Probing Functional Brain Networks with Cortical Electrical Stimulation

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  • Yamao Yukihiro
    Department of Neurosurgery, Kyoto University Graduate School of Medicine Department of Neurosurgery, Takeda Hospital
  • Kunieda Takeharu
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • Matsumoto Riki
    Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine

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  • 皮質電気刺激によるヒト脳機能ネットワークの探索

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Abstract

  The preservation of brain function during and after surgery still poses a challenge for neurosurgeons. High-frequency electrical stimulation techniques have been established in order to map the intraoperative brain function and preserve the eloquent areas during surgery. In addition to this functional cortical mapping, the subcortical fibers related to eloquent function have been extensively investigated by using high-frequency electrical stimulation. However, these cortical- and subcortical high-frequency electrical stimulation methods are only able to identify the local function (i. e., stimulus site). Even during awake craniotomy, no monitoring methods have as yet been established to preserve the integrity of the language network during surgery, as opposed to the monitoring methods utilizing motor evoked potentials for the motor network.<br>  We have recently developed an in vivo electrical tract tracing method using cortico-cortical evoked potentials (CCEPs). In an extraoperative setting for presurgical evaluation of epilepsy surgery, single-pulse electrical stimulation was applied directly to the cortex, and CCEPs were recorded from the adjacent and remote cortices through cortico-cortical connections. In an extraoperative setting, this method has successfully probed eloquent brain functional networks such as the language and motor networks. Because of the high reproducibility and reliability, CCEP technique could be applicable in an intraoperative setting to identify and monitor functionally eloquent networks.<br>  In our pilot intraoperative CCEP study, using CCEP connectivity patterns, we were able to map the anterior and posterior perisylvian language areas. Combined single-pulse and high-frequency electrical stimulation to the removal cavity (white matter) delineated both the function and cortical terminations of the dorsal language pathway. Although further case studies are necessary to establish a clear cut-off value to prevent language dysfunction, intraoperative CCEP monitoring is clinically useful for evaluating the integrity of the dorsal language network.

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