02881nas a2200397 4500008004100000022001400041245011100055210006900166260001200235300001100247490000700258520172500265653001501990653002002005653001802025653002002043653002502063653002702088653002402115653001102139653001102150653001302161653002902174653003202203653001102235100002602246700001902272700002602291700002402317700001902341700001902360700001802379700002302397700001502420856004802435 2014 eng d a1933-071500aReal-time functional mapping: potential tool for improving language outcome in pediatric epilepsy surgery.0 aRealtime functional mapping potential tool for improving languag c09/2014 a287-950 v143 a

Accurate language localization expands surgical treatment options for epilepsy patients and reduces the risk of postsurgery language deficits. Electrical cortical stimulation mapping (ESM) is considered to be the clinical gold standard for language localization. While ESM affords clinically valuable results, it can be poorly tolerated by children, requires active participation and compliance, carries a risk of inducing seizures, is highly time consuming, and is labor intensive. Given these limitations, alternative and/or complementary functional localization methods such as analysis of electrocorticographic (ECoG) activity in high gamma frequency band in real time are needed to precisely identify eloquent cortex in children. In this case report, the authors examined 1) the use of real-time functional mapping (RTFM) for language localization in a high gamma frequency band derived from ECoG to guide surgery in an epileptic pediatric patient and 2) the relationship of RTFM mapping results to postsurgical language outcomes. The authors found that RTFM demonstrated relatively high sensitivity (75%) and high specificity (90%) when compared with ESM in a "next-neighbor" analysis. While overlapping with ESM in the superior temporal region, RTFM showed a few other areas of activation related to expressive language function, areas that were eventually resected during the surgery. The authors speculate that this resection may be associated with observed postsurgical expressive language deficits. With additional validation in more subjects, this finding would suggest that surgical planning and associated assessment of the risk/benefit ratio would benefit from information provided by RTFM mapping.

10aAdolescent10aAnticonvulsants10aBrain Mapping10aCerebral Cortex10aElectric Stimulation10aElectroencephalography10aEpilepsies, Partial10aFemale10aHumans10aLanguage10aNeuropsychological Tests10aSensitivity and Specificity10aSpeech1 aKorostenskaja, Milena1 aChen, Po-Ching1 aSalinas, Christine, M1 aWesterveld, Michael1 aBrunner, Peter1 aSchalk, Gerwin1 aCook, Jane, C1 aBaumgartner, James1 aLee, Ki, H uhttp://www.ncbi.nlm.nih.gov/pubmed/2499581503481nas a2200289 4500008004100000022001400041245009200055210006900147260001200216300001000228490000700238520264000245653001802885653002002903653002002923653001502943653002502958653002702983653001103010653002703021100001803048700001903066700002003085700001903105700001903124856004803143 2010 eng d a1525-506900aPassive real-time identification of speech and motor cortex during an awake craniotomy.0 aPassive realtime identification of speech and motor cortex durin c05/2010 a123-80 v183 a

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'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.

10aBrain Mapping10aBrain Neoplasms10aCerebral Cortex10aCraniotomy10aElectric Stimulation10aElectroencephalography10aHumans10aNeurologic Examination1 aRoland, Jarod1 aBrunner, Peter1 aJohnston, James1 aSchalk, Gerwin1 aLeuthardt, E C uhttp://www.ncbi.nlm.nih.gov/pubmed/2047874502591nas a2200433 4500008004100000022001400041245012500055210006900180260001200249300001100261490000700272520133300279653001001612653001801622653002001640653002501660653002601685653002701711653001301738653001101751653001101762653000901773653001601782653003301798653004101831653001601872100001901888700001801907700002201925700002201947700002001969700002401989700002302013700002002036700001902056700001502075700001902090856004802109 2009 eng d a1525-506900aA practical procedure for real-time functional mapping of eloquent cortex using electrocorticographic signals in humans.0 apractical procedure for realtime functional mapping of eloquent  c07/2009 a278-860 v153 a

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.

10aAdult10aBrain Mapping10aCerebral Cortex10aElectric Stimulation10aElectrodes, Implanted10aElectroencephalography10aEpilepsy10aFemale10aHumans10aMale10aMiddle Aged10aPractice Guidelines as Topic10aSignal Processing, Computer-Assisted10aYoung Adult1 aBrunner, Peter1 aRitaccio, A L1 aLynch, Timothy, M1 aEmrich, Joseph, F1 aWilson, Adam, J1 aWilliams, Justin, C1 aAarnoutse, Erik, J1 aRamsey, Nick, F1 aLeuthardt, E C1 aBischof, H1 aSchalk, Gerwin uhttp://www.ncbi.nlm.nih.gov/pubmed/19366638