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Study Design for Navigated Repetitive Transcranial Magnetic Stimulation for Speech Cortical Mapping

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Intraoperative dorsal language network mapping by using single-pulse electrical stimulation.

Yukihiro Yamao¹, Riki Matsumoto, Takeharu Kunieda

¹Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Human Brain Mapping

|March 12, 2014

Summary

This study introduces cortico-cortical evoked potentials (CCEPs) for real-time monitoring of the brain's language network during surgery. CCEP monitoring proved effective in preserving language function, even when stimulating eloquent subcortical sites.

Keywords:

arcuate fasciculus awake craniotomy cortico-cortical evoked potential dorsal language network subcortico-cortical evoked potential

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Transcranial Direct Current Stimulation tDCS of Wernicke's and Broca's Areas in Studies of Language Learning and Word Acquisition

Transcranial Direct Current Stimulation tDCS of Wernicke's and Broca's Areas in Studies of Language Learning and Word Acquisition

Published on: July 13, 2019

Area of Science:

Neurosurgery
Neuroscience
Neurolinguistics

Background:

Preserving language function during brain surgery remains a significant challenge.
Current intraoperative methods for monitoring the language network lack reliability.

Purpose of the Study:

To establish intraoperative language network monitoring using cortico-cortical evoked potentials (CCEPs).
To evaluate the clinical utility of CCEP monitoring for assessing language network integrity during neurosurgery.

Main Methods:

Six patients with tumors near the arcuate fasciculus (AF) underwent CCEP monitoring under general anesthesia and awake conditions.
The anterior perisylvian language area (AL) was identified using CCEP connectivity and presurgical imaging.
Language function was confirmed via electrical stimulation (ES) during awake craniotomy; CCEPs monitored network integrity between AL and the posterior perisylvian language area (PL).

Main Results:

CCEP monitoring successfully identified the anterior perisylvian language area (AL) and monitored its connections to the posterior perisylvian language area (PL).
Intraoperative electrical stimulation confirmed language function at AL in all patients.
Despite minor amplitude declines in two patients, CCEP monitoring prevented persistent language deficits. Direct subcortical connections between AL and PL were identified in three patients.
The study confirmed that AL, PL, and AF form the dorsal language network.

Conclusions:

Intraoperative cortico-cortical evoked potential (CCEP) monitoring is a clinically valuable tool for assessing the integrity of the brain's language network.
This method aids in preserving crucial language functions during neurosurgical procedures, particularly for tumors near eloquent areas like the arcuate fasciculus.