PMID- 33835202
OWN - NLM
STAT- MEDLINE
DCOM- 20210625
LR  - 20240401
IS  - 1433-0350 (Electronic)
IS  - 0256-7040 (Print)
IS  - 0256-7040 (Linking)
VI  - 37
IP  - 5
DP  - 2021 May
TI  - Feasibility of cerebello-cortical stimulation for intraoperative 
      neurophysiological monitoring of cerebellar mutism.
PG  - 1505-1514
LID - 10.1007/s00381-021-05126-7 [doi]
AB  - BACKGROUND: Cerebellar mutism can occur in a third of children undergoing 
      cerebellar resections. Recent evidence proposes it may arise from uni- or 
      bilateral damage of cerebellar efferents to the cortex along the 
      cerebello-dento-thalamo-cortical pathway. At present, no neurophysiological 
      procedure is available to monitor this pathway intraoperatively. Here, we 
      specifically aimed at filling this gap. METHODS: We assessed 10 patients 
      undergoing posterior fossa surgery using a conditioning-test stimulus paradigm. 
      Electrical conditioning stimuli (cStim) were delivered to the exposed cerebellar 
      cortex at interstimulus intervals (ISIs) of 8-24 ms prior to transcranial 
      electric stimulation of the motor cortex, which served as test stimulus (tStim). 
      The variation of motor-evoked potentials (MEP) to cStim + tStim compared with 
      tStim alone was taken as a measure of cerebello-cortical connectivity. RESULTS: 
      cStim alone did not produce any MEP. cStim preceding tStim produced a significant 
      inhibition at 8 ms (p < 0.0001) compared with other ISIs when applied to the 
      lobules IV-V-VI in the anterior cerebellum and the lobule VIIB in the posterior 
      cerebellum. Mixed effects of decrease and increase in MEP amplitude were observed 
      in these areas for longer ISIs. CONCLUSIONS: The inhibition exerted by cStim at 8 
      ms on the motor cortex excitability is likely to be the product of activity along 
      the cerebello-dento-thalamo-cortical pathway. We show that monitoring efferent 
      cerebellar pathways to the motor cortex is feasible in intraoperative settings. 
      This study has promising implications for pediatric posterior fossa surgery with 
      the aim to preserve the cerebello-cortical pathways and thus prevent cerebellar 
      mutism.
FAU - Giampiccolo, Davide
AU  - Giampiccolo D
AD  - Department of Neurosciences, Biomedicine and Movement Sciences, Section of 
      Neurosurgery, University Hospital, Piazzale Stefani 1, 37124, Verona, Italy.
FAU - Basaldella, Federica
AU  - Basaldella F
AD  - Intraoperative Neurophysiology Unit, Division of Neurology, University Hospital, 
      Verona, Italy.
FAU - Badari, Andrea
AU  - Badari A
AD  - Intraoperative Neurophysiology Unit, Division of Neurology, University Hospital, 
      Verona, Italy.
FAU - Squintani, Giovanna Maddalena
AU  - Squintani GM
AD  - Division of Neurology, University Hospital, Verona, Italy.
FAU - Cattaneo, Luigi
AU  - Cattaneo L
AD  - CIMeC-Center for Mind/Brain Sciences, University of Trento, Trento, Italy.
FAU - Sala, Francesco
AU  - Sala F
AUID- ORCID: 0000-0003-1263-9859
AD  - Department of Neurosciences, Biomedicine and Movement Sciences, Section of 
      Neurosurgery, University Hospital, Piazzale Stefani 1, 37124, Verona, Italy. 
      francesco.sala@univr.it.
LA  - eng
PT  - Journal Article
DEP - 20210409
PL  - Germany
TA  - Childs Nerv Syst
JT  - Child's nervous system : ChNS : official journal of the International Society for 
      Pediatric Neurosurgery
JID - 8503227
SB  - IM
MH  - Cerebellum/surgery
MH  - Child
MH  - Electric Stimulation
MH  - Evoked Potentials, Motor
MH  - Feasibility Studies
MH  - Humans
MH  - *Intraoperative Neurophysiological Monitoring
MH  - *Mutism/etiology
PMC - PMC8084839
OTO - NOTNLM
OT  - Cerebellar mutism
OT  - Intraoperative neurophysiological monitoring
OT  - Pediatric brain tumours
OT  - Posterior fossa
COIS- The authors have no competing interests to declare.
EDAT- 2021/04/10 06:00
MHDA- 2021/06/29 06:00
PMCR- 2021/04/09
CRDT- 2021/04/09 12:45
PHST- 2020/11/12 00:00 [received]
PHST- 2021/03/11 00:00 [accepted]
PHST- 2021/04/10 06:00 [pubmed]
PHST- 2021/06/29 06:00 [medline]
PHST- 2021/04/09 12:45 [entrez]
PHST- 2021/04/09 00:00 [pmc-release]
AID - 10.1007/s00381-021-05126-7 [pii]
AID - 5126 [pii]
AID - 10.1007/s00381-021-05126-7 [doi]
PST - ppublish
SO  - Childs Nerv Syst. 2021 May;37(5):1505-1514. doi: 10.1007/s00381-021-05126-7. Epub 
      2021 Apr 9.