Feasibility of cerebello-cortical stimulation for intraoperative neurophysiological monitoring of cerebellar mutism View Full Text


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Article Info

DATE

2021-04-09

AUTHORS

Davide Giampiccolo, Federica Basaldella, Andrea Badari, Giovanna Maddalena Squintani, Luigi Cattaneo, Francesco Sala

ABSTRACT

BackgroundCerebellar mutism can occur in a third of children undergoing cerebellar resections. Recent evidence proposes it may arise from uni- or bilateral damage of cerebellar efferents to the cortex along the cerebello-dento-thalamo-cortical pathway. At present, no neurophysiological procedure is available to monitor this pathway intraoperatively. Here, we specifically aimed at filling this gap.MethodsWe assessed 10 patients undergoing posterior fossa surgery using a conditioning-test stimulus paradigm. Electrical conditioning stimuli (cStim) were delivered to the exposed cerebellar cortex at interstimulus intervals (ISIs) of 8–24 ms prior to transcranial electric stimulation of the motor cortex, which served as test stimulus (tStim). The variation of motor-evoked potentials (MEP) to cStim + tStim compared with tStim alone was taken as a measure of cerebello-cortical connectivity.ResultscStim alone did not produce any MEP. cStim preceding tStim produced a significant inhibition at 8 ms (p < 0.0001) compared with other ISIs when applied to the lobules IV-V-VI in the anterior cerebellum and the lobule VIIB in the posterior cerebellum. Mixed effects of decrease and increase in MEP amplitude were observed in these areas for longer ISIs.ConclusionsThe inhibition exerted by cStim at 8 ms on the motor cortex excitability is likely to be the product of activity along the cerebello-dento-thalamo-cortical pathway. We show that monitoring efferent cerebellar pathways to the motor cortex is feasible in intraoperative settings. This study has promising implications for pediatric posterior fossa surgery with the aim to preserve the cerebello-cortical pathways and thus prevent cerebellar mutism. More... »

PAGES

1505-1514

References to SciGraph publications

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  • 2009-11-04. Anesthesia and intraoperative neurophysiological monitoring in children in CHILD'S NERVOUS SYSTEM
  • 2020-04-03. Intraoperative neurophysiology of the cerebellum: a tabula rasa in CHILD'S NERVOUS SYSTEM
  • 2019-08-03. Awake brain surgery in children—review of the literature and state-of-the-art in CHILD'S NERVOUS SYSTEM
  • 2018-06-20. Post-operative paediatric cerebellar mutism syndrome: time to move beyond structural MRI in CHILD'S NERVOUS SYSTEM
  • 2005-12-01. The effects of cerebellar stimulation on the motor cortical excitability in neurological disorders: A review in THE CEREBELLUM
  • 2006-07-11. Intraoperative Motor Evoked Potential Monitoring: Overview and Update in JOURNAL OF CLINICAL MONITORING AND COMPUTING
  • 2000. BrainSuite: An Automated Cortical Surface Identification Tool in MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION – MICCAI 2000
  • 2014-09-18. Unique genetic and epigenetic mechanisms driving paediatric diffuse high-grade glioma in NATURE REVIEWS CANCER
  • 2011-04-09. Heralding Cerebellar Mutism: Evidence for Pre-surgical Language Impairment as Primary Risk Factor in Posterior Fossa Surgery in THE CEREBELLUM
  • 2016-05-03. Consensus paper on post-operative pediatric cerebellar mutism syndrome: the Iceland Delphi results in CHILD'S NERVOUS SYSTEM
  • 2016-06-07. Effect of Anatomically Realistic Full-Head Model on Activation of Cortical Neurons in Subdural Cortical Stimulation—A Computational Study in SCIENTIFIC REPORTS
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    URI

    http://scigraph.springernature.com/pub.10.1007/s00381-021-05126-7

    DOI

    http://dx.doi.org/10.1007/s00381-021-05126-7

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1137041776

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/33835202


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