scholarly journals Intraoperative mapping of executive function using electrocorticography for patients with low-grade gliomas

2020 ◽  
Author(s):  
Yaara Erez ◽  
Moataz Assem ◽  
Pedro Coelho ◽  
Rafael Romero-Garcia ◽  
Mallory Owen ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Executive Function ◽  
Executive Functions ◽  
Neural Activity ◽  
Task Difficulty ◽  
Awake Surgery ◽  
Low Grade ◽  
Direct Electrical Stimulation ◽  
High Gamma ◽  
Gamma Power

Abstract Background Intraoperative functional mapping with direct electrical stimulation during awake surgery for patients with diffuse low-grade glioma has been used in recent years to optimize the balance between surgical resection and quality of life following surgery. Mapping of executive functions is particularly challenging because of their complex nature, with only a handful of reports published so far. Here, we propose the recording of neural activity directly from the surface of the brain using electrocorticography to map executive functions and demonstrate its feasibility and potential utility. Methods To track a neural signature of executive function, we recorded neural activity using electrocorticography during awake surgery from the frontal cortex of three patients judged to have an appearance of diffuse low-grade glioma. Based on existing functional magnetic resonance imaging (fMRI) evidence from healthy participants for the recruitment of areas associated with executive function with increased task demands, we employed a task difficulty manipulation in two counting tasks performed intraoperatively. Following surgery, the data were extracted and analyzed offline to identify increases in broadband high-gamma power with increased task difficulty, equivalent to fMRI findings, as a signature of activity related to executive function. Results All three patients performed the tasks well. Data were recorded from five electrode strips, resulting in data from 15 channels overall. Eleven out of the 15 channels (73.3%) showed significant increases in high-gamma power with increased task difficulty, 26.6% of the channels (4/15) showed no change in power, and none of the channels showed power decrease. High-gamma power increases with increased task difficulty were more likely in areas that are within the canonical frontoparietal network template. Conclusions These results are the first step toward developing electrocorticography as a tool for mapping of executive function complementarily to direct electrical stimulation to guide resection. Further studies are required to establish this approach for clinical use.

scholarly journals Intraoperative mapping of executive function using electrocorticography for patients with low-grade gliomas

2020 ◽  
Author(s):  
Yaara Erez ◽  
Moataz Assem ◽  
Pedro Coelho ◽  
Rafael Romero-Garcia ◽  
Mallory Owen ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Executive Function ◽  
Executive Functions ◽  
Neural Activity ◽  
Task Difficulty ◽  
Awake Surgery ◽  
Low Grade ◽  
Direct Electrical Stimulation ◽  
High Gamma ◽  
Gamma Power

Background: Intraoperative functional mapping with direct electrical stimulation during awake surgery for patients with diffuse low-grade glioma has been used in recent years to optimize the balance between surgical resection and quality of life following surgery. Mapping of executive functions is particularly challenging because their complex nature, with only a handful of reports so far. Here, we propose recording of neural activity directly from the surface of the brain using electrocorticography to map executive functions and demonstrate its feasibility and potential utility.Methods: To track a neural signature of executive function, we recorded neural activity using electrocorticography during awake surgery from the frontal cortex of three patients judged to have an appearance of diffuse low-grade glioma. Based on existing functional magnetic resonance imaging (fMRI) evidence from healthy participants for the recruitment of areas associated with executive function with increased task demands, we employed a task difficulty manipulation in two counting tasks performed intraoperatively. Following surgery, the data were extracted and analyzed offline to identify increases in broadband high-gamma power with increased task difficulty, equivalent to fMRI findings, as a signature of activity related to executive function.Results: All three patients performed the tasks well. Data were recorded from five electrode strips, resulting in data from 15 channels overall. 73.3% of the channels (11/15) showed significant increases in high-gamma power with increased task difficulty, 26.6% channels (4/15) showed no change in power, and none of the channels showed power decrease. High-gamma power increases with increased task difficulty were more likely in areas that are within the canonical frontoparietal network template.Conclusions: These results are the first step towards developing electrocorticography as a tool for mapping of executive function complementarily to direct electrical stimulation to guide resection. Further studies and clinical trials are required to establish this approach for clinical use.

scholarly journals Executive functional deficits during electrical stimulation of the right frontal aslant tract

2021 ◽  
Author(s):  
Geert-Jan M. Rutten ◽  
Maud J. F. Landers ◽  
Wouter De Baene ◽  
Tessa Meijerink ◽  
Stephanie van der Hek ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Clinical Practice ◽  
Executive Functions ◽  
Tumor Resection ◽  
Awake Surgery ◽  
Low Grade ◽  
Functional Deficits ◽  
Frontal Aslant Tract ◽  
The Right ◽  
Stimulation Of

