Estimulación eléctrica transcraneal hemisférica en cirugía supratentorial: resultados clínicos

Abstract

Transcranial electrical stimulation (TES) is a technique widely used in intraoperative neurophysiological monitoring. However, there are theoretical limitations to their use in supratentorial surgery. To test the usefulness of hemispheric TES (C3/C4-Cz) in supratentorial surgery. Hemispheric TES was conducted in a group of 15 patients operated on supratentorial region with possible compromise of the inner capsule. In all cases orbicularis oris, extensor digitorum, abductor of V finger, anterior tibialis and abductor hallucis brevis contralateral to stimulation were recorded. We used trains of 4-6 pulses of 50 micro-seconds at 500 Hz. The intensity of the movements induced by hemispheric TES did not interfere with the microsurgical dissection. We have used 78.5 +/- 11.2 trains per patient, with the voltage of 235 +/- 21 V and the equivalent current 370 +/- 37 mA. Stimulation resulted in response in facial region in 80% of cases, 100% in arm/hand and 66.7% in leg/foot. In eight patients, there was no change in latency and/or amplitude during resection. In six patients we observed retardation, decreased amplitude or both in any of the region studied. In these patients no neurologic injury was observed. In one patient a sharp decrease and complete absence of motor response was observed. In this case there was a post-surgical neurologic injury. The hemispheric TES have high sensitivity and specificity monitoring the inner capsule in supratentorial neurosurgery.