@article {2197, title = {Passive real-time identification of speech and motor cortex during an awake craniotomy.}, journal = {Epilepsy Behav}, volume = {18}, year = {2010}, month = {05/2010}, pages = {123-8}, abstract = {

Precise localization of eloquent cortex is a clinical necessity prior to surgical resections adjacent to speech or\ motor\ cortex. In the intraoperative setting, this traditionally requires inducing temporary lesions by direct electrocortical stimulation (DECS). In an attempt to increase efficiency and potentially reduce the amount of necessary stimulation, we used a passive mapping procedure in the setting of an awake craniotomy for tumor in two patients resection. We recorded electrocorticographic (ECoG) signals from exposed cortex while patients performed simple cue-directed\ motor\ and speech tasks. SIGFRIED, a procedure for real-time event detection, was used to identify areas of\ cortical\ activation by detecting task-related modulations in the ECoG high gamma band. SIGFRIED{\textquoteright}s real-time output quickly localized\ motor\ and speech areas of cortex similar to those identified by DECS. In conclusion, real-time passive identification of\ cortical\ function using SIGFRIED may serve as a useful adjunct to\ cortical\ stimulation mapping in the intraoperative setting.

}, keywords = {Brain Mapping, Brain Neoplasms, Cerebral Cortex, Craniotomy, Electric Stimulation, Electroencephalography, Humans, Neurologic Examination}, issn = {1525-5069}, doi = {10.1016/j.yebeh.2010.02.017}, url = {http://www.ncbi.nlm.nih.gov/pubmed/20478745}, author = {Roland, Jarod and Peter Brunner and Johnston, James and Gerwin Schalk and Leuthardt, E C} } @article {2192, title = {A practical procedure for real-time functional mapping of eloquent cortex using electrocorticographic signals in humans.}, journal = {Epilepsy Behav}, volume = {15}, year = {2009}, month = {07/2009}, pages = {278-86}, abstract = {

Functional mapping of eloquent cortex is often necessary prior to invasive brain surgery, but current techniques that derive this mapping have important limitations. In this article, we demonstrate the first comprehensive evaluation of a rapid, robust, and practical mapping system that uses passive recordings of electrocorticographic signals. This mapping procedure is based on the BCI2000 and SIGFRIED technologies that we have been developing over the past several years. In our study, we evaluated 10 patients with epilepsy from four different institutions and compared the results of our procedure with the results derived using electrical cortical stimulation (ECS) mapping. The results show that our procedure derives a functional motor cortical map in only a few minutes. They also show a substantial concurrence with the results derived using ECS mapping. Specifically, compared with ECS maps, a next-neighbor evaluation showed no false negatives, and only 0.46 and 1.10\% false positives for hand and tongue maps, respectively. In summary, we demonstrate the first comprehensive evaluation of a practical and robust mapping procedure that could become a new tool for planning of invasive brain surgeries.

}, keywords = {Adult, Brain Mapping, Cerebral Cortex, Electric Stimulation, Electrodes, Implanted, Electroencephalography, Epilepsy, Female, Humans, Male, Middle Aged, Practice Guidelines as Topic, Signal Processing, Computer-Assisted, Young Adult}, issn = {1525-5069}, doi = {10.1016/j.yebeh.2009.04.001}, url = {http://www.ncbi.nlm.nih.gov/pubmed/19366638}, author = {Peter Brunner and A L Ritaccio and Lynch, Timothy M and Emrich, Joseph F and Adam J Wilson and Williams, Justin C and Aarnoutse, Erik J and Ramsey, Nick F and Leuthardt, E C and H Bischof and Gerwin Schalk} } @article {2179, title = {Electrocorticographic Frequency Alteration Mapping: A Clinical Technique for Mapping the Motor Cortex.}, journal = {Neurosurgery}, volume = {60}, year = {2007}, month = {04/2007}, pages = {260-70; discussion 270-1}, abstract = {

OBJECTIVE:\ 

Electrocortical stimulation (ECS) has been well established for delineating the eloquent cortex. However, ECS is still coarse and inefficient in delineating regions of the functional cortex and can be hampered by after-discharges. Given these constraints, an adjunct approach to defining the motor cortex is the use of electrocorticographic signal changes associated with active regions of the cortex. The broad range of frequency oscillations are categorized into two main groups with respect to the sensorimotor cortex: low and high frequency bands. The low frequency bands tend to show a power reduction with cortical activation, whereas the high frequency bands show power increases. These power changes associated with the activated cortex could potentially provide a powerful tool in delineating areas of the motor cortex. We explore electrocorticographic signal alterations as they occur with activated regions of the motor cortex, as well as its potential in clinical brain mapping applications.

METHODS:\ 

We evaluated seven patients who underwent invasive monitoring for seizure localization. Each patient had extraoperative ECS mapping to identify the motor cortex. All patients also performed overt hand and tongue motor tasks to identify associated frequency power changes in regard to location and degree of concordance with ECS results that localized either hand or tongue motor function.

RESULTS:\ 

The low frequency bands had a high sensitivity (88.9-100\%) and a lower specificity (79.0-82.6\%) for identifying electrodes with either hand or tongue ECS motor responses. The high frequency bands had a lower sensitivity (72.7-88.9\%) and a higher specificity (92.4-94.9\%) in correlation with the same respective ECS positive electrodes.

CONCLUSION:\ 

The concordance between stimulation and spectral power changes demonstrate the possible utility of electrocorticographic frequency alteration mapping as an adjunct method to improve the efficiency and resolution of identifying the motor cortex.

}, keywords = {Adult, Biological Clocks, Brain Mapping, Electric Stimulation, Electrodes, Implanted, Electroencephalography, Female, Hand, Humans, Male, Middle Aged, Motor Cortex, Oscillometry, Signal Processing, Computer-Assisted, Tongue}, issn = {1524-4040}, doi = {10.1227/01.NEU.0000255413.70807.6E}, url = {http://www.ncbi.nlm.nih.gov/pubmed/17415162}, author = {Leuthardt, E C and Miller, John W and Nicholas R Anderson and Gerwin Schalk and Dowling, Joshua and Miller, John W and Moran, D and Ojemann, J G} }