AbstractDirect electrical stimulation mapping was used to map executive functions during awake surgery of a patient with a right frontal low-grade glioma. We specifically targeted the frontal aslant tract, as this pathway had been infiltrated by the tumor. The right frontal aslant tract has been implicated in executive functions in the neuroscientific literature, but is yet of unknown relevance for clinical practice. Guided by tractography, electrical stimulation of the frontal aslant tract disrupted working memory and inhibitory functions. In this report we illustrate the dilemmas that neurosurgeons face when balancing maximal tumor resection against optimal cognitive performance. In particular, we emphasize that intraoperative tasks that target cognitive functions should be carefully introduced in clinical practice to prevent clinically irrelevant responses and too early termination of the resection.

scholarly journals Direct electrical stimulation of human cortex evokes high gamma activity that predicts conscious somatosensory perception

2018 ◽  
Vol 15 (2) ◽  
pp. 026015 ◽  
Author(s):  
Leah Muller ◽  
John D Rolston ◽  
Neal P Fox ◽  
Robert Knowlton ◽  
Vikram R Rao ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Gamma Activity ◽  
Direct Electrical Stimulation ◽  
Human Cortex ◽  
High Gamma ◽  
Stimulation Of

scholarly journals Including measures of high gamma power can improve the decoding of natural speech from EEG

2019 ◽  
Author(s):  
Shyanthony R. Synigal ◽  
Emily S. Teoh ◽  
Edmund C. Lalor
Keyword(s):  
Brain Imaging ◽  
Neural Activity ◽  
Speech Processing ◽  
Signal To Noise Ratio ◽  
Low Frequency ◽  
Natural Speech ◽  
Low Frequencies ◽  
High Gamma ◽  
Gamma Power ◽  
Speech Tracking

ABSTRACTThe human auditory system is adept at extracting information from speech in both single-speaker and multi-speaker situations. This involves neural processing at the rapid temporal scales seen in natural speech. Non-invasive brain imaging (electro-/magnetoencephalography [EEG/MEG]) signatures of such processing have shown that the phase of neural activity below 16 Hz tracks the dynamics of speech, whereas invasive brain imaging (electrocorticography [ECoG]) has shown that such rapid processing is even more strongly reflected in the power of neural activity at high frequencies (around 70-150 Hz; known as high gamma). The aim of this study was to determine if high gamma power in scalp recorded EEG carries useful stimulus-related information, despite its reputation for having a poor signal to noise ratio. Furthermore, we aimed to assess whether any such information might be complementary to that reflected in well-established low frequency EEG indices of speech processing. We used linear regression to investigate speech envelope and attention decoding in EEG at low frequencies, in high gamma power, and in both signals combined. While low frequency speech tracking was evident for almost all subjects as expected, high gamma power also showed robust speech tracking in a minority of subjects. This same pattern was true for attention decoding using a separate group of subjects who undertook a cocktail party attention experiment. For the subjects who showed speech tracking in high gamma power, the spatiotemporal characteristics of that high gamma tracking differed from that of low-frequency EEG. Furthermore, combining the two neural measures led to improved measures of speech tracking for several subjects. Overall, this indicates that high gamma power EEG can carry useful information regarding speech processing and attentional selection in some subjects and combining it with low frequency EEG can improve the mapping between natural speech and the resulting neural responses.

Impact of Multi-modality Monitoring Using Direct Electrical Stimulation to Determine Corticospinal Tract Shift and Integrity in Tumors using the Intraoperative MRI

2019 ◽  
Author(s):  
Daria Krivosheya ◽  
Ganesh Rao ◽  
Sudhakar Tummala ◽  
Vinodh Kumar ◽  
Dima Suki ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Corticospinal Tract ◽  
Diffusion Tensor ◽  
Tumor Resection ◽  
Similar Degree ◽  
Low Grade ◽  
Direct Electrical Stimulation ◽  
Resection Cavity ◽  
Group 4 ◽  
The Impact

