O5.02CORTICAL AND SUBCORTICAL LANGUAGE MAPPING WITH HIGHFREQUENCY (HF) STIMULATION: FEASIBILITY AND CLINICAL RESULTS

摘要

Resection of language pathways tumors requires intraoperative identification of cortical and subcortical language essential sites. Language mapping is traditionally performed with LowFrequency(60Hz) stimulation. In patients with previous treatment or long history of seizures, the use of LF may be problematic and results in inadequate mapping. HighFrequency(HF)(To5) stimulation represents an alternative strategy. We present our experience with HF stimulation for language mapping in patients with gliomas involving language pathways. Efficacy of mapping was compared with LF, and clinical impact (percentage of immediate and permanent deficits) and Extent-of-Resection(EOR)) was also reported. 80 patients were included (49 were frontal, 21 temporal). HF (repetition rate of 3Hz) identified language sites in all patients. In patients with long history of seizures, high doses of antiepileptic drugs (AEDs), previous treatments, in whom LF induced seizures and was inadequate for mapping, HF efficiently identified language sites at cortical and subcortical level. In patients (30 cases) in whom LF and HF were compared, HF induced positive language responses in the same sites as LF, in frontal and temporal lobes. Intraoperative seizures were 24% with LF, 2% with HF, also in patients with previous history of seizures, high doses of AEDs. Percentage of immediate and permanent deficits were 78% and 2%, also in patients in whom only HF was used. EOR was total in 82%. HF(To5, repetition rate of 3Hz) represents an efficient alternative stimulation strategy for language mapping, particularly in patients with long history of seizures and high AEDs, associated with a low risk of intraoperative seizures.