BACKGROUND AND STUDY AIMS: Cortical mapping (CM) with direct cortical stimulation (DCS) in awake craniotomy is used to preserve cognitive functions such as language. Nevertheless, patient collaboration during this procedure is influenced by previous neurological symptoms and growing discomfort with DCS duration. Our study aimed to evaluate the impact of navigated task-specific functional magnetic resonance imaging (nfMRI) on the practical aspects of DCS. MATERIAL AND METHODS: We recruited glioma patients scheduled for awake craniotomy for prior fMRI-based CM, acquired during motor and language tasks (i.e., verb generation, semantic and syntactic decision tasks). Language data was combined to generate a probabilistic map indicating brain regions activated with more than one paradigm. Presurgical neurophysiological language tests (i.e., verb generation, picture naming, and semantic tasks) were also performed. We considered for subsequent study only the patients with a minimum rate of correct responses of 50% in all tests. These patients were then randomized to perform intraoperative language CM either using the multimodal approach (mCM), using nfMRI and DCS combined, or electrical CM (eCM), with DCS alone. DCS was done while the patient performed picture naming and nonverbal semantic decision tasks. Methodological features such as DCS duration, number of stimuli, total delivered stimulus duration per task, and frequency of seizures were analyzed and compared between groups. The correspondence between positive responses obtained with DCS and nfMRI was also evaluated. RESULTS: Twenty-one surgeries were included, thirteen of which using mCM (i.e., test group). Patients with lower presurgical neuropsychological performance (correct response rate between 50 and 80% in language tests) showed a decreased DCS duration in comparison with the control group. None of the compared methodological features showed differences between groups. Correspondence between DCS and nfMRI was 100/84% in the identification of the precentral gyrus for motor function/opercular frontal inferior gyrus for language function, respectively. CONCLUSION: Navigated fMRI data did not influence DCS in practice. Presurgical language disturbances limited the applicability of DCS mapping in awake surgery.

译文

背景与研究目的:在清醒的开颅手术中使用带有直接皮质刺激(DCS)的皮质映射(CM)来保留诸如语言之类的认知功能。然而,在此过程中的患者协作会受到先前的神经症状和DCS持续时间的不适感的影响。我们的研究旨在评估导航任务特定功能磁共振成像(nfMRI)对DCS实用方面的影响。
材料和方法:我们招募了计划进行清醒开颅手术的脑胶质瘤患者,以进行基于功能磁共振成像的先前CM,并在运动和语言任务(即动词生成,语义和句法决策任务)中获得。语言数据被合并以生成一个概率图,该概率图指示了被多个范式激活的大脑区域。还进行了术前神经生理语言测试(即动词生成,图片命名和语义任务)。对于随后的研究,我们仅考虑所有测试中正确反应率最低为50%的患者。然后将这些患者随机分为两组,分别使用多模式方法(mCM),nfMRI和DCS组合或电CM(eCM)单独使用DCS进行术中语言CM。在患者执行图片命名和非言语语义决策任务的同时进行了DCS。分析方法特征,例如DCS持续时间,刺激次数,每项任务的总传递刺激持续时间以及癫痫发作频率,并在各组之间进行比较。还评估了DCS和nfMRI获得的阳性反应之间的对应关系。
结果:包括21例手术,其中13例使用mCM(即测试组)。与对照组相比,术前神经心理性能较低的患者(语言测试中正确的应答率在50%至80%之间)显示DCS持续时间缩短。比较的方法学特征均未显示组之间的差异。 DCS和nfMRI之间的对应关系在识别运动功能的中央前回/语言功能的额叶下回分别为100/84%。
结论:f功能性MRI数据在实践中不影响DCS。术前语言障碍限制了DCS绘图在清醒手术中的适用性。

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