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Figure legends
Figure 1.
Measurement of the N1 amplitude and latency of cortico-cortical evoked potentials. A line
was drawn from the onset to the offset of the N1 peak, and the N1 amplitude was then
measured as the height of a vertical line drawn from the negative peak of N1 to the
intersection of the vertical line with the above-described line (Matsumoto et al., 2004). The
latencies of N1 onset and N1 peak were measured from the time of stimulation to the N1
onset and N1 peak, respectively. The vertical bar represents the time of stimulation.
10
Figure 2.
11
Intraoperative CCEP distribution map (Patient 10). A: CCEP waveforms under general
12
anesthesia and in the awake condition (before tumor removal). In each waveform, two trials
13
are plotted in superimposition. CCEP distribution, including the maximum CCEP response
14
site (Electrode B13), did not change between the two conditions. Each waveform was
15
averaged and time-locked to the stimulus onset (analysis window: -100 to +500 ms,
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Yamao, et al. 40
baseline: –100 to –5 ms). To improve visualization, line has been lifted in each waveform.
B: CCEP distribution map under general anesthesia. The diameter of the circle at each
electrode represents the percentile to the amplitude at the maximum CCEP response site
(Electrode B13). C: Change of the N1 amplitude during surgery at the maximum CCEP
response site (Electrode B13). The waveform correlation coefficient was calculated at 0.95.
The N1 amplitude increased from 188.6 to 232.6 V. CCEP N1 latencies are shown only in
the awake condition.
CCEP = cortico–cortical evoked potential
10
Video 1.
11
The illustrative case (Patient 10) of the on-line CCEP monitoring in the operation theater,
12
using a 32-channel intraoperative evoked potential machine (MEE 1232 Neuromaster,
13
equipped with MS 120B electrical stimulator; NIHON KOHDEN CORPORATION, Tokyo,
14
Japan). The contents of the video are described below. (0-2 s); Left upper column;
15
Preoperative MR images (left; fluid-attenuated inversion recovery image, right; T1-weighted
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Yamao, et al. 41
image with gadolinium enhancement). Right upper column; Electrode configuration in the
intraoperative view (after tumor removal). Lower column; Electrode placement. A plate is
placed on the frontal cortex, and B plate is placed on the temporoparietal cortex. (2-4 s);
CCEPs were recorded by single-pulse electrical stimulation at the electrode pair A14-15
(anterior language area). Three consecutive sets (i.e., averaged CCEP waveforms) are shown
at each electrode on the display. The upper two waveforms are the ones currently being
recorded (two sets were obtained to confirm the reproducibility). The lower one is the one
performed 5 min previously. The left 5 x 4 columns (red square) demonstrate waveforms on
the B plate, and the right 3 x 4 columns (blue square) show waveforms on the A plate.
10
Electrode B13 (red circle) shows the maximum CCEP response at the posterior language area.
11
(4 s to the end of the video); Real-time CCEP acquisition. The blue waveform (the uppermost
12
waveform) represents the ongoing averaged CCEP waveform. The other two waveforms
13
(green) were already recorded previously. Note that the waveform being averaged on-line is
14
very similar to the one recorded just previously (the second upper waveform in green) within
15
several seconds (i.e., several trials), although 30 stimuli were delivered to obtain the averaged
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Yamao, et al. 42
CCEP in each set. The intraoperative integrity of the dorsal language pathway can be
evaluated by the amplitude change in the maximum CCEP response site (Electrode B13).
CCEP = cortico–cortical evoked potential
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