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Related Experiment Video

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Study Design for Navigated Repetitive Transcranial Magnetic Stimulation for Speech Cortical Mapping
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Identifying proximity to white matter language tracts with gradient-based intraoperative electrical mapping.

Naomi Kahana1, Akiva Korn1, Naama Friedmann2

  • 11Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv.

Journal of Neurosurgery
|May 9, 2025
PubMed
Summary

Direct electrical stimulation intensity can intraoperatively map language white matter tracts (WMTs), aiding surgeons in preserving speech function during brain tumor removal. This method correlates stimulation threshold with distance to WMTs identified by diffusion tensor imaging (DTI).

Keywords:
awake craniotomybipolar stimulationdiffusion tensor imagingdirect electrical stimulationintraoperative monitoringlanguage white matter tractsmonopolar stimulationtumor

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Area of Science:

  • Neurosurgery
  • Neuroimaging
  • Neurophysiology

Background:

  • Intraoperative identification of language white matter tracts (WMTs) is crucial for preserving speech function during brain surgery.
  • WMTs are visually imperceptible, posing a significant challenge for surgeons.
  • Diffusion tensor imaging (DTI)-based tractography provides preoperative anatomical information but lacks real-time intraoperative guidance.

Purpose of the Study:

  • To assess the feasibility of intraoperatively determining proximity to language WMTs.
  • To correlate direct electrical stimulation (DES) intensity with the distance to language tracts.
  • To support maximal tumor resection while minimizing language deficits.

Main Methods:

  • Twenty-eight patients undergoing awake craniotomy for glioma resection were included.
  • Preoperative language assessments and DTI-based language tract reconstruction were performed.
  • Subcortical DES was applied along the tumor cavity border, with stimulation locations registered.

Main Results:

  • A significant positive linear correlation (r = 0.57) was found between distance to language WMTs and DES electrical threshold.
  • Stimulation evoking language interference required significantly lower intensity compared to non-interfering stimulation.
  • Tumor characteristics did not significantly impact the distance-intensity correlation or language interference likelihood.

Conclusions:

  • Intraoperative threshold-based electrical mapping is a feasible method for assessing language tract proximity.
  • This technique can guide surgeons to balance maximal tumor resection with the preservation of language function.
  • Bipolar stimulation demonstrated a significant correlation, suggesting its utility in intraoperative mapping.