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corkscrew_electrode

Corkscrew electrode

Corkscrew electrodes (CS) are usually used for transcranial electrical stimulation (TES) in the intraoperative monitoring of motor evoked potential (MEP). Direct cranial stimulation with peg-screw (PS) electrodes can elicit MEP.

A study investigated the difference in the initial threshold between peg-screw and corkscrew electrodes in intraoperative MEP monitoring.

Kanaya et al., retrospectively analysed TES-MEP monitoring for supratentorial surgery in 72 patients. Of these, 44 patients were monitored with peg-screw and corkscrew (PS/CS) group and 28 patients were monitored with corkscrew and corkscrew (CS/CS) group. TES was used to deliver electrical stimulation by a train of 4 pulse anodal constant current stimulation (mA). The initial threshold (mA) in each electrode was checked and analysed.

In the PS/CS group, the initial threshold with the peg-screw electrode was 38.3 ± 15.1 mA (mean ± SD) on the affected side and the initial threshold with the corkscrew electrode was 51.4 ± 13.9 mA on the unaffected side. The initial threshold with the peg-screw electrode was significantly lower than that with the corkscrew electrode (P = 0.0001). In the CS/CS group, the initial threshold was 56.2 ± 16.5 mA on the affected side and 62.1 ± 18.6 mA on the unaffected side, which showed no significant difference (P = 0.23).

The initial threshold to elicit MEP was significantly lower with the peg-screw electrode than with the corkscrew electrode. A peg-screw electrode can be used as a feasible stimulation electrode for TES-MEP 1).


Ito et al., used surface electrodes of an endotracheal tube to record compound electromyographic responses from the vocalis muscle. Motor neurons were stimulated using corkscrew electrodes placed subdermally on the scalp at C3 and C4. During surgery, the operator received a warning when the amplitude of the vagal motor evoked potential (MEP) decreased to less than 50% of the control level. After surgery, swallowing function was assessed clinically using grading criteria.

In 5 patients, vagal MEP amplitude permanently deteriorated to less than 50% of the control level on the right side when meningiomas were dissected from the pons or basilar artery, or when a schwannoma was dissected from the vagal rootlets. These 5 patients had postoperative dysphagia. At 4 weeks after surgery, 2 patients still had dysphagia. In 2 patients, vagal MEPs of one side transiently disappeared when the tumors were dissected from the brainstem or the vagal rootlets. After surgery, both patients had dysphagia, which recovered in 4 weeks. In 7 patients, MEP amplitude was consistent, maintaining more than 50% of the control level throughout the operative procedures. After surgery all 7 patients were neurologically intact with normal swallowing function.

Vagal MEP monitoring with transcranial electrical stimulation and endotracheal tube electrode recording was a safe and effective method to provide continuous real-time information on the integrity of both the supranuclear and infranuclear vagal pathway. This method is useful to prevent intraoperative injury of the brainstem corticobulbar tract or the vagal rootlets and to avoid the postoperative dysphagia that is often associated with brainstem or skull base surgeries 2).

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2: Berends HI, Journée HL. Influence of the Montage of Stimulation Electrodes for Intraoperative Neuromonitoring During Orthopedic Spine Surgery. J Clin Neurophysiol. 2018 Sep;35(5):419-425. doi: 10.1097/WNP.0000000000000498. PubMed PMID: 30024455.

3: Szelényi A, Journée HL, Herrlich S, Galistu GM, van den Berg J, van Dijk JM. Experimental study of the course of threshold current, voltage and electrode impedance during stepwise stimulation from the skin surface to the human cortex. Brain Stimul. 2013 Jul;6(4):482-9. doi: 10.1016/j.brs.2012.10.002. Epub 2012 Oct 27. PubMed PMID: 23137703.

5: Fukuda M, Oishi M, Hiraishi T, Saito A, Fujii Y. Pharyngeal motor evoked potentials elicited by transcranial electrical stimulation for intraoperative monitoring during skull base surgery. J Neurosurg. 2012 Mar;116(3):605-10. doi: 10.3171/2011.10.JNS111343. Epub 2011 Dec 9. PubMed PMID: 22149376.

6: Benedičič M, Bošnjak R. Intraoperative monitoring of the visual function using cortical potentials after electrical epidural stimulation of the optic nerve. Acta Neurochir (Wien). 2011 Oct;153(10):1919-27. doi: 10.1007/s00701-011-1098-y. Epub 2011 Aug 5. PubMed PMID: 21818643.

7: Fukuda M, Oishi M, Hiraishi T, Saito A, Fujii Y. Intraoperative facial nerve motor evoked potential monitoring during skull base surgery predicts long-term facial nerve function outcomes. Neurol Res. 2011 Jul;33(6):578-82. doi: 10.1179/016164110×12700393823697. PubMed PMID: 21708066.

8: Hiraishi T, Fukuda M, Oishi M, Nishino K, Shinbo J, Sorimachi T, Ito Y, Fujii Y. Usefulness of motor-evoked potential monitoring during coil embolization of anterior choroidal artery aneurysms: technical reports. Neurol Res. 2011 May;33(4):360-2. doi: 10.1179/016164110×12807570. PubMed PMID: 21535934.

9: Acioly MA, Liebsch M, Carvalho CH, Gharabaghi A, Tatagiba M. Transcranial electrocortical stimulation to monitor the facial nerve motor function during cerebellopontine angle surgery. Neurosurgery. 2010 Jun;66(6 Suppl Operative):354-61; discussion 362. PubMed PMID: 20514692.

10: Fukuda M, Oishi M, Hiraishi T, Fujii Y. Facial nerve motor-evoked potential monitoring during microvascular decompression for hemifacial spasm. J Neurol Neurosurg Psychiatry. 2010 May;81(5):519-23. doi: 10.1136/jnnp.2009.181495. Epub 2009 Sep 2. PubMed PMID: 19726411.

11: Fukuda M, Oishi M, Saito A, Takao T, Fujii Y. [Facial nerve motor evoked potentials elicited by transcranial electrical stimulation for intraoperative monitoring]. No Shinkei Geka. 2008 Apr;36(4):315-21. Japanese. PubMed PMID: 18411796.

12: Fukuda M, Oishi M, Takao T, Saito A, Fujii Y. Facial nerve motor-evoked potential monitoring during skull base surgery predicts facial nerve outcome. J Neurol Neurosurg Psychiatry. 2008 Sep;79(9):1066-70. doi: 10.1136/jnnp.2007.130500. Epub 2008 Feb 1. PubMed PMID: 18245141.

1)
Kanaya K, Goto T, Horiuchi T, Hongo K. Comparison of intraoperative motor evoked potential monitoring with direct cranial stimulation by peg-screw and transcranial stimulation by corkscrew for supratentorial surgery. World Neurosurg. 2019 Apr 10. pii: S1878-8750(19)31031-9. doi: 10.1016/j.wneu.2019.04.039. [Epub ahead of print] PubMed PMID: 30980975.
2)
Ito E, Ichikawa M, Itakura T, Ando H, Matsumoto Y, Oda K, Sato T, Watanabe T, Sakuma J, Saito K. Motor evoked potential monitoring of the vagus nerve with transcranial electrical stimulation during skull base surgeries. J Neurosurg. 2013 Jan;118(1):195-201. doi: 10.3171/2012.10.JNS12383. Epub 2012 Nov 2. PubMed PMID: 23121435.
corkscrew_electrode.txt · Last modified: 2019/04/15 08:28 by administrador