Intra-operative multi-site stimulation: Expanding methodology for cortical brain mapping of language functions

PLoS One. 2017 Jul 10;12(7):e0180740. doi: 10.1371/journal.pone.0180740. eCollection 2017.

Abstract

Direct cortical stimulation (DCS) is considered the gold-standard for functional cortical mapping during awake surgery for brain tumor resection. DCS is performed by stimulating one local cortical area at a time. We present a feasibility study using an intra-operative technique aimed at improving our ability to map brain functions which rely on activity in distributed cortical regions. Following standard DCS, Multi-Site Stimulation (MSS) was performed in 15 patients by applying simultaneous cortical stimulations at multiple locations. Language functioning was chosen as a case-cognitive domain due to its relatively well-known cortical organization. MSS, performed at sites that did not produce disruption when applied in a single stimulation point, revealed additional language dysfunction in 73% of the patients. Functional regions identified by this technique were presumed to be significant to language circuitry and were spared during surgery. No new neurological deficits were observed in any of the patients following surgery. Though the neuro-electrical effects of MSS need further investigation, this feasibility study may provide a first step towards sophistication of intra-operative cortical mapping.

MeSH terms

  • Adult
  • Brain Mapping / methods*
  • Electric Stimulation
  • Female
  • Humans
  • Language*
  • Magnetic Resonance Imaging
  • Male
  • Monitoring, Intraoperative / methods*
  • Treatment Outcome

Grants and funding

This research has been partly supported by the European Union ACTIVE grant (FP7-ICT-2009-270460), the Israel Cancer Association and by the BRAIN division grant TLVMC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.