Abstract Introduction Preserving the integrity of the corticospinal tract (CST) while maximizing the extent of tumor resection is one of the key principles of brain tumor surgery to prevent new neurologic deficits. Our goal was to determine the impact of the use of perioperative diffusion tensor imaging (DTI) fiber-tracking protocols for location of the CSTs, in conjunction with intraoperative direct electrical stimulation (DES) on patient neurologic outcomes. The role of combining DES and CST shift in intraoperative magnetic resonance imaging (iMRI) to enhance extent of resection (EOR) has not been studied previously. Methods A total of 53 patients underwent resection of tumors adjacent to the motor gyrus and the underlying CST between June 5, 2009, and April 16, 2013. All cases were performed in the iMRI (BrainSuite 1.5 T). Preoperative DTI mapping and intraoperative cortical and subcortical DES including postoperative DTI mapping were performed in all patients. There were 32 men and 21 women with 40 high-grade gliomas (76%), 4 low-grade gliomas (8%), and 9 (17%) metastases. Thirty-four patients (64%) were newly diagnosed, and 19 (36%) had a previous resection. There were 31 (59%) right-sided and 22 (42%) left-sided tumors. Eighteen patients (34%) had a re-resection after the first intraoperative scan. Most patients had motor-only mapping, and one patient had both speech and motor mapping. Relative to the resection margin, the CST after the first iMRI was designated as having an outward shift (OS), inward shift (IS), or no shift (NS). Results A gross total resection (GTR) was achieved in 41 patients (77%), subtotal resection in 4 (7.5%), and a partial resection in 8 (15%). Eighteen patients had a re-resection, and the mean EOR increased from 84% to 95% (p = 0.002). Of the 18 patients, 7 had an IS, 8 an OS, and in 3 NS was noted. More patients in the OS group had a GTR compared with the IS or NS groups (p = 0.004). Patients were divided into four groups based on the proximity of the tumor to the CST as measured from the preoperative scan. Group 1 (32%) included patients whose tumors were 0 to 5 mm from the CST based on preoperative scans; group 2 (28%), 6 to 10 mm; group 3 (13%), 11 to 15 mm; and group 4 (26%), 16 to 20 mm, respectively. Patients in group 4 had fewer neurologic complications compared with other groups at 1 and 3 months postoperatively (p = 0.001 and p = 0.007, respectively) despite achieving a similar degree of resection (p = 0.61). Furthermore, the current of intraoperative DES was correlated to the distance of the tumor to the CST, and the regression equation showed a close linear relationship between the two parameters. Conclusions Combining information about intraoperative CST and DES in the iMRI can enhance resection in brain tumors (77% had a GTR). The relative relationship between the positions of the CST to the resection cavity can be a dynamic process that could further influence the surgeon's decision about the stimulation parameters and EOR. Also, the patients with an OS of the CST relative to the resection cavity had a GTR comparable with the other groups.

scholarly journals Changes in language white matter tract microarchitecture associated with cognitive deficits in patients with presumed low-grade glioma

2019 ◽  
Vol 130 (5) ◽  
pp. 1538-1546 ◽  
Author(s):  
Fatih Incekara ◽  
Djaina Satoer ◽  
Evy Visch-Brink ◽  
Arnaud Vincent ◽  
Marion Smits
Keyword(s):  
Executive Function ◽  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Diffusion Tensor ◽  
Mean Diffusivity ◽  
Low Grade Glioma ◽  
Cognitive Domain ◽  
Awake Surgery ◽  
Low Grade ◽  
Linear Regression Models

OBJECTIVEThe authors conducted a study to determine whether cognitive functioning of patients with presumed low-grade glioma is associated with white matter (WM) tract changes.METHODSThe authors included 77 patients with presumed low-grade glioma who underwent awake surgery between 2005 and 2013. Diffusion tensor imaging with deterministic tractography was performed preoperatively to identify the arcuate, inferior frontooccipital, and uncinate fasciculi and to obtain the mean fractional anisotropy (FA) and mean diffusivity per tract. All patients were evaluated preoperatively using an extensive neuropsychological protocol that included assessments of the language, memory, and attention/executive function domains. Linear regression models were used to analyze each cognitive domain and each diffusion tensor imaging metric of the 3 WM tracts.RESULTSSignificant correlations (corrected for multiple testing) were found between FA of the arcuate fasciculus and results of the repetition test for the language domain (β = 0.59, p < 0.0001) and between FA of the inferior frontooccipital fasciculus and results of the imprinting test for the memory domain (β = −0.55, p = 0.002) and the attention test for the attention and executive function domain (β = −0.62, p = 0.006).CONCLUSIONSIn patients with glioma, language deficits in repetition of speech, imprinting, and attention deficits are associated with changes in the microarchitecture of the arcuate and inferior frontooccipital fasciculi.

scholarly journals Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice

2010 ◽  
Vol 28 (2) ◽  
pp. E7 ◽  
Author(s):  
Andrea Szelényi ◽  
Lorenzo Bello ◽  
Hugues Duffau ◽  
Enrica Fava ◽  
Guenther C. Feigl ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Cognitive Function ◽  
Low Grade Glioma ◽  
Awake Craniotomy ◽  
Awake Surgery ◽  
Low Grade ◽  
Glioma Surgery ◽  
Neurological Sequelae ◽  
Intraoperative Electrical Stimulation ◽  
Methodological Aspects

