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Article: [COMPARISON OF HIGH GAMMA ELECTROCORTICOGRAPHY AND DIRECT CORTICAL STIMULATION MAPPING OF CORTICAL FUNCTION IN AWAKE CRANIOTOMY: INITIAL EXPERIENCE].

Shahar, Tal / Gonen, Lior / Michaeli, Avner / Korn, Akiva / Margalit, Nevo

2023 Volume 162, Issue 4, Page(s) 221–227

Abstract: Introduction: The use of intraoperative electrical cortical stimulation (ECS) to map function is the standard of care in modern neurosurgery. Recently, high gamma electrocorticography (hgECOG) mapping has had encouraging results. In this study we aim to ...

Abstract	Introduction: The use of intraoperative electrical cortical stimulation (ECS) to map function is the standard of care in modern neurosurgery. Recently, high gamma electrocorticography (hgECOG) mapping has had encouraging results. In this study we aim to compare hgECOG and fMRI with ECS for motor and language mapping. Methods: We retrospectively evaluated medical records of patients who underwent awake surgery for tumor resection between January 2018 and December 2021. The first 10 consecutive patients who underwent ECS and hgECOG for mapping of motor and language functions were defined as the study group. Pre- and intra-operative imaging and electrophysiology data were used for analysis. Results: ECS and hgECOG motor mapping demonstrated functional motor areas in 71.4% and 85.7% of patients, respectively. All motor areas identified with ECS were also demonstrated using hgECOG. In 2 patients, hgECOG-based mapping demonstrated motor areas not demonstrated with ECS but present in preoperative fMRI imaging. Of the 15 hgECOG tasks performed for language mapping, the findings of 6 (40%) were in accordance with the ECS mapping. Two (13.3%), showed language areas that were demonstrated using ECS and in addition, showed areas that were not. Four mappings (26.7%) showed language areas that were not demonstrated using ECS. In 3 mappings (20%), the functional areas identified by ECS were not demonstrated by hgECOG. Conclusions: Intraoperative hgECOG for mapping of motor and language functions provide a fast and reliable method without the risk of stimulation-induced seizures. Further studies are needed to assess functional outcome of patients undergoing hgECOG-guided tumor resection.
MeSH term(s)	Humans ; Electrocorticography ; Brain Neoplasms/surgery ; Wakefulness ; Retrospective Studies ; Brain Mapping/methods ; Craniotomy/methods ; Magnetic Resonance Imaging/methods
Language	Hebrew
Publishing date	2023-04-29
Publishing country	Israel
Document type	English Abstract ; Journal Article
ZDB-ID	953872-0
ISSN	0017-7768
ISSN	0017-7768
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Article: [INTRAOPERATIVE ELECTROPHYSIOLOGY MAPPING OF CORTICAL FUNCTION: A BRIEF HISTORY AND EVOLVING ALTERNATIVE].

Shahar, Tal / Gonen, Lior / Michaeli, Avner / Korn, Akiva / Margalit, Nevo

Harefuah

2022 Volume 162, Issue 4, Page(s) 236–242

Abstract: Introduction: Multiple studies have demonstrated that the improved extent of resection for patients with glioma is associated with improved survival. The use of intraoperative electrophysiology cortical mapping to demonstrate function became a standard ... ...

Abstract	Introduction: Multiple studies have demonstrated that the improved extent of resection for patients with glioma is associated with improved survival. The use of intraoperative electrophysiology cortical mapping to demonstrate function became a standard of care in modern neurosurgery and an indispensable tool to achieve the goal of maximal safe resection in tumor surgery. In this study, we review the brief history of intraoperative electrophysiology cortical mapping from the first cortical mapping study back in 1870 to the innovative tool of broad gamma cortical mapping used today.
MeSH term(s)	Humans ; Brain Neoplasms/surgery ; Brain Mapping ; Glioma/pathology ; Glioma/surgery ; Neurosurgical Procedures ; Electrophysiology
Language	Hebrew
Publishing date	2022-01-21
Publishing country	Israel
Document type	Review ; English Abstract ; Journal Article
ZDB-ID	953872-0
ISSN	0017-7768
ISSN	0017-7768
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Article ; Online: Post-laminectomy Dorsal Cord Migration Resulting in Immediate Neurologic Deterioration during Ventral Meningioma Resection: Proposed Mechanism of Injury and Prevention Technique.

