Multimodal Brain Mapping in Patients with Early Brain Lesions

fMRI ◽  
2020 ◽  
pp. 149-156
Author(s):  
Martin Staudt
Keyword(s):  
Brain Mapping ◽  
Brain Lesions

scholarly journals Intraoperative mapping of pre-central motor cortex and subcortex: a proposal for supplemental cortical and novel subcortical maps to Penfield’s motor homunculus

2021 ◽  
Author(s):  
Prajwal Ghimire ◽  
Jose Pedro Lavrador ◽  
Asfand Baig Mirza ◽  
Noemia Pereira ◽  
Hannah Keeble ◽  
...  
Keyword(s):  
Brain Mapping ◽  
Retrospective Cohort ◽  
Corticospinal Tract ◽  
Brain Lesions ◽  
Body Parts ◽  
Single Institution ◽  
Motor Representation ◽  
Motor Mapping ◽  
Subcortical Stimulation ◽  
Motor Maps

AbstractPenfield’s motor homunculus describes a caricaturised yet useful representation of the map of various body parts on the pre-central cortex. We propose a supplemental map of the clinically represented areas of human body in pre-central cortex and a novel subcortical corticospinal tract map. We believe this knowledge is essential for safe surgery in patients with eloquent brain lesions. A single-institution retrospective cohort study of patients who underwent craniotomy for motor eloquent lesions with intraoperative motor neuromonitoring (cortical and subcortical) between 2015 and 2020 was performed. All positive cortical and subcortical stimulation points were taken into account and cartographic maps were produced to demonstrate cortical and subcortical areas of motor representation and their configuration. A literature review in PubMed was performed. One hundred and eighty consecutive patients (58.4% male, 41.6% female) were included in the study with 81.6% asleep and 18.4% awake craniotomies for motor eloquent lesions (gliomas 80.7%, metastases 13.8%) with intraoperative cortical and subcortical motor mapping. Based on the data, we propose a supplemental clinical cortical and a novel subcortical motor map to the original Penfield’s motor homunculus, including demonstration of localisation of intercostal muscles both in the cortex and subcortex which has not been previously described. The supplementary clinical cortical and novel subcortical motor maps of the homunculus presented here have been derived from a large cohort of patients undergoing direct cortical and subcortical brain mapping. The information will have direct relevance for improving the safety and outcome of patients undergoing resection of motor eloquent brain lesions.

Cortical calculation localization using electrostimulation

2009 ◽  
Vol 110 (6) ◽  
pp. 1291-1299 ◽  
Author(s):  
Franck-Emmanuel Roux ◽  
Leila Boukhatem ◽  
Louisa Draper ◽  
Oumar Sacko ◽  
Jean-François Démonet
Keyword(s):  
Brain Mapping ◽  
Parietal Lobe ◽  
Naming Task ◽  
Brain Lesions ◽  
Awake Surgery ◽  
Mapping Procedure ◽  
Cortical Areas ◽  
Surgical Data ◽  
Calculation Task ◽  
Language Areas

Object A naming task has been used to spare cortical areas involved in language. In the present study, a calculation task was combined with electrostimulation mapping (awake surgery) to spare cortical areas involved in calculation in patients undergoing surgery for brain lesions. The organization of language and calculation areas was analyzed in relation to these surgical data. Methods Twenty patients with brain lesions close to areas possibly involved in calculation (dominant parietal lobe and F2) were prospectively studied over a 4-year period. Four patients had preoperative symptoms of acalculia and therefore were not included in the brain mapping procedure. Results In 16 patients, direct electrostimulation caused calculation interferences in localized small cortical areas (< 2 cm2). Of the 53 calculation interferences found, 23 were independent of language areas, especially those in the inferior left parietal lobule. Various patterns of interference were observed (11 complete acalculia, 5 acalculia with wrong answers, 2 hesitations, and 5 mixed responses), although error patterns were fairly similar across angular, parietal, and frontal stimulation sites. Calculation areas in 4 patients could not be spared for oncological reasons; postoperatively, 3 of these patients showed significant acalculia symptoms. In contrast, none of the patients whose calculation areas were spared had arithmetic difficulties 1 month after surgery. Improvements in acalculia symptoms after surgery were also found in 3 of the 4 patients with preoperative calculation difficulties. Conclusions To limit the risk of personal and professional disturbances caused by acquired anarithmetia in patients undergoing surgery for brain tumors or epilepsy, the authors think it is necessary to use a calculation task during brain mapping, especially when operating in the dominant parietal lobe.

scholarly journals Intraoperative mapping of pre-central motor cortex and subcortex: a proposal for supplemental cortical and novel subcortical maps to Penfield’s motor homunculus

2020 ◽  
Author(s):  
Prajwal Ghimire ◽  
Jose Lavrador ◽  
Asfand Mirza ◽  
Noemia Pereira ◽  
Hannah Keeble ◽  
...  
Keyword(s):  
Brain Mapping ◽  
Retrospective Cohort ◽  
Corticospinal Tract ◽  
Brain Lesions ◽  
Body Parts ◽  
Single Institution ◽  
Motor Representation ◽  
Motor Mapping ◽  
Subcortical Stimulation ◽  
Motor Maps

