TRANSIENT INHIBITION OF MOTOR FUNCTION INDUCED BY THE CAVITRON ULTRASONIC SURGICAL ASPIRATOR DURING BRAIN MAPPING

ABSTRACT OBJECTIVE We report, for the first time, the occurrence of interference between a Cavitron ultrasonic surgical aspirator (CUSA) and intraoperative brain mapping performed by direct electrical stimulation (DES). METHODS Intraoperative polygraphic recordings (electrocorticogram and electromyogram) were gathered from a 44-year-old patient harboring a recurrent Grade II oligoastrocytoma operated on with the aid of a CUSA and DES. RESULTS Simultaneous use of CUSA and DES at the subcortical level in proximity to the corticospinal tract brought about the abolition of previously evident motor responses. This abolition was fully reversible after the CUSA was turned off. An analogous pattern of motor response inhibition was evident when the DES was applied cortically and the CUSA was used subcortically close to motor pathways. Interestingly, the authors had already observed a similar phenomenon in many patients when the CUSA was used for resection of lesions located within or in proximity to subcortical language pathways. In this setting, the CUSA induced transient speech disturbances that were confirmed afterwards by the DES. This interference with language and motor mapping might be interpreted as a transitory inhibition of axonal conduction. CONCLUSION The clinical significance of this interference is relevant when the CUSA and DES are used simultaneously for motor mapping because the CUSA can decrease the sensitivity of the brain mapping technique. Further studies will be required to determine the neurophysiological mechanism underlying this interference.

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A Study on Brain Mapping Technique Based on Hierarchical Decomposition Analysis

IEEJ Transactions on Electronics Information and Systems ◽

10.1541/ieejeiss.129.1675 ◽

2009 ◽

Vol 129 (9) ◽

pp. 1675-1681 ◽

Cited By ~ 8

Author(s):

Kunihiko Oura

Keyword(s):

Brain Mapping ◽

Decomposition Analysis ◽

Mapping Technique ◽

Hierarchical Decomposition

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Intraoperative mapping of pre-central motor cortex and subcortex: a proposal for supplemental cortical and novel subcortical maps to Penfield’s motor homunculus

Brain Structure and Function ◽

10.1007/s00429-021-02274-z ◽

2021 ◽

Author(s):

Prajwal Ghimire ◽

Jose Pedro Lavrador ◽

Asfand Baig Mirza ◽

Noemia Pereira ◽

Hannah Keeble ◽

...

Keyword(s):

Brain Mapping ◽

Retrospective Cohort ◽

Corticospinal Tract ◽

Brain Lesions ◽

Body Parts ◽

Single Institution ◽

Motor Representation ◽

Motor Mapping ◽

Subcortical Stimulation ◽

Motor Maps

AbstractPenfield’s motor homunculus describes a caricaturised yet useful representation of the map of various body parts on the pre-central cortex. We propose a supplemental map of the clinically represented areas of human body in pre-central cortex and a novel subcortical corticospinal tract map. We believe this knowledge is essential for safe surgery in patients with eloquent brain lesions. A single-institution retrospective cohort study of patients who underwent craniotomy for motor eloquent lesions with intraoperative motor neuromonitoring (cortical and subcortical) between 2015 and 2020 was performed. All positive cortical and subcortical stimulation points were taken into account and cartographic maps were produced to demonstrate cortical and subcortical areas of motor representation and their configuration. A literature review in PubMed was performed. One hundred and eighty consecutive patients (58.4% male, 41.6% female) were included in the study with 81.6% asleep and 18.4% awake craniotomies for motor eloquent lesions (gliomas 80.7%, metastases 13.8%) with intraoperative cortical and subcortical motor mapping. Based on the data, we propose a supplemental clinical cortical and a novel subcortical motor map to the original Penfield’s motor homunculus, including demonstration of localisation of intercostal muscles both in the cortex and subcortex which has not been previously described. The supplementary clinical cortical and novel subcortical motor maps of the homunculus presented here have been derived from a large cohort of patients undergoing direct cortical and subcortical brain mapping. The information will have direct relevance for improving the safety and outcome of patients undergoing resection of motor eloquent brain lesions.

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Ultrasonic Mucosectomy of the Gallbladder: A Histological Analysis

HPB Surgery ◽

10.1155/1993/31403 ◽

1993 ◽

Vol 6 (3) ◽

pp. 169-173 ◽

Cited By ~ 1

Author(s):

Michel Gagner ◽

Ramon Blanco ◽

Ricardo L. Rossi

Keyword(s):

Potential Application ◽

Intestinal Tract ◽

Histological Analysis ◽

Chronic Cholecystitis ◽

Histological Studies ◽

Cavitron Ultrasonic Surgical Aspirator ◽

Gastro Intestinal Tract ◽

Ultrasonic Surgical Aspirator

The Cavitron Ultrasonic Surgical Aspirator (CUSA) may be used to remove mucosa of organs of the gastro-intestinal tract. A histological analysis was performed on gallbladders treated with a CUSA-mucosectomy to assess the extent and degree of mucosectomy and to evaluate parietal damage. The histological studies performed on three specimens of chronic cholecystitis revealed a complete mucosectomy except in areas where Rokitansky-Aschof sinuses were present. There was no evidence of parietal damage. The CUSA may be used to remove the mucosa of gallbladders without injury to other layers, and may have a potential application in procedures such as mucosal cholecystectomy.

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A Survey of 65 Tumors within the Spinal Cord: Surgical Results and the Importance of Preoperative Magnetic Resonance Imaging

Neurosurgery ◽

10.1227/00006123-199111000-00002 ◽

1991 ◽

Vol 29 (5) ◽

pp. 651-657 ◽

Cited By ~ 82

Author(s):

Jacques Brotchi ◽

Olivier Dewitte ◽

Danielle Balériaux ◽

Arlette Vandesteene ◽

Christian Raftopoulos ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Surgical Results ◽

Resonance Imaging ◽

Intramedullary Spinal Cord ◽

Cavitron Ultrasonic Surgical Aspirator ◽

Highly Sensitive ◽

Previously Treated ◽

Ultrasonic Surgical Aspirator

Abstract Between January 1984 and December 1990. 65 intramedullary spinal cord tumors were diagnosed and operated on. In this series, all patients underwent magnetic resonance imaging investigations and were operated on with the Cavitron ultrasonic surgical aspirator whenever necessary. Major surgical difficulties have been found in patients previously treated by radiotherapy with or without biopsy. We found magnetic resonance imaging to be a highly sensitive imaging procedure and the method of choice for visualizing tumors within the spinal cord. Nevertheless, accurate diagnosis may only be suggested by magnetic resonance imaging, rather than made definitively. Surgery is necessary in every case in order to obtain a definite diagnosis. Radical surgery can be performed when a plane exists between the tumor and the normal spinal cord: biopsy or debulking with the Cavitron ultrasonic surgical aspirator should be performed when the tumor is infiltrative. We have performed 33 so-called total resections, 22 partial resections, and 10 biopsies, among which 5 were performed on lipomas. Surgical results were assessed at 3 months after surgery, showing 35 improvements (53%), 24 stabilizations (37%), and 6 deteriorations (10%).

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