Harel, Ran / Kimchi, Gil / Perry, Avital / Korn, Akiva / Knoller, Nachshon

Journal of neurological surgery. Part A, Central European neurosurgery

2022 Volume 84, Issue 5, Page(s) 498–505

Abstract: Background: Ventral thoracic meningiomas may pose a technical challenge owing to a limited surgical corridor and the presence of long-standing ventral cord compression. Unopposed dorsal spinal cord migration may occur following a laminectomy resulting ... ...

Abstract	Background: Ventral thoracic meningiomas may pose a technical challenge owing to a limited surgical corridor and the presence of long-standing ventral cord compression. Unopposed dorsal spinal cord migration may occur following a laminectomy resulting in immediate neurologic injury. We discuss the possible mechanism underlying such a phenomenon, suggesting alternative approach to prevent neurologic injury. Methods: Two patients operated on for ventral thoracic meningioma and sustained neurologic compromise were retrospectively evaluated. Image editing software was used for 3D modeling to simulate the possible underlying mechanism of injury. Cases where ventral thoracic meningiomas were approached via unilateral hemilaminectomy, performed in 2020, were retrospectively analyzed and compared with the laminectomy approach cohort. Results: Two patients sustained postoperative neurologic function decline following resection of ventral thoracic meningioma via the laminectomy approach. Both exhibited permanent abolishment of transcranial motor evoked potentials (MEPs) following laminectomy. Based on the extrapolated 3D models for these two cases, dorsal cord migration was postulated as the cause for the acute neurologic compromise. Conclusion: Laminectomy for resection of thoracic ventral meningioma may lead in some cases to dorsal cord migration resulting in grave neurologic deterioration. Unilateral approach to these tumors restricts the dorsal migration and may mitigate neurologic outcomes.
MeSH term(s)	Humans ; Meningioma/surgery ; Laminectomy/adverse effects ; Laminectomy/methods ; Retrospective Studies ; Meningeal Neoplasms/surgery ; Magnetic Resonance Imaging
Language	English
Publishing date	2022-04-22
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2651663-9
ISSN	2193-6323 ; 2193-6315
ISSN (online)	2193-6323
ISSN	2193-6315
DOI	10.1055/a-1832-3393
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Article ; Online: Intraoperative Deterioration of Neurophysiological Potentials of the Spinal Tracts in Cervical Spine Surgery: Correlation With Patient-Related and Procedure-Related Variables.

Michaeli, Avner / Appel, Shmuel / Danto, Joseph / Korn, Akiva / Schroeder, Josh E

Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society

2022 Volume 40, Issue 4, Page(s) 325–330

Abstract: Purpose: To identify characteristics associated with higher incidence of intraoperative deterioration of neurophysiological potentials related to spinal tracts in cervical spine surgeries.: Methods: Electrophysiological raw data and ... ...

Abstract	Purpose: To identify characteristics associated with higher incidence of intraoperative deterioration of neurophysiological potentials related to spinal tracts in cervical spine surgeries. Methods: Electrophysiological raw data and neurophysiological case reports of 1,611 patients from multiple medical centers, who underwent cervical spine surgery for decompression and/or fusion, were retrospectively reviewed. Patient-related and procedure-related variables were identified and analyzed for correlation with intraoperative neurophysiological event of the spinal tracts. The neurophysiological events were analyzed for identification of collective characteristics. Results: The study cohort presented consistent dominancy of male over female patients (67% vs. 33%). Intraoperative deterioration of spinal tract-derived potentials was noted in 10.5% of the total cases, which was not correlated with gender, age, or indication of the surgery. Higher incidence of neurophysiological events was noted in patients with impaired baseline of motor evoked potentials from the thenar muscle ( P = 0.01) or somatosensory evoked potentials of the posterior tibial nerve ( P = 0.0002). Procedures of circumferential approach or procedures that involved ≥3 spinal levels demonstrated higher incidence of neurophysiological events as well ( P = 0.0003 and 0.001, respectively). Conclusions: Patients with deteriorated neurophysiological baseline and procedures of extensive intervention are at higher risk of intraoperative neurophysiological event in cervical spine surgery. Inclusion of intraoperative neurophysiological monitoring should be encouraged in complicated cases of cervical spine surgeries.
MeSH term(s)	Humans ; Male ; Female ; Retrospective Studies ; Evoked Potentials, Motor/physiology ; Evoked Potentials, Somatosensory/physiology ; Intraoperative Neurophysiological Monitoring ; Cervical Vertebrae/surgery
Language	English
Publishing date	2022-01-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	605640-4
ISSN	1537-1603 ; 0736-0258
ISSN (online)	1537-1603
ISSN	0736-0258
DOI	10.1097/WNP.0000000000000889
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Article: Post-laminectomy Dorsal Cord Migration Resulting in Immediate Neurologic Deterioration during Ventral Meningioma Resection: Proposed Mechanism of Injury and Prevention Technique

