Intraoperative identification of the corticospinal tract and dorsal column of the spinal cord by electrical stimulation.

Deletis, Vedran; Seidel, Kathleen; Sala, Francesco; Raabe, Andreas; Chudy, Darko; Beck, Jürgen; Kothbauer, Karl F (2018). Intraoperative identification of the corticospinal tract and dorsal column of the spinal cord by electrical stimulation. Journal of neurology, neurosurgery and psychiatry, 89(7), pp. 754-761. BMJ Publishing Group 10.1136/jnnp-2017-317172

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OBJECTIVES Anatomical identification of the corticospinal tract (CT) and the dorsal column (DC) of the exposed spinal cord is difficult when anatomical landmarks are distorted by tumour growth. Neurophysiological identification is complicated by the fact that direct stimulation of the DC may result in muscle motor responses due to the centrally activated H-reflex. This study aims to provide a technique for intraoperative neurophysiological differentiation between CT and DC in the exposed spinal cord. METHODS Recordings were obtained from 32 consecutive patients undergoing spinal cord tumour surgery from July 2015 to March 2017. A double train stimulation paradigm with an intertrain interval of 60 ms was devised with recording of responses from limb muscles. RESULTS In non-spastic patients (55% of cohort) an identical second response was noted following the first CT response, but the second response was absent after DC stimulation. In patients with pre-existing spasticity (45%), CT stimulation again resulted in two identical responses, whereas DC stimulation generated a second response that differed substantially from the first one. The recovery times of interneurons in the spinal cord grey matter were much shorter for the CT than those for the DC. Therefore, when a second stimulus train was applied 60 ms after the first, the CT-fibre interneurons had already recovered ready to generate a second response, whereas the DC interneurons were still in the refractory period. CONCLUSIONS Mapping of the spinal cord using double train stimulation allows neurophysiological distinction of CT from DC pathways during spinal cord surgery in patients with and without pre-existing spasticity.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Seidel, Kathleen; Raabe, Andreas and Beck, Jürgen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0022-3050

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Nicole Söll

Date Deposited:

23 Apr 2018 11:42

Last Modified:

04 Nov 2019 23:32

Publisher DOI:

10.1136/jnnp-2017-317172

PubMed ID:

29436487

BORIS DOI:

10.7892/boris.113856

URI:

https://boris.unibe.ch/id/eprint/113856

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