraoperative mapping, i.e. bipolar direct electrical stimulation at 50-60Hz (Penfield technique mapping). Most importantly, the monopolar probe emits a radial, homogenous electrical field different to the more focused inter-tip bipolar electrical field. Most users combine monopolar stimulation with the short train technique, also called high frequency stimulation, or train-of-five techniques. It consists of trains of four to nine monopolar rectangular electrical pulses of 200-500μs pulse length with an inter stimulus interval of 2-4msec. High frequency short train stimulation triggers a time-locked motor-evoked potential response, which has a defined latency and an easily quantifiable amplitude. In this way, motor thresholds might be used to evaluate a current-to-distance relation. The homogeneous electrical field and the current-to-distance approximation provide the surgeon with an estimate of the remaining distance to the corticospinal tract, enabling the surgeon to adjust the speed of resection as the corticospinal tract is approached. Furthermore, this stimulation paradigm is associated with a lower incidence of intraoperative seizures, allowing continuous stimulation. Hence, monopolar mapping is increasingly used as part of a strategy of continuous dynamic mapping: ergonomically integrated into the surgeon's tools, the monopolar probe reliably provides continuous/uninterrupted feedback on motor function. As part of this strategy, motor mapping is not any longer a time consuming interruption of resection but rather a radar-like, real-time information system on the spatial relationship of the current resection site to eloquent motor structures.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Schucht, Philippe; Seidel, Kathleen; Jilch, Astrid; Beck, Jürgen and Raabe, Andreas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0028-3770

Publisher:

Elsevier Masson SAS

Language:

English

Submitter:

Nicole Söll

Date Deposited:

26 Feb 2018 08:27

Last Modified:

26 Feb 2018 08:27

Publisher DOI:

10.1016/j.neuchi.2017.01.007

PubMed ID:

28506487

Uncontrolled Keywords:

Continuous dynamic mapping Glioma surgery Intraoperative neuromonitoring Monopolar motor mapping Motor-evoked potential

URI:

https://boris.unibe.ch/id/eprint/107911

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