Harel, Ran / Kimchi, Gil / Perry, Avital / Korn, Akiva / Knoller, Nachshon

Journal of Neurological Surgery Part A: Central European Neurosurgery

2022 Volume 84, Issue 05, Page(s) 498–505

Abstract	Background: Ventral thoracic meningiomas may pose a technical challenge owing to a limited surgical corridor and the presence of long-standing ventral cord compression. Unopposed dorsal spinal cord migration may occur following a laminectomy resulting in immediate neurologic injury. We discuss the possible mechanism underlying such a phenomenon, suggesting alternative approach to prevent neurologic injury. Methods: Two patients operated on for ventral thoracic meningioma and sustained neurologic compromise were retrospectively evaluated. Image editing software was used for 3D modeling to simulate the possible underlying mechanism of injury. Cases where ventral thoracic meningiomas were approached via unilateral hemilaminectomy, performed in 2020, were retrospectively analyzed and compared with the laminectomy approach cohort. Results: Two patients sustained postoperative neurologic function decline following resection of ventral thoracic meningioma via the laminectomy approach. Both exhibited permanent abolishment of transcranial motor evoked potentials (MEPs) following laminectomy. Based on the extrapolated 3D models for these two cases, dorsal cord migration was postulated as the cause for the acute neurologic compromise. Conclusion: Laminectomy for resection of thoracic ventral meningioma may lead in some cases to dorsal cord migration resulting in grave neurologic deterioration. Unilateral approach to these tumors restricts the dorsal migration and may mitigate neurologic outcomes.
Keywords	thoracic meningioma ; dorsal cord migration ; unilateral approach ; Intradural tumors ; Intraoperative neuromonitoring
Language	English
Publishing date	2022-04-22
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2651663-9
ISSN	2193-6323 ; 2193-6315
ISSN (online)	2193-6323
ISSN	2193-6315
DOI	10.1055/a-1832-3393
Database	Thieme publisher's database

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Article ; Online: Intraoperative monitoring of corticospinal tracts in anterior cervical decompression and fusion surgery: Excitability differentials of lower extremity muscles.

Michaeli, Avner / Appel, Shmuel / Korn, Akiva / Danto, Joseph / Ashkenazi, Ely

Clinical neurophysiology practice

2020 Volume 5, Page(s) 59–63

Abstract: Objective: This study examines and compares excitability characteristics of tibialis anterior (TA) and abductor hallucis (AH) transcranial motor evoked potentials (tcMEP) during anterior cervical decompression and fusion (ACDF) surgery.: Methods: ... ...

Abstract	Objective: This study examines and compares excitability characteristics of tibialis anterior (TA) and abductor hallucis (AH) transcranial motor evoked potentials (tcMEP) during anterior cervical decompression and fusion (ACDF) surgery. Methods: Electrophysiological and clinical data of 89 patients who underwent ACDF procedure were retrospectively reviewed. TcMEP data of TA and AH muscles from 178 limbs were analyzed for availability, robustness and stability during the procedure. Results: TA tcMEP was available at 83% whereas AH tcMEP was available at 99% of the monitored lower limbs at preposition baseline. Availability of both TA and AH tcMEP was demonstrated in 147/178 limbs. The baseline amplitude of AH tcMEP was significantly greater than that of TA tcMEP recorded from the same limb (744.6 ± 54.0 and 326.9 ± 33.3 µV, respectively). Simultaneous deterioration of TA and AH tcMEP data was demonstrated in 10/147 limbs. Deterioration of either TA or AH tcMEP data accompanied by unchanged tcMEP data from the other lower limb muscle was noted in 32/147 compared to 1/147 limbs, respectively. The deteriorated TA and AH tcMEP data returned to baseline before closing at incidence of 17% compared to 46%, respectively. No new lower extremity (LE) neurological deficit was presented postoperatively in any patient. Conclusions: AH tcMEP is a more reliable candidate than TA tcMEP for intraoperative LE monitoring in ACDF procedure. Significance: The excitability differentials in LE tcMEP in ACDF is a variable that need to be considered while interpreting intraoperative neurophysiological data.
Language	English
Publishing date	2020-03-10
Publishing country	Netherlands
Document type	Journal Article
ISSN	2467-981X
ISSN (online)	2467-981X
DOI	10.1016/j.cnp.2020.02.002
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Article ; Online: Filum terminale lipomas - the role of intraoperative neuromonitoring.

