Demarcation and localization of primary sensor and motor areas in human cortex by cortical somatosensory. Evoked potential (Co-SEP) during operation in surgery for epilepsy and intracranial tumor.

In neurosurgical operation, when the focus is close to the central fissure, precise delineation of the precentral motor and postcentral somatosensory areas is cardinal in defining the extent of the surgical resection. Eight ASA II-III patients scheduled for neurosurgery for intractable complex partial seizure (n = 5) and intracranial tumor (n = 3) were enrolled in the study. Subdural grids of electrodes were used for recording cortical evoked somatosensory potentials elicited by stimulating the median nerves to locate the primary somatosensory cortex and to delineate the central fissure through demonstration of phase-reversal pattern across the rolandic fissure. In all cases under general anesthesia, we were able to determine precisely the location of the central fissure. At the same time, we detected the evoked potential from SII (second sensory area) in one patient with intracerebral tumor. In conclusion, Co-SEP under general anesthesia is feasible and recommended to be performed as a routine intraoperatively for intractable epilepsy and tumor originating close to the primary motor or sensory strip in order to avoid iatrogenic damage to the vital cerebral cortex.