Visualization-Based Mapping of Language Function in the Brain

Cortical language maps, obtained through intraoperative electrical stimulation studies, provide a rich source of information for research on language organization. Previous studies have shown interesting correlations between the distribution of essential language sites and such behavioral indicators as verbal IQ and have provided suggestive evidence for regarding human language cortex as an organization of multiple distributed systems. Noninvasive studies using ECoG, PET, and functional MR lend support to this model; however, there as yet are no studies that integrate these two forms of information. In this paper we describe a method for mapping the stimulation data onto a 3-D MRI-based neuroanatomic model of the individual patient. The mapping is done by comparing an intraoperative photograph of the exposed cortical surface with a computer-based MR visualization of the surface, interactively indicating corresponding stimulation sites, and recording 3-D MR machine coordinates of the indicated sites. Repeatability studies were performed to validate the accuracy of the mapping technique. Six observers—a neurosurgeon, a radiologist, and four computer scientists, independently mapped 218 stimulation sites from 12 patients. The mean distance of a mapping from the mean location of each site was 2.07 mm, with a standard deviation of 1.5 mm, or within 5.07 mm with 95% confidence. Since the surgical sites are accurate within approximately 1 cm, these results show that the visualization-based approach is accurate within the limits of the stimulation maps. When incorporated within the kind of information system envisioned by the Human Brain Project, this anatomically based method will not only provide a key link between noninvasive and invasive approaches to understanding language organization, but will also provide the basis for studying the relationship between language function and anatomical variability

Optimization of signal-to-noise ratio in short-duration SEP recordings by variation of stimulation rate

Objective: The intraoperative averaging of the somatosensory evoked potential (SEP) requires reliable recordings within the shortest possible duration. We here systematically optimized the repetition rate of stimulus presentation. Methods: We recorded medianus and tibial nerve SEP during 22 surgeries and varied the rate of stimulus presentation between 2.7 Hz and 28.7 Hz. We randomly sampled a number of sweeps corresponding to recording durations up to 20 s and calculated the signal-to-noise ratio (SNR). Results: For the medianus nerve at 5 s recording duration, SEP stimulation rate at 12.7 Hz obtained the highest median SNR = 22.9 for the N20, which was higher than for rate 4.7 Hz (p = 1.5e-4). When increasing the stimulation rate, latency increased and amplitude decayed for cortical but not for peripheral recording sites. For the tibial nerve, the rate 4.7 Hz achieved the highest SNR for all durations. Conclusions: We determined the time-dependence of SNR for N20 and elucidated the underlying physiology. For short recordings, rapid reduction of noise through averaging at high stimulation rate outweighs the disadvantage of smaller amplitude. Significance: For a short duration of medianus nerve SEP recording only, it may be advantageous to stimulate with a repetition rate of 12.7 Hz. Keywords: Erb’s point; High frequency oscillation; Intraoperative neuromonitoring; Neurosurgery; Peripheral nerve conduction; Stimulation frequency

Presurgical language mapping in children with epilepsy: Clinical usefulness of functional magnetic resonance imaging for the planning of cortical stimulation

Purpose: Presurgical language mapping in dominant hemisphere epilepsy to evaluate the risk of postoperative deficit is particularly difficult in children. Extraoperative invasive cortical stimulation can show some areas critical to language, but not all of them, due to scarce sampling, poor cooperation, cortical immaturity, or network reorganization, whereas functional magnetic resonance imaging (fMRI) displays entire networks involved in, but not necessarily critical to, language. In a homogeneous series of children with epilepsy, we compared the contributions of language fMRI and depth electrode stimulations to optimize language mapping. Methods: Eight children (7.5-15.5 years) with left frontal or temporal epilepsy underwent language fMRI and language stimulation with depth electrodes as part of their comprehensive presurgical workup. fMRI data collected during sentence generation were analyzed using statistical parametric mapping (SPM2) (false discovery rate [FDR] p \u3c 0.05). Bipolar stimulations were performed during language production tasks. By coregistering fMRI and postimplantation computed tomography (CT) images, we were able to directly compare the cortical areas identified by both investigations. Key Findings: fMRI during sentence generation robustly showed activation in the whole perisylvian regions with little reorganization (left hemisphere dominant in 7). Of the 184 electrode contacts tested for language, only 8 were positive (language disruption) in three of the seven patients with periictal language impairment and left language dominance. All of the positive contacts colocalized with an fMRI activated cluster, that is, fMRI did not miss any region critical to language (sensitivity = 100%). However, 54 of the 176 negative contacts were within activated clusters (low specificity). Significance: In children with epilepsy, the sensitivity of fMRI during sentence generation allows for the detection of all critical regions displayed by cortical stimulation within the large perisylvian language network, but with a low specificity. It is, therefore, useful to optimize the placement of intracranial electrodes when language mapping is necessary. Systematic planning of the electrode placement according to language fMRI maps should increase the yield of extraoperative cortical stimulation, which appears rather low in children when compared to adults. © 2011 International League Against Epilepsy

Laser speckle contrast imaging for intraoperative monitoring of cerebral blood flow

Ensuring adequate blood flow during surgical procedures is crucial, as prolonged ischemia can result in tissue death and lead to poor clinical outcomes. This is especially important during neurosurgery, since the brain relies on a constant supply of cerebral blood flow (CBF) to maintain normal function. Intraoperative blood flow monitoring tools are essential to detect ischemia in a timely manner, and allow surgical correction before the onset of irreversible brain injury. Laser speckle contrast imaging (LSCI) is an optical imaging method that provides blood flow maps with high spatiotemporal resolution, and overcomes many of the limitations of current intraoperative monitoring technologies. The objective of this dissertation is to demonstrate that LSCI is an effective tool for blood flow monitoring during neurosurgery, and to optimize and improve LSCI technology for clinical use. This research has two primary elements: assessing the LSCI instrumentation components in a controlled laboratory setting, and evaluating the clinical performance of LSCI during neurosurgery. The laboratory study aims to determine the optimal specifications for the clinical instrument design, using controlled static and microfluidic flow experiments. Two of the main components of the LSCI instrument are the camera used for recording, and the laser used for coherent illumination of the tissue. Thus, a broad camera and laser comparison was performed spanning a wide array of available hardware options to determine which specifications are the most important for reliable and highly sensitive flow measurements. The two-phase clinical study aims to demonstrate the performance and utility of LSCI in a neurosurgical setting as a potential tool for real-time, continuous, and noninvasive image guidance. These studies demonstrate that LSCI can produce blood flow maps consistent with expected physiological trends, and show the impact of instrument design and image acquisition techniques on image quality and quantitative flow assessment. The results from both the laboratory and clinical studies can be used to design a more sensitive and robust LSCI system, which increases its value as an intraoperative tool for monitoring blood flow. LSCI has the potential to be the next generation of neurosurgical image guidance for blood flow visualization, and the work presented in this dissertation can accelerate its clinical adoption.Biomedical Engineerin