{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:27:56Z","timestamp":1784136476202,"version":"3.55.0"},"reference-count":33,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,9]],"date-time":"2022-09-09T00:00:00Z","timestamp":1662681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: The role played by the non-dominant parietal lobe in motor cognition, attention and spatial awareness networks has potentiated the use of awake surgery. When this is not feasible, asleep monitoring and mapping techniques should be used to achieve an onco-functional balance. Objective: This study aims to assess the feasibility of a dual-strip method to obtain direct cortical stimulation for continuous real-time cortical monitoring and subcortical mapping of motor and visual pathways simultaneously in parietal lobe tumour surgery. Methods: Single-centre prospective study between 19 May\u201320 November of patients with intrinsic non-dominant parietal-lobe tumours. Two subdural strips were used to simultaneously map and monitor motor and visual pathways. Results: Fifteen patients were included. With regards to motor function, a large proportion of patients had abnormal interhemispheric resting motor threshold ratio (iRMTr) (71.4%), abnormal Cortical Excitability Score (CES) (85.7%), close distance to the corticospinal tract\u2014Lesion-To-Tract Distance (LTD)\u20144.2 mm, Cavity-To-Tract Distance (CTD)\u20147 mm and intraoperative subcortical distance\u20146.4 mm. Concerning visual function, the LTD and CTD for optic radiations (OR) were 0.5 mm and 3.4 mm, respectively; the mean intensity for positive subcortical stimulation of OR was 12 mA \u00b1 2.3 mA and 5\/6 patients with deterioration of VEPs &gt; 50% had persistent hemianopia and transgression of ORs. Twelve patients remained stable, one patient had a de-novo transitory hemiparesis, and two showed improvements in motor symptoms. A higher iRMTr for lower limbs was related with a worse motor outcome (p = 0.013) and a longer CTD to OR was directly related with a better visual outcome (p = 0.041). At 2 weeks after hospital discharge, all patients were ambulatory at home, and all proceeded to have oncological treatment. Conclusion: We propose motor and visual function boundaries for asleep surgery of intrinsic non-dominant parietal tumours. Pre-operative abnormal cortical excitability of the motor cortex, deterioration of the VEP recordings and CTD &lt; 2 mm from the OR were related to poorer outcomes.<\/jats:p>","DOI":"10.3390\/jpm12091478","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T01:44:03Z","timestamp":1663033443000},"page":"1478","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Simultaneous Motor and Visual Intraoperative Neuromonitoring in Asleep Parietal Lobe Surgery: Dual Strip Technique"],"prefix":"10.3390","volume":"12","author":[{"given":"Devika","family":"Rajashekar","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, King\u2019s College Hospital NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9518-111X","authenticated-orcid":false,"given":"Jose Pedro","family":"Lavrador","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King\u2019s College Hospital NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2884-956X","authenticated-orcid":false,"given":"Prajwal","family":"Ghimire","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King\u2019s College Hospital NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Keeble","sequence":"additional","affiliation":[{"name":"Inomed Neurocare Ltd., London W6 0NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Harris","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Queen\u2019s Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, London RM7 0AG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6696-3753","authenticated-orcid":false,"given":"Noemia","family":"Pereira","sequence":"additional","affiliation":[{"name":"Inomed Neurocare Ltd., London W6 0NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King\u2019s College Hospital NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Beyh","sequence":"additional","affiliation":[{"name":"NatBrainLab, Neuroimaging Department, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College, London SE5 8AF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Gullan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King\u2019s College Hospital NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keyoumars","family":"Ashkan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King\u2019s College Hospital NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjeev","family":"Bhangoo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King\u2019s College Hospital NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Vergani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King\u2019s College Hospital NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.neubiorev.2016.02.024","article-title":"Left inferior parietal lobe engagement in social cognition and language","volume":"68","author":"Bzdok","year":"2016","journal-title":"Neurosci. 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