Srinivasan, Harishchandra Lalgudi / Korn, Akiva / Roth, Jonathan / Constantini, Shlomi

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2020 Volume 36, Issue 12, Page(s) 2897–2898

MeSH term(s)	Cauda Equina ; Humans ; Lipoma/surgery ; Neurosurgical Procedures
Language	English
Publishing date	2020-10-01
Publishing country	Germany
Document type	Letter ; Comment
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-020-04909-8
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Article ; Online: Dynamic mapping using an electrified ultrasonic aspirator in lipomyelomeningocele and spinal cord detethering surgery-a feasibility study.

Sapir, Yechiam / Buzaglo, Nahum / Korn, Akiva / Constantini, Shlomi / Roth, Jonathan / Rochkind, Shimon

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2021 Volume 37, Issue 5, Page(s) 1633–1639

Abstract: Background: Intraoperative neurophysiologic monitoring (IONM) is an established technique and adjunct of brain and spinal lesion resection surgery. In spina bifida syndrome surgery, mapping of the surgical wound is a common and accepted method in ... ...

Abstract	Background: Intraoperative neurophysiologic monitoring (IONM) is an established technique and adjunct of brain and spinal lesion resection surgery. In spina bifida syndrome surgery, mapping of the surgical wound is a common and accepted method in determining the position and functionality of nerve roots of the cauda equina (CE), especially when the anatomy is not straightforward and roots are splayed across or entangled within the lesion. Here, we describe a novel technique of continuous CE mapping using an electrified cavitron ultrasonic aspirator (eCUSA) in children with lipomyelomeningocele (LMMC) lesions. Methods: We assessed a method of dynamic CE mapping using an eCUSA as a stimulation probe. Twenty children (0.5-18 years) were included in this study, diagnosed with occult spina bifida LMMC in which the eCUSA stimulator was applied. IONM data and 2-weeks post-operative data were collected. Results: LMMC lesions were located in the lumbar, sacral, and lumbosacral spine. eCUSA stimulation at 0.3-3.0 mA intensities elicited positive lower extremity muscle responses in 12 of the 20 patients included in the study. These responses allowed the surgeon real-time identification of the nerve roots tangent at the LMMC-cauda equina structure and intensive removal of the fat tissue in the area non-responding to the eCUSA stimulation. Conclusion: Continuous eCUSA-based stimulation of the cauda equina during LMMC resection is a feasible mapping technique with potential added value improving safety of untethering. Future studies evaluating extension of untethering, as well as the rates of retethering and long-term neurological and urological outcomes, are warranted.
MeSH term(s)	Cauda Equina ; Child ; Feasibility Studies ; Humans ; Meningomyelocele/surgery ; Spinal Cord ; Ultrasonics
Language	English
Publishing date	2021-01-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-020-05012-8
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Article ; Online: Optimization of Radiofrequency Needle Placement in Percutaneous Cordotomy Using Electromyography in the Deeply Sedated Patient.

Gabay, Segev / Sapir, Yechiam / Korn, Akiva / Hochberg, Uri / Tellem, Rotem / Zegerman, Alex / Brogan, Shane E / Rahimpour, Shervin / Shofty, Ben / Strauss, Ido

Operative neurosurgery (Hagerstown, Md.)

2023 Volume 26, Issue 1, Page(s) 22–27

Abstract: Background and objectives: Cordotomy, the selective disconnection of the nociceptive fibers in the spinothalamic tract, is used to provide pain palliation to oncological patients suffering from intractable cancer-related pain. Cordotomies are commonly ... ...

