J Neurol Surg A Cent Eur Neurosurg 2021; 82(06): 581-584
DOI: 10.1055/s-0039-1691824
Technical Note

Subcortical Stimulation with Tip of Ultrasound Aspirator

Henry Colle
1   Department of Neurosurgery, St Lucas Hospital, Ghent, Belgium
David Colle
1   Department of Neurosurgery, St Lucas Hospital, Ghent, Belgium
Bonny Noens
1   Department of Neurosurgery, St Lucas Hospital, Ghent, Belgium
Bob Dhaen
1   Department of Neurosurgery, St Lucas Hospital, Ghent, Belgium
Giovanni Alessi
1   Department of Neurosurgery, St Lucas Hospital, Ghent, Belgium
Peter Muller
2   Department of Neuro-anesthesiology, St Lucas Hospital, Ghent, Belgium
Annelies Aerts
3   Department of Neurolinguistics, St Lucas Hospital, Ghent, Belgium
Erik Robert
3   Department of Neurolinguistics, St Lucas Hospital, Ghent, Belgium
Chris van der Linden
4   Department of Neurophysiology, St Lucas Hospital, Ghent, Belgium
› Author Affiliations


Background During resection of intrinsic brain tumors in eloquent areas, particularly under awake mapping, subcortical stimulation is mandatory to avoid irreversible deficits by damaging white fiber tracts. The current practice is to alternate between subcortical stimulation with an appropriate probe and resection of tumoral tissue with an ultrasound aspiration device. Switching between different devices induces supplementary movement and possible tissue trauma, loss of time, and inaccuracies in the localization of the involved area.

Objective To use one device for both stimulation as well as a resecting tool.

Methods The tip of different ultrasound aspiration devices is currently used for monopolar current transmission (e.g., for vessel coagulation in liver surgery). We use the same circuitry for monopolar subcortical stimulation when connected with the usual stimulator devices.

Results We have applied this method since 2004 in over 500 patients during tumor resection with cortical and subcortical stimulation, mostly with awake language and motor monitoring.

Conclusion A method is presented using existing stimulation and wiring devices by which simultaneous subcortical stimulation and ultrasonic aspiration are applied with the same tool. The accuracy, safety, and speed of intrinsic intracranial lesion resection can be improved when subcortical stimulation is applied.

Publication History

Received: 18 December 2018

Accepted: 25 February 2019

Article published online:
25 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Berger MS, Deliganis AV, Dobbins J, Keles GE. The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 1994; 74 (06) 1784-1791
  • 2 De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol 2012; 30 (20) 2559-2565
  • 3 Sanai N, Mirzadeh Z, Berger MS. Functional outcome after language mapping for glioma resection. N Engl J Med 2008; 358 (01) 18-27
  • 4 Yordanova YN, Moritz-Gasser S, Duffau H. Awake surgery for WHO Grade II gliomas within “noneloquent” areas in the left dominant hemisphere: toward a “supratotal” resection. Clinical article. J Neurosurg 2011; 115 (02) 232-236
  • 5 Duffau H. Contribution of cortical and subcortical electrostimulation in brain glioma surgery: methodological and functional considerations. Neurophysiol Clin 2007; 37 (06) 373-382
  • 6 Bello L, Gallucci M, Fava M. et al. Intraoperative subcortical language tract mapping guides surgical removal of gliomas involving speech areas. Neurosurgery 2007; 60 (01) 67-80 ; discussion 80–82
  • 7 Duffau H, Peggy Gatignol ST, Mandonnet E, Capelle L, Taillandier L. Intraoperative subcortical stimulation mapping of language pathways in a consecutive series of 115 patients with Grade II glioma in the left dominant hemisphere. J Neurosurg 2008; 109 (03) 461-471
  • 8 Duffau H, Capelle L, Sichez N. et al. Intraoperative mapping of the subcortical language pathways using direct stimulations. An anatomo-functional study. Brain 2002; 125 (Pt 1): 199-214
  • 9 Gras-Combe G, Moritz-Gasser S, Herbet G, Duffau H. Intraoperative subcortical electrical mapping of optic radiations in awake surgery for glioma involving visual pathways. J Neurosurg 2012; 117 (03) 466-473
  • 10 Picht T, Mularski S, Kuehn B, Vajkoczy P, Kombos T, Suess O. Navigated transcranial magnetic stimulation for preoperative functional diagnostics in brain tumor surgery. Neurosurgery 2009;65(06, Suppl):93–98; discussion 98–99
  • 11 Picht T, Schmidt S, Brandt S. et al. Preoperative functional mapping for rolandic brain tumor surgery: comparison of navigated transcranial magnetic stimulation to direct cortical stimulation. Neurosurgery 2011; 69 (03) 581-588 , discussion 588
  • 12 Bello L, Gambini A, Castellano A. et al. Motor and language DTI Fiber Tracking combined with intraoperative subcortical mapping for surgical removal of gliomas. Neuroimage 2008; 39 (01) 369-382
  • 13 Duffau H. The anatomo-functional connectivity of language revisited. New insights provided by electrostimulation and tractography. Neuropsychologia 2008; 46 (04) 927-934
  • 14 Kamada K, Todo T, Ota T. et al. The motor-evoked potential threshold evaluated by tractography and electrical stimulation. J Neurosurg 2009; 111 (04) 785-795
  • 15 Duffau H, Capelle L, Denvil D. et al. Usefulness of intraoperative electrical subcortical mapping during surgery for low-grade gliomas located within eloquent brain regions: functional results in a consecutive series of 103 patients. J Neurosurg 2003; 98 (04) 764-778
  • 16 Szelényi A, Bello L, Duffau H. et al; Workgroup for Intraoperative Management in Low-Grade Glioma Surgery within the European Low-Grade Glioma Network. Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice. Neurosurg Focus 2010; 28 (02) E7
  • 17 Nossek E, Korn A, Shahar T. et al. Intraoperative mapping and monitoring of the corticospinal tracts with neurophysiological assessment and 3-dimensional ultrasonography-based navigation. J Neurosurg 2011; 114 (03) 738-746
  • 18 Colle H, Muller P, Robert E. Wakkere craniotomieën met ‘asleep-awake-asleep’ anesthesia. Tijdschrift voor Neurologie en Neurochirurgie 2005; 106 (04) 170-176
  • 19 Reithmeier T, Krammer M, Gumprecht H, Gerstner W, Lumenta CB. Neuronavigation combined with electrophysiological monitoring for surgery of lesions in eloquent brain areas in 42 cases: a retrospective comparison of the neurological outcome and the quality of resection with a control group with similar lesions. Minim Invasive Neurosurg 2003; 46 (02) 65-71
  • 20 Kombos T, Suess O, Ciklatekerlio O, Brock M. Monitoring of intraoperative motor evoked potentials to increase the safety of surgery in and around the motor cortex. J Neurosurg 2001; 95 (04) 608-614