====== Subcortical Stimulation ======

Subcortical [[stimulation]] is a method used to evaluate the distance from the stimulation site to the [[corticospinal tract]] (CST) and to decide whether the [[resection]] of an adjacent lesion should be terminated to prevent damage to the CST.

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

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

They 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.

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
((Colle H, Colle D, Noens B, Dhaen B, Alessi G, Muller P, Aerts A, Robert E, van der Linden C. [[Subcortical Stimulation]] with Tip of [[Ultrasound Aspirator]]. J Neurol Surg A Cent Eur Neurosurg. 2021 Aug 25. doi: 10.1055/s-0039-1691824. Epub ahead of print. PMID: 34433223.)).