Abstract	Background and objectives: Cordotomy, the selective disconnection of the nociceptive fibers in the spinothalamic tract, is used to provide pain palliation to oncological patients suffering from intractable cancer-related pain. Cordotomies are commonly performed using a cervical (C1-2) percutaneous approach under imaging guidance and require patients' cooperation to functionally localize the spinothalamic tract. This can be challenging in patients suffering from extreme pain. It has recently been demonstrated that intraoperative neurophysiology monitoring by electromyography may aid in safe lesion positioning. The aim of this study was to evaluate the role of compound muscle action potential (CMAP) in deeply sedated patients undergoing percutaneous cervical cordotomy (PCC). Methods: A retrospective analysis was conducted of all patients who underwent percutaneous cordotomy while deeply sedated between January 2019 and November 2022 in 2 academic centers. The operative report, neuromonitoring logs, and clinical medical records were evaluated. Results: Eleven patients underwent PCC under deep sedation. In all patients, the final motor assessment prior to ablation was done using the electrophysiological criterion alone. The median threshold for evoking CMAP activity at the lesion site was 0.9 V ranging between 0.5 and 1.5 V (average 1 V ± 0.34 V SD). An immediate, substantial decrease in pain was observed in 9 patients. The median pain scores (Numeric Rating Scale) decreased from 10 preoperatively (range 8-10) to a median 0 (range 0-10) immediately after surgery. None of our patients developed motor deficits. Conclusion: CMAP-guided PCC may be feasible in deeply sedated patients without added risk to postoperative motor function. This technique should be considered in a group of patients who are not able to undergo awake PCC.
MeSH term(s)	Humans ; Cordotomy/methods ; Electromyography ; Retrospective Studies ; Pain, Intractable ; Spinothalamic Tracts/surgery
Language	English
Publishing date	2023-09-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2767575-0
ISSN	2332-4260 ; 2332-4252
ISSN (online)	2332-4260
ISSN	2332-4252
DOI	10.1227/ons.0000000000000907
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Article ; Online: Treatment failure of syringomyelia associated with Chiari I malformation following foramen magnum decompression: how should we proceed?

Soleman, Jehuda / Bartoli, Andrea / Korn, Akiva / Constantini, Shlomi / Roth, Jonathan

Neurosurgical review

2018 Volume 42, Issue 3, Page(s) 705–714

Abstract: The preferred treatment of patients with persistent, recurrent, or progressive syringomyelia after foramen magnum decompression (FMD) for Chiari I (CMI)-associated syringomyelia is controversial, and may include redo FMD, stabilization, or shunting ... ...

Abstract	The preferred treatment of patients with persistent, recurrent, or progressive syringomyelia after foramen magnum decompression (FMD) for Chiari I (CMI)-associated syringomyelia is controversial, and may include redo FMD, stabilization, or shunting procedures (such as syringopleural or syringo-subarachnoid shunts). We describe our experience in treating these patients and discuss the treatment modalities for these patients. We retrospectively collected data of CMI patients with persistent, recurrent, or progressive syringomyelia after FMD. In addition to baseline characteristics, surgical treatments and neurological and radiological outcomes were assessed. Further, we assessed through uni- and multivariate analyses possible technical, surgical, and radiological factors which might lead to failed FMD. Between 1998 and 2017, 48 consecutive patients (35 females (73%), average age 16.8 ± 11.5 years) underwent FMD for a syringomyelia-Chiari complex. Twenty-four patients (50%) underwent surgical treatment for a persistent (n = 10), progressive (n = 12), or recurrent (n = 2) syringomyelia 21.4 ± 27.9 months (median 14.6 months, range 12 days-134.9 months) after FMD. Of all analyzed factors, only extradural FMD was significantly associated with lower failure rates. Two patients (8%) underwent redo FMD, 18 (75%) underwent 19 syringo-subarachnoid-shunts, and 4 (17%) had 6 cranial CSF diversion procedures. The overall follow-up time was 40.1 ± 47.4 months (median 25 months, range 3-230 months). Based on our results, 50% of the patients undergoing FMD for syringomyelia-Chiari complex may require further surgical treatment due to persistent, progressive, or recurrent syringomyelia. Treatment should be tailored to the suspected underlying pathology. A subgroup of patients may be managed conservatively; however, these patients need close clinical and radiological follow-ups. The technical aspects of FMD in CMI-syrinx complex should be the focus of larger studies, as an effort to improve failure rates.
MeSH term(s)	Adolescent ; Adult ; Arnold-Chiari Malformation/complications ; Arnold-Chiari Malformation/diagnostic imaging ; Arnold-Chiari Malformation/surgery ; Child ; Child, Preschool ; Decompression, Surgical/adverse effects ; Decompression, Surgical/methods ; Female ; Foramen Magnum/surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurosurgical Procedures ; Radiography ; Recurrence ; Retrospective Studies ; Syringomyelia/diagnostic imaging ; Syringomyelia/etiology ; Syringomyelia/surgery ; Treatment Failure ; Young Adult
Language	English
Publishing date	2018-12-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	6907-3
ISSN	1437-2320 ; 0344-5607
ISSN (online)	1437-2320
ISSN	0344-5607
DOI	10.1007/s10143-018-01066-0
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