Automated intraoperative central sulcus localization and somatotopic mapping using median nerve stimulation

Area of Science:

• Neurosurgery
• Neurophysiology
• Medical Imaging

Background:

• Accurate identification of functional cortical regions is crucial for neurological resections.
• The central sulcus (CS) is a key landmark for delineating functional areas.
• Intraoperative localization of the CS is typically achieved using median nerve stimulation (MNS).

Purpose of the Study:

• To introduce an automated procedure utilizing MNS for rapid CS localization.
• To develop functional somatotopic maps using the automated MNS-based method.
• To assess the accuracy and concordance of the automated method compared to existing techniques.

Main Methods:

• Recorded electrocorticographic signals from 13 patients during awake craniotomy with MNS.
• Developed and analyzed an automated algorithm to determine CS location from MNS data.
• Generated functional somatotopic maps using the automated procedure.

Main Results:

• The automated method demonstrated 89% sensitivity in identifying the CS compared to neurosurgeon visual inspection.
• Functional somatotopic maps generated by the automated method showed 92% sensitivity in concordance with passive functional mapping.
• The procedure rapidly localizes the CS and creates functional maps without increasing clinical burden.

Conclusions:

• The automated MNS-based method offers a rapid and accurate approach for CS localization and functional mapping.
• This technique has the potential to become a valuable diagnostic tool for neurosurgeons.
• Further development and validation could lead to reduced postoperative morbidity in resective brain surgery.