Abstract Introduction: Penfield’s motor homunculus describes a caricaturised yet useful representation of the map of various body parts on the pre-central cortex. We propose a supplemental map of the clinically represented areas of human body in pre-central cortex and a novel subcortical corticospinal tract map that are accurate and essential for safe surgery in patients with eloquent brain lesions. Materials and methods: A single-institution retrospective cohort study of patients who underwent craniotomy for motor eloquent lesions with intraoperative motor neuromonitoring (cortical and subcortical) between 2015 and 2020 was performed. All positive cortical and subcortical stimulation points were taken into account and cartographic maps were produced to demonstrate cortical and subcortical areas of motor representation and their configuration. A literature review in PubMed was performed. Results: 180 patients (58.4% male, 41.6% female) were included in the study with 81.6% asleep and 18.4% awake craniotomies for motor eloquent lesions (gliomas 80.7%, metastases 13.8%) with intraoperative cortical and subcortical motor mapping. Based on the data, we propose a supplemental clinical cortical and a novel subcortical motor map to the original Penfield’s motor homunculus, including demonstration of localisation of intercostal muscles both in the cortex and subcortex which has not been previously described. Conclusion: The supplementary clinical cortical and novel subcortical motor maps of the homunculus presented here have been derived from a large cohort of patients undergoing direct cortical and subcortical brain mapping. The information will have direct relevance for improving the safety and outcome of patients undergoing resection of motor eloquent brain lesions.

Is Preoperative Functional Magnetic Resonance Imaging Reliable for Language Areas Mapping in Brain Tumor Surgery? Review of Language Functional Magnetic Resonance Imaging and Direct Cortical Stimulation Correlation Studies

Neurosurgery ◽  
2010 ◽  
Vol 66 (1) ◽  
pp. 113-120 ◽  
Author(s):  
Carlo Giussani ◽  
Frank-Emmanuel Roux ◽  
Jeffrey Ojemann ◽  
Erik Pietro Sganzerla ◽  
David Pirillo ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Functional Magnetic Resonance Imaging ◽  
Brain Mapping ◽  
Brain Lesions ◽  
Cortical Stimulation ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Direct Cortical Stimulation ◽  
Language Areas

Abstract OBJECTIVE Language functional magnetic resonance imaging (fMRI) has been used extensively in the past decade for both clinical and research purposes. Its integration in the preoperative imaging assessment of brain lesions involving eloquent areas is progressively more diffused in neurosurgical practice. Nevertheless, the reliability of language fMRI is unclear. To understand the reliability of preoperative language fMRI in patients operated on for brain tumors, the surgical studies that compared language fMRI with direct cortical stimulation (DCS) were reviewed. METHODS Articles comparing language fMRI with DCS of language areas were reviewed with attention to the lesion pathology, the magnetic field, the language tasks used pre- and intraoperatively, and the validation modalities adopted to establish the reliability of language fMRI. We tried to explore the effectiveness of language fMRI in gliomas. RESULTS Nine language brain mapping studies compared the findings of fMRI with those of DCS. The studies are not homogeneous for tumor types, magnetic fields, pre- and intraoperative language tasks, intraoperative matching criteria, and results. Sensitivity and specificity were calculated in 5 studies (respectively ranging from 59% to 100% and from 0% to 97%). CONCLUSION The contradictory results of these studies do not allow consideration of language fMRI as an alternative tool to DCS in brain lesions located in language areas, especially in gliomas because of the pattern of growth of these tumors. However, language fMRI conducted with high magnet fields is a promising brain mapping tool that must be validated by DCS in methodological robust studies.

scholarly journals Cortical stimulation of language fields under local anesthesia: optimizing removal of brain lesions adjacent to speech areas

2008 ◽  
Vol 66 (3a) ◽  
pp. 534-538 ◽  
Author(s):  
Robson Luis Oliveira de Amorim ◽  
Antônio Nogueira de Almeida ◽  
Paulo Henrique Pires de Aguiar ◽  
Erich Talamoni Fonoff ◽  
Suely Itshak ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Brain Mapping ◽  
Conscious Sedation ◽  
Brain Lesions ◽  
Neurological Deficits ◽  
Consecutive Series ◽  
Total Resection ◽  
Safe Technique ◽  
Language Areas ◽  
Stimulation Of

OBJECTIVE: The main objective when resecting benign brain lesions is to minimize risk of postoperative neurological deficits. We have assessed the safety and effectiveness of craniotomy under local anesthesia and monitored conscious sedation for the resection of lesions involving eloquent language cortex. METHODS: A retrospective review was performed on a consecutive series of 12 patients who underwent craniotomy under local anesthesia between 2001 and 2004. All patients had lesions close to the speech cortex. All resection was verified by post-operative imaging. Six subjects were male and 6 female, and were aged between 14 and 52 years. RESULTS: Lesions comprised 7 tumour lesions, 3 cavernomas and 1 dermoid cyst. Radiological gross total resection was achieved in 66% of patients while remaining cases had greater than 80% resection. Only one patient had a post-operative permanent deficit, whilst another had a transient post-operative deficit. All patients with uncontrollable epilepsy had good outcomes after surgery. None of our cases subsequently needed to be put under general anesthesia. CONCLUSION: Awake craniotomy with brain mapping is a safe technique and the "gold standard" for resection of lesions involving language areas.

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