Short-range axono-cortical evoked-potentials in brain tumor surgery: Waveform characteristics as markers of direct connectivity

Objective: Intraoperative measurement of axono-cortical evoked potentials (ACEP) has emerged as a promising tool for studying neural connectivity. However, it is often difficult to determine if the activity recorded by cortical grids is generated by stimulated tracts or by spurious phenomena. This study aimed to identify criteria that would indicate a direct neurophysiological connection between a recording contact and a stimulated pathway. Methods: Electrical stimulation was applied to white matter fascicles within the resection cavity, while the evoked response was recorded at the cortical level in seven patients. Results: By analyzing the ACEP recordings, we identified a main epicenter characterized by a very early positive (or negative) evoked response occurring just after the stimulation artifact (<5 ms, |Amplitud e| > 100 lV) followed by an early and large negative (or positive) monophasic evoked response (<40 ms; |Amplitude| > 300 lV). The neighboring activity had a different waveform and was attenuated compared to the hot-spot activity. Conclusions: It is possible to distinguish the hotspot with direct connectivity to the stimulated site from neighboring activity using the identified criteria. Significance: The electrogenesis of the ACEP at the hotspot and neighboring activity is discussed. (c) 2023 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.