There is increasing evidence that the extent of tumor removal in low-grade glioma surgery is related to patient survival time. Thus, the goal of resecting the largest amount of tumor possible without leading to permanent neurological sequelae is a challenge for the neurosurgeon. Electrical stimulation of the brain to detect cortical and axonal areas involved in motor, language, and cognitive function and located within the tumor or along its boundaries has become an essential tool in combination with awake craniotomy. Based on a literature review, discussions within the European Low-Grade Glioma Group, and illustrative clinical experience, the authors of this paper provide an overview for neurosurgeons, neurophysiologists, linguists, and anesthesiologists as well as those new to the field about the stimulation techniques currently being used for mapping sensorimotor, language, and cognitive function in awake surgery for low-grade glioma. The paper is intended to help the understanding of these techniques and facilitate a comparison of results between users.

The difference between electrical microstimulation and direct electrical stimulation – towards new opportunities for innovative functional brain mapping?

2016 ◽  
Vol 27 (3) ◽  
pp. 231-258 ◽  
Author(s):  
Marion Vincent ◽  
Olivier Rossel ◽  
Mitsuhiro Hayashibe ◽  
Guillaume Herbet ◽  
Hugues Duffau ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Brain Mapping ◽  
Awake Surgery ◽  
Direct Electrical Stimulation ◽  
Functional Brain ◽  
Electrical Microstimulation ◽  
Functional Brain Mapping ◽  
Technical Developments ◽  
Stimulation Parameters ◽  
The Brain

AbstractBoth electrical microstimulation (EMS) and direct electrical stimulation (DES) of the brain are used to perform functional brain mapping. EMS is applied to animal fundamental neuroscience experiments, whereas DES is performed in the operating theatre on neurosurgery patients. The objective of the present review was to shed new light on electrical stimulation techniques in brain mapping by comparing EMS and DES. There is much controversy as to whether the use of DES during wide-awake surgery is the ‘gold standard’ for studying the brain function. As part of this debate, it is sometimes wrongly assumed that EMS and DES induce similar effects in the nervous tissues and have comparable behavioural consequences. In fact, the respective stimulation parameters in EMS and DES are clearly different. More surprisingly, there is no solid biophysical rationale for setting the stimulation parameters in EMS and DES; this may be due to historical, methodological and technical constraints that have limited the experimental protocols and prompted the use of empirical methods. In contrast, the gap between EMS and DES highlights the potential for new experimental paradigms in electrical stimulation for functional brain mapping. In view of this gap and recent technical developments in stimulator design, it may now be time to move towards alternative, innovative protocols based on the functional stimulation of peripheral nerves (for which a more solid theoretical grounding exists).

scholarly journals Direct Electrical Stimulation of Premotor Areas: Different Effects on Hand Muscle Activity during Object Manipulation

2019 ◽  
Vol 30 (1) ◽  
pp. 391-405 ◽  
Author(s):  
Luca Fornia ◽  
Marco Rossi ◽  
Marco Rabuffetti ◽  
Antonella Leonetti ◽  
Guglielmo Puglisi ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Muscle Activity ◽  
Premotor Cortex ◽  
Object Manipulation ◽  
Awake Surgery ◽  
Direct Electrical Stimulation ◽  
Task Execution ◽  
Hand Muscles ◽  
Premotor Areas ◽  
Stimulation Of

Abstract Dorsal and ventral premotor (dPM and vPM) areas are crucial in control of hand muscles during object manipulation, although their respective role in humans is still debated. In patients undergoing awake surgery for brain tumors, we studied the effect of direct electrical stimulation (DES) of the premotor cortex on the execution of a hand manipulation task (HMt). A quantitative analysis of the activity of extrinsic and intrinsic hand muscles recorded during and in absence of DES was performed. Results showed that DES applied to premotor areas significantly impaired HMt execution, affecting task-related muscle activity with specific features related to the stimulated area. Stimulation of dorsal vPM induced both a complete task arrest and clumsy task execution, characterized by general muscle suppression. Stimulation of ventrocaudal dPM evoked a complete task arrest mainly due to a dysfunctional recruitment of hand muscles engaged in task execution. These results suggest that vPM and dPM contribute differently to the control of hand muscles during object manipulation. Stimulation of both areas showed a significant impact on motor output, although the different effects suggest a stronger relationship of dPM with the corticomotoneuronal circuit promoting muscle recruitment and a role for vPM in supporting sensorimotor integration.

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