Microelectrode Recording in Functional Neurosurgery

Abstract

Whenever a neurosurgical procedure involves a target or endangers an important neighboring structure that cannot be seen or distinctly imaged intraoperatively, some form of invasive physiological localization is required to assure accuracy and safety. Sometimes a whole structure cannot be visualized clearly (such as STN); on other occasions, the gross structure can be imaged but its important functional subdivisions cannot (such as the case with motor thalamus), even with the highest-quality magnetic resonance imaging (MRI). In both circumstances, the structure must be penetrated and its identity must be established by functional means. The first part of this chapter is concerned with invasive physiological localization of deep brain structures with micro- or macro-electrodes prior to surgery. The second part of this chapter is devoted to imaging techniques and their use in cortical and subcortical localization; localization relevant to the superficial cerebral cortex regions and to surgery for epilepsy is discussed in the section dealing with epilepsy (see chapters 153 and 157).