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Practical localization of the central sulcus using a video display during surgery by cortical somatosensory evoked potentials and how to discern precentral P20 and central P25 Jun NAMIKI 1 , Takayuki OHIRA 2 , Masayuki ISHIHARA 2 , Shigeo TOYA 2 , Masashi NAKATSUKASA 1 , Ikuro MURASE 1 1Department of Neurosurgery, Saiseikai Utsunomiya Hospital 2Department of Neurosugery, Keio University School of Medicine Keyword: somatosensory evoked potentials , median nerve , intraoperative monitoring , central sulcus pp.123-129
Published Date 1997/2/10
DOI https://doi.org/10.11477/mf.1436901343
  • Abstract
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In patients with lesions around the central sulcus, cortical surface somatosensory evoked potentials (SEPs) have been applied for the purpose of localiza-tion of the central sulcus based on the polarity inver-sion of postcentral N20 to precentral P20 across the central sulcus. We have intraoperatively monitored SEPs to infer the location of the central sulcus in 16 cases since December 1988. Intraoperative localization of the central sulcus has been most useful in patients with frontal lobe gliomas in which the localization of the central sulcus enables the surgeon to extensively re-sect tumor without postoperative motor weakness. The localization of the central sulcus, however, might be misjudged by using the polarity inversion criterion alone, because central P25 following N20 and P20 com-plicates SEP waveforms. It is significant that P25,which is recorded also posterior to the central sulcus, is discerned from the precentral P20. In order to solve this matter, we regarded only the positivity in SEP waveforms having the identical peak latency to that of N20 as the precentral P20. Positive potentials having a later peak latency than that of N20 are the superposi-tion of P20 and P25, and might also be recorded post-erior to the central sulcus.

For the observation of the polarity inversion of N20 to P20 across the central sulcus, a multi-channel SEP should be recorded using a sheet of silicone rubber embedded in a 16-electrode array consisting of a 4 by 4 grid. We projected the exposed cortical surface on the video display through the microscope apparatus and marked the locations of the recording electrodes on the video display. This enabled the location of the record-ing electrodes to correspond easily and precisely to the cortical surface.

Our reliable and simple method of intraoperative localization of the central sulcus by cortical SEPs moni-toring is presented in a practical case.


Copyright © 1997, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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