Subdural motor cortex stimulation

Motor cortex stimulation (MCS) is considered to be useful in the treatment of some types of chronic neuropathic pain. The use of subdural electrodes has been seldom reported 1) 2) 3) 4) 5) 6) 7)

Subdural or intrasulcal stimulation allows a more focused stimulation with lower current intensities. This advantage, however, is counterbalanced by a higher complication rate with regard to epileptic seizures, subdural or intracerebral hemorrhages, and wound infections 8).

Indications

Neuropathic pain

Subdural motor cortex stimulation in 18 consecutive patients (12 male) between 2000 and 2010, with a mean age of 63 years (11-91). The mean follow-up was 86 months (20-140 months). Delavallée et al. identified the central sulcus by using classical anatomic landmarks and neuronavigation (BrainLab system; BrainLAB, Inc., Redwood City, CA). An elongated craniotomy (3 cm in length, 1 cm in width) was performed followed by linear opening of the dura mater. An eight-polar plate electrode (Specify Lead, 3998; Medtronic, Minneapolis, MN) was then slipped smoothly through this linear opening. In patients with interhemispheric electrodes (patients 2 and 17), we performed a parasagittal craniotomy of 4 cm length and 2 cm width. At last follow-up assessment, 14 patients had a favourable outcome (77.7 %): 10 patients with excellent relief of pain (>80 %), 1 with good relief of pain (60-80 %) and 3 with satisfactory relief of pain (50-60 %). Four patients showed bad results (<50 %). We did not observe any late complications specific to SD MCS.

They report an efficacy at least as good as epidural MCS, with no complications specific to subdural MCS, even with prolonged follow-up. The data are insufficient to actually prove a lower energy use in SD MCS 9).

Induced topographic plasticity

Induced topographic plasticity using continuous high-frequency cortical electrical stimulation (cHFCS) in eloquent areas within a tumor, allowed increased tumor removal. This results open the possibility to induce plasticity before the resection of brain tumors near eloquent areas, in order to increase the extent of resection 10).

1)
Delavallée M, Abu-Serieh B, de Tourtchaninoff M, Raftopoulos C (2008) Subdural motor cortex stimulation for central and peripheral neuropathic pain: a long-term follow-up study in a series of eight patients. Neurosurgery 63(1):101–105, discussion 105–8
2)
Delavallée M, Rooijakkers H,Koerts G, Raftopoulos C (2011)Motor cortex stimulation in a three-year-old child with trigeminal neuropathic pain caused by a malignant glioma in the cerebellopontine angle: case report. Neurosurgery 69(2):E494–E496
3)
Hosomi K, Saitoh Y, Kishima H, Oshino S, Hirata M, Tani N, Shimokawa T, Yoshimine T (2008) Electrical stimulation of primary motor cortex within the central sulcus for intractable neuropathic pain. Clin Neurophysiol 119:993–1001
4)
Saitoh Y, Hirano S, Kato A, Kishima H, Hirata M, Yamamoto K, Yoshimine T (2001) Motor cortex stimulation for deafferentation pain. Neurosurg Focus 15:E1
5)
Saitoh Y, Hirayama A, Kishima H, Oshino S, Hirata M, Kato A, Yoshimine T (2006) Stimulation of primary motor cortex for intractable deafferentation pain. Acta Neurochir Suppl 99:57–59
6)
Saitoh Y, Kato A, Ninomiya H, Baba T, Shibata M, Mashimo T, Yoshimine T (2003) Primary motor cortex stimulation within the central sulcus for treating deafferentation pain. Acta Neurochir Suppl 87:149–152
7)
Saitoh Y, Shibata M, Hirano S, Hirata M, Mashimo T, Yoshimine T (2000) Motor cortex stimulation for central and peripheral deafferentation pain. Report of eight cases. J Neurosurg 92:150–155
8)
Tronnier V, Rasche D. Epidural and subdural stimulation. Handb Clin Neurol. 2013;116:343-51. doi: 10.1016/B978-0-444-53497-2.00028-0. Review. PubMed PMID: 24112907.
9)
Delavallée M, Finet P, de Tourtchaninoff M, Raftopoulos C. Subdural motor cortex stimulation: feasibility, efficacy and security on a series of 18 consecutive cases with a follow-up of at least 3 years. Acta Neurochir (Wien). 2014 Dec;156(12):2289-94. doi: 10.1007/s00701-014-2240-4. Epub 2014 Sep 26. PubMed PMID: 25257135.
10)
Barcia JA, Sanz A, Balugo P, Alonso-Lera P, Brin JR, Yus M, Gonzalez-Hidalgo M, Acedo VM, Oliviero A. High-frequency cortical subdural stimulation enhanced plasticity in surgery of a tumor in Broca's area. Neuroreport. 2012 Mar 28;23(5):304-9. doi: 10.1097/WNR.0b013e3283513307. PubMed PMID: 22336871.