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A probabilistic functional atlas based on extraoperative electrocortical stimulation mapping.

Andrew J Michalak¹, Leyao Yu^1,2, Amirhossein Khalilian-Gourtani²

¹New York University School of Medicine, Department of Neurology, Epilepsy Division, New York, NY 10016, United States of America.

Biorxiv : the Preprint Server for Biology

|September 26, 2025

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This summary is machine-generated.

Direct electrocortical stimulation (DES) mapping reveals that brain functions are probabilistic, not fixed. This large-scale atlas highlights individual variability, emphasizing personalized surgical planning for epilepsy patients.

Area of Science:

Neuroscience
Neurosurgery
Epileptology

Background:

Direct electrocortical stimulation (DES) is crucial for identifying eloquent cortex during neurosurgery.
Current DES methods face limitations in sampling and analysis, particularly for understanding functional brain organization in epilepsy.
Probabilistic mapping of cortical functions remains underexplored, especially concerning inter-patient variability.

Purpose of the Study:

To create the largest probabilistic atlas of motor, sensory, and language functions using extraoperative DES.
To investigate the probability of typical and atypical cortical organization in epilepsy patients.
To analyze functional mapping data for improved neurosurgical guidance.

Main Methods:

Retrospective analysis of 2,124 extraoperative DES trials from 125 epilepsy patients (2008-2023).

Keywords:

Electrical Stimulation Mapping Language Motor Speech

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Mapping functional responses to Montreal Neurological Institute space and analyzing with probability mapping and clustering techniques.

Utilizing mixed-effects models to identify predictors of language disruption.

Main Results:

Probabilistic maps showed functional regions with expected locations but also significant variability and deviations.
Language, motor, and sensory disruptions were mapped, with language likelihood following probabilistic gradients and high inter-patient variability.
The middle frontal gyrus was identified as a key language node; motor functions extended into parietal cortex; unique experiential phenomena were evoked.

Conclusions:

Eloquent cortical functions are organized probabilistically, not in fixed regions, necessitating individualized surgical mapping.
The study provides a large-scale DES atlas, identifying the middle frontal gyrus in language processing and extending motor mapping.
Significant inter-patient variability in functional organization underscores the critical need for personalized neurosurgical approaches in epilepsy care.