Mapping the Mirror Neuron System in Neurosurgery

Brain mapping is considered an important approach in neurosurgery to achieve better functional outcomes. The mirror neuron system (MNS) is a brain network implicated in understanding of action and imitation. No previous study has focused on identifying and monitoring the function of the MNS during the perioperative period in brain lesions. The aim of this study was to describe the application of a functional magnetic resonance imaging (fMRI) protocol to identify the MNS in a patient with a lesion in the premotor region.

A specific fMRI protocol to identify regions belonging to the MNS was performed on a 19-year-old female patient who presented a cavernous angioma in the premotor region. The patient showed signs of impairment when imitating simple and complex hand movements. The fMRI protocol was performed before and 3 months after the surgical procedure. The protocol consisted of observation and execution conditions of a simple intransitive finger movement (precision grasping). MNS regions were identified during the pre- and postsurgical fMRI trials. Such mirror areas were respected during the procedure. The activation of these regions improved notably after the procedure, with a correlation between recovery of the ability to imitate simple and complex hand movements and higher and better-defined MNS activity.

The use of an fMRI protocol with observation and execution conditions based on simple intransitive finger actions allows the easy identification and preservation of the MNS. Increased activity on postoperative fMRI may be associated with improvement in motor functions.