Abstract
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.
Keywords
subcortical stimulation - ultrasonic aspirator tip - suction device tip
