Subcortical Stimulation with Tip of Ultrasound Aspirator.

BACKGROUND: During resection of intrinsic brain tumors in eloquent areas, particularly under awake mapping, subcortical stimulation is mandatory to avoid irreversible deficits by damaging white fiber tracts. The current practice is to alternate between subcortical stimulation with an appropriate probe and resection of tumoral tissue with an ultrasound aspiration device. Switching between different devices induces supplementary movement and possible tissue trauma, loss of time, and inaccuracies in the localization of the involved area. OBJECTIVE: To use one device for both stimulation as well as a resecting tool. METHODS: The tip of different ultrasound aspiration devices is currently used for monopolar current transmission (e.g., for vessel coagulation in liver surgery). We use the same circuitry for monopolar subcortical stimulation when connected with the usual stimulator devices. RESULTS: We 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. CONCLUSION: 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.

Facial nerve regeneration after facial allotransplantation: A longitudinal clinical and electromyographic follow-up of lip movements during speech.

INTRODUCTION: Facial allotransplantation constitutes a reconstructive option after extensive damage to facial structures. Functional recovery has been reported but remains an issue. CASE REPORT - METHODS: A patient underwent facial allotransplantation after a ballistic injury with extensive facial tissue damage. Speech motor function was sequentially assessed clinically, along with repeated electromyography of lip movements during a follow-up of 3 years. RESULTS: Facial nerve recovery could be demonstrated within the first month, followed by a gradual increase in electromyographic amplitude and decrease in reaction times. These were accompanied by gradual improvement of clinical assessments. CONCLUSIONS: Axonal recovery starts early after transplantation. Electromyographic testing is sensitive in demonstrating this early recovery, which ultimately results in clinical improvements.

Spatiotemporal differentiation in auditory and motor regions during auditory phoneme discrimination.

Auditory phoneme discrimination (APD) is supported by both auditory and motor regions through a sensorimotor interface embedded in a fronto-temporo-parietal cortical network. However, the specific spatiotemporal organization of this network during APD with respect to different types of phonemic contrasts is still unclear. Here, we use source reconstruction, applied to event-related potentials in a group of 47 participants, to uncover a potential spatiotemporal differentiation in these brain regions during a passive and active APD task with respect to place of articulation (PoA), voicing and manner of articulation (MoA). Results demonstrate that in an early stage (50-110 ms), auditory, motor and sensorimotor regions elicit more activation during the passive and active APD task with MoA and active APD task with voicing compared to PoA. In a later stage (130-175 ms), the same auditory and motor regions elicit more activation during the APD task with PoA compared to MoA and voicing, yet only in the active condition, implying important timing differences. Degree of attention influences a frontal network during the APD task with PoA, whereas auditory regions are more affected during the APD task with MoA and voicing. Based on these findings, it can be carefully suggested that APD is supported by the integration of early activation of auditory-acoustic properties in superior temporal regions, more perpetuated for MoA and voicing, and later auditory-to-motor integration in sensorimotor areas, more perpetuated for PoA.

Neurophysiological sensitivity for impaired phonological processing in the acute stage of aphasia.

The present study aimed to investigate neurophysiological substrates of phoneme and word processing in 10 patients with acute aphasia (PWA). More specifically, phoneme discrimination was studied in a passive and active oddball task with respect to different phonemic contrasts, while lexical detection was investigated by presenting infrequent pseudowords among frequent words in a passive oddball task. Concerning phoneme discrimination, PWA in the acute stage had smaller MMN and P300 amplitudes than the norm group for voicing, whereas for place and manner they only demonstrated smaller P300 amplitudes. PWA showed a distinct pattern of impaired phonemic contrast sensitivity, with place displaying the largest amplitude and voicing the smallest. Concerning lexical detection, pseudowords elicited larger responses than words in both groups, but with a delay and larger P200 amplitude for pseudowords in PWA compared to the norm group. For clinical practice, passive tasks seem more suitable than active tasks in acute aphasia.

Sex Differences in Neurophysiological Activation Patterns During Phonological Input Processing: An Influencing Factor for Normative Data.

In the context of neurophysiological normative data, it has been established that aging has a significant impact on neurophysiological correlates of auditory phonological input processes, such as phoneme discrimination (PD) and word recognition (WR). Besides age, sex is another demographic factor that influences several language processes. We aimed to disentangle whether sex has a similar effect on PD and WR. Event-related potentials (ERPs) were recorded in 20 men and 24 women. During PD, three phonemic contrasts (place and manner of articulation and voicing) were compared using the attentive P300 and pre-attentive Mismatch Negativity. To investigate WR, real words were contrasted with pseudowords in a pre-attentive oddball task. Women demonstrated a larger sensitivity to spectrotemporal differences, as evidenced by larger P300 responses to the place of articulation (PoA) contrast and larger P300 and MMN responses than men in PoA-based PD. Men did not display such sensitivity. Attention played an important role, considering that women needed more attentional resources to differentiate between PoA and the other phonemic contrasts. During WR, pseudowords evoked larger amplitudes already 100 ms post-stimulus independent of sex. However, women had decreased P200 latencies, but longer N400 latencies in response to pseudowords, whereas men showed increased N400 latencies compared to women in response to real words. The current results demonstrate significant sex-related influences on phonological input processes. Therefore, existing neurophysiological normative data for age should be complemented for the factor sex.

Neurophysiological investigation of phonological input: aging effects and development of normative data.

The current study investigated attended and unattended auditory phoneme discrimination using the P300 and Mismatch Negativity event-related potentials (ERPs). Three phonemic contrasts present in the Dutch language were compared. Additionally, auditory word recognition was investigated by presenting rare pseudowords among frequent words. Two main goals were: (1) obtain normative data for ERP latencies (ms) and amplitudes (µV) and (2) examine aging influences. Seventy-one healthy subjects (21-83 years) were included. During phoneme discrimination aging was associated with increased latencies and decreased amplitudes. However, a discrepancy between attended and unattended processing, as well as between phonemic contrasts, was found. During word recognition aging only had an impact on ERPs elicited by real words, indicating that mainly semantic processes were altered leaving lexical processes unharmed. Early sensory-perceptual processes, reflected by N100 and P50, were free from aging influences. In future, neurophysiological normative data can be applied in the evaluation of acquired language disorders.