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Individual Variability of the Human Cerebral Cortex Identified Using Intraoperative Mapping
Johan Pallud1, Marc Zanello1, Grégory Kuchcinski2
1Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm U894 Centre Psychiatrie et Neurosciences, Paris, France.
World Neurosurgery
|October 10, 2017
Summary
Direct electrical stimulation reveals greater individual variability in frontal eye fields and speech arrest sites than previously thought. This functional mapping highlights atypical cortical organization in patients with brain tumors.
Area of Science:
- Neurosurgery
- Neuroscience
- Neuroimaging
Background:
- Intraoperative functional cortical mapping via direct electrical stimulation may reveal greater individual variability than noninvasive imaging suggests.
- Previous studies often relied on data from healthy subjects, potentially underestimating patient-specific variations.
Purpose of the Study:
- To assess intraoperative variability of frontal eye fields (FEF) and speech arrest sites.
- To compare direct electrostimulation findings with Human Connectome Project cortical parcellation in patients with diffuse gliomas.
Main Methods:
- Awake craniotomy with direct electrostimulation in adult patients with gliomas in eloquent regions.
- Analysis of functional mapping data and comparison with standardized cortical parcellation from the Human Connectome Project.
Main Results:
- Frontal eye fields identified in 14.3% of patients, located in premotor cortex subdivisions and the dorsolateral prefrontal cortex.
- Speech arrest sites identified in 100% of patients, predominantly posterior to the inferior frontal gyrus in premotor cortex subdivisions.
Conclusions:
- Intraoperative direct electrostimulation demonstrates wider individual variability in functional cortical organization than previously suggested.
- Pathologic conditions, such as gliomas, can lead to atypical patterns of functional organization and structural/functional cortical changes.
