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Stephen T. Magill, Seunggu J. Han, Jing Li, and Mitchel S. Berger

than 8000 patients found that intraoperative stimulation mapping reduced the rate of severe neurological deficits by nearly 60%. 5 Furthermore, the use of intraoperative stimulation mapping increased the rate of gross-total resection from 58% to 75%, emphasizing its utility in maximizing the extent of resection safely. Despite all the current advances in glioma surgery, including stimulation mapping, as well as the impact of maximal resection on survival, many neurosurgeons still believe that tumors involving certain areas, such as the primary motor cortex, are

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Neurosurgical Forum: Letters to the Editor To The Editor Sergio Canavero , M.D. Vincenzo Bonicalzi , M.D. Molinette Hospital Turin, Italy 688 688 Abstract The authors describe a case of complete recovery from the so-called “thalamic hand” syndrome following chronic motor cortex stimulation in a 64-year-old man suffering from poststroke thalamic central pain. As of the 2-year follow-up examination, the patient's dystonia and pain are still controlled by electrical stimulation. It is speculated

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Mitchel S. Berger, Wendy A. Cohen, and George A. Ojemann

multiplanar MR images that could be used preoperatively to predict the relationship of a tumor to the motor cortex. Materials and Methods Multiplanar MR imaging data obtained from nine patients who had previously undergone craniotomy, brain mapping, and resection for intrinsic tumors in the region of the rolandic cortex were retrospectively analyzed. The patients ranged in age from 11 to 55 years and presented with seizures and/or sensorimotor deficits. The MR images were obtained using a 1.5-tesla magnet in eight patients and a 0.5-tesla magnet in one patient

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Eric C. Leuthardt, Zac Freudenberg, David Bundy, and Jarod Roland

purposes, a 16-contact microwire array (1-mm electrode spacing) was placed over primary motor cortex. Microscale brain activity was recorded while the patient performed simple contra- and ipsilateral wrist movements that were monitored in parallel with EMG. Using various statistical methods, we defined linear and nonlinear relationships between these microcortical changes and recorded EMG activity. We find that small regions of primary cortex carry enough information to distinguish between various states of motor movement. Sufficient information was present to discern

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Srikantan Nagarajan, Heidi Kirsch, Peter Lin, Anne Findlay, Susanne Honma, and Mitchel S. Berger

. 3 , 19–21 , 24 , 28 , 41–43 , 50–52 However, although ECD procedures have been successfully applied to movementevoked magnetic fields, they appear to have both low specificity and sensitivity, and are thus unsuitable for clinical mapping of the location of motor cortex using ESI. 3 , 9 , 19 , 20 , 23–25 , 54 Therefore, there is a clear need for alternate procedures to localize motor cortex. Several studies have shown that voluntary movement results in desynchronization in the α (~ 10 Hz) and β (~ 20 Hz) frequency bands of brainwaves recorded from the

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Francisco Velasco, Carlos Argüelles, José D. Carrillo-Ruiz, Guillermo Castro, Ana Luisa Velasco, Fiacro Jiménez, and Marcos Velasco

E lectrical stimulation of the motor cortex was initially proposed to treat cases of central neuropathic pain caused by thalamic and suprathalamic lesions, mainly of vascular origin. 43–45 These lesions could not be treated by dorsal column, periaqueductal, or thalamic stimulation. Since that time, MCS has been attempted and frequently reported as successful in treating neuropathic pain syndromes involving practically any body segment and pain syndromes of the most diverse origins. To date, indications for MCS, including the central poststroke syndromes

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Luca Valci, Martina Dalolio, Dominique Kuhlen, Emanuele Pravatà, Claudio Gobbi, and Michael Reinert

the primary motor cortex and subcortical corticospinal fibers in a 70-year-old man who experienced a spastic progressive paresis of the left lower limb. We describe how intraoperative electrophysiology can help in surgical planning and preservation of eloquent regions. Our findings also demonstrate excellent correlation between functional anatomy and preoperative MR images. Case Report History and Examination This 70-year-old man came to the attention of neurologists because of the appearance and worsening of mild gait difficulties that progressed over the course of

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Yoichi Katayama, Chikashi Fukaya, and Takamitsu Yamamoto

the precentral area of the cortex afforded excellent pain control in some patients with poststroke pain. 29, 59, 60, 67 The area providing strong pain inhibition appeared to correspond to the motor cortex (MC) because such an area caused muscle contraction when stimulated at higher intensities. Analysis of our own experience has indicated that MC stimulation could achieve better control of poststroke pain than was possible with any other therapies, including stimulation of the dorsal column, thalamic somatosensory relay nucleus, internal capsule, or somatosensory

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Fabien Almairac, Denys Fontaine, Thomas Demarcy, Hervé Delingette, Stéphanie Beuil, and Charles Raffaelli

transducers (up to 70 MHz) in clinical use 3 may extend the US applications to explore brain functioning. Here, we provide the first study that aims to explore NVC of the human motor cortex with new UHF-US Doppler imaging (Vevo MD, Visualsonics), allowing a resolution of 50 μM up to 12.5 mm deep, and the detection by Doppler of the cortical microvasculature flow < 1 mm/sec in patients undergoing awake craniotomy for brain tumor resection. We also aimed to investigate the feasibility of and potential interest in UHF-US as a tool to explore brain functions during

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Takashi Tsubokawa, Yoichi Katayama, Takamitsu Yamamoto, Teruyasu Hirayama, and Seigou Koyama

original disease and the occurrence of pain was 1 to 4 years. The patients had been treated with various kinds of medication (anticonvulsant and/or antidepressant drugs), and no patient reported a beneficial effect of either peripheral or dorsal column stimulation. TABLE 1 Clinical data of patients with thalamic pain treated by motor cortex stimulation Case No. Sex, Age (yrs) Original Disease Barbiturate Test Morphine Test Results * (2 yrs) 1 M, 72 putaminal hemorrhage sensitive resistant excellent 2