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Intraoperative Cortico-Cortical Evoked Potentials for Monitoring Language Function during Brain Tumor Resection in

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Cortico-cortical evoked potentials (CCEPs) reliably map language areas during surgery. This neurophysiological technique shows high sensitivity and specificity for predicting postsurgical language outcomes in anesthetized patients.

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Area of Science:

  • Neuroscience
  • Neurosurgery
  • Epileptology

Background:

  • Cortico-cortical evoked potentials (CCEPs) traditionally map frontal (FLA) and parietal (PLA) language regions.
  • CCEPs were primarily used as a complementary method during sleep-awake surgery.

Purpose of the Study:

  • To evaluate CCEPs as a primary neurophysiological tool for mapping language areas during surgery.
  • To assess the reliability and predictive value of CCEPs in patients undergoing tumor resection near language cortices.

Main Methods:

  • CCEPs were used for motor and somatosensory mapping in seven patients undergoing tumor surgery.
  • Electrocorticography monitored responses, with single pulses delivered to FLA and recorded from PLA (and vice versa).
  • Sensitivity, specificity, and predictive values were calculated for CCEP warning alterations.

Main Results:

  • Gross tumor resection was achieved in four patients; most postsurgical language deficits were transitory.
  • CCEPs demonstrated high sensitivity and specificity in predicting warning events.
  • Differences in amplitude and latency relationships were observed between FLA and PLA.

Conclusions:

  • CCEPs are a reliable neurophysiological technique for mapping and monitoring language regions in anesthetized patients.
  • High correlation between warning events and outcomes suggests CCEPs can be used systematically under general anesthesia.
  • Results from this small cohort should be interpreted cautiously.