engleski

Methodologies for detection of speech and language cortical areas preoperatively and intraoperatively during awake craniotomy

Objective: To develop methodologies for detection of speech and language related cortical areas preoperatively and intraoperatively in patients during awake craniotomy. Methodology: Noninvasive navigated transcranial magnetic stimulation (nTMS) was used preoperatively, while direct cortical electrical stimulation (DES) was used intraoperatively in patients during awake craniotomy. Primary motor cortex for laryngeal muscles and Broca’s area (posterior part of inferior frontal gyrus) was stimulated magnetically/electrically while recording evoked potentials from laryngeal muscle. The responses were recorded by using hook-wire electrodes percutaneously inserted into the cricothyroid muscle. Results: Motor evoked potentials (MEP) were recorded from cricothyroid muscle during stimulation of primary motor cortex for laryngeal muscles, while long latency responses (LLR) were recorded from cricothyroid muscle during stimulation of Broca’s area. The latency of MEP was 12.66 ± 1.09 ms with nTMS, and with DES 12.67 ± 1.23 ms. The latency of LLR was 58.5 ± 5.9 ms with nTMS, and with DES 54.25 ± 3.69 ms. Conclusion: Evoked responses recorded from laryngeal muscles in specific time window after the application of stimulation represent neurophysiologic markers of primary motor cortex for laryngeal muscles and Broca’s area. Significance: The methodology can be used in preoperative mapping, and it is expected to facilitate surgical planning and intraoperative mapping, preserving these areas from injuries. Furthermore, the methodology for detection of neurophysiologic marker of primary motor cortex for laryngeal muscles can be used during operation of thyroid gland to preserve functional integrity of corticobulbar tract, vagal nuclei in the brainstem, vagal nerve and laryngeal mucles.

speech mapping; TMS; DCS; awake craniotomy

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