Intraoperative Mapping of Language Using High Gamma

描述（由申请人提供）：需要切除脑肿瘤、癫痫区或其他可能靠近语言皮层的结构性病变的神经外科患者需要进行45分钟的侵入性手术（术中电刺激测绘；ESM）来绘制语言和运动功能，并指导神经外科医生的手术方法。从ESM中获得的信息对于节省语言区域至关重要，并已被证明可以改善术后发病率。60年来，测绘过程中使用的方法一直没有改变。该手术需要将电流输入患者的大脑，以暂时破坏其功能，这与手术过程中诱发癫痫等问题有关。此外，这个过程通常需要45分钟，许多患者不能很好地耐受，并且有多达25%的病例必须流产。因此，需要一种新的语言映射方法。这项提议的目的是评估是否可以使用人体皮质电图（ECoG）中的高伽马活动（70-250 Hz）来准确快速地跟踪手术室中的关键语言皮层。据推测，高伽马活动（可能是皮质激活的指标）可以帮助外科医生识别关键的语言区域，并有可能取代传统的术中ESM，从而消除与该手术相关的风险并缩短手术时间。为了调查这个问题，将进行两项研究。首先，我们将在神经外科医生传统使用的图片命名/计数研究中记录醒着的神经外科患者在手术室的ECoG。其次，我们将在手术室中对这些患者进行简短的动词生成研究。据预测，在图像命名和数字计数过程中，在ESM中显示停止的区域将引发高伽马活动。我们进一步预测，在动词生成任务中获得的高伽马语言映射也将与研究一中获得的刺激映射结果相关联。如果获得结果，将提供证据，证明使用ECoG和高伽马记录的语言映射可能为传统的术中ESM方法提供一种更安全、更快速的替代方法，从而降低术中发病率，改善术后预后。神经外科医生需要确定人类大脑中关键的语言区域，以避免在切除肿瘤和其他大脑异常时造成语言问题。目前实现这一目标的方法需要一种60年前的方法，这种方法有严重的副作用，比如在手术室引起癫痫发作。我们建议用一种新的脑电分析方法来取代传统的方法。如果成功，结果将导致更安全、更有效的神经外科手术。

DESCRIPTION (provided by applicant): Neurosurgical patients who need a brain tumor, epileptic region or other structural lesion removed that might be near language cortex require an invasive 45 min procedure (intra-operative electrical stimulation mapping; ESM) to map language and motor function and guide the neurosurgeon's operative approach. The information gained from ESM is critical to spare language areas and has been shown to improve post-operative morbidity. The methods used in this mapping procedure have remained unchanged for 60 years. The procedure requires passing current into the patient's brain to temporarily disrupt function and is associated with problems such as seizure induction during surgery. Further, the procedure typically takes 45 minutes, is not well tolerated in many patients and must be aborted in up to 25% of cases. Hence, a new method to map language is needed. The goal of this proposal is to assess whether high gamma activity (70-250 Hz) in the human electrocorticogram (ECoG) can be used to accurately and rapidly track critical language cortex in the operating room. It is hypothesized that high gamma activity, a likely index of cortical activation, can aid surgeons identify critical language areas and potentially replace classic intra-operative ESM eliminating the risks associated with this procedure and shortening the surgical time. In order to investigate this issue, two studies will be conducted. First, we will record ECoG in the awake neurosurgical patient in the operating room during the picture naming/number counting study traditionally employed by neurosurgeons. Second, we will perform a brief verb generation study in the OR in these same patients. It is predicted that during picture naming and number counting regions showing arrest during ESM will elicit high gamma activity. We further predict that the high gamma map of language obtained in the verb generation task will also correlate with the stimulation mapping results obtained during study one. If obtained the results would provide evidence that language mapping using ECoG and high gamma recording might provide a safer and faster alternative method to the traditional intra-operative ESM method resulting in reduced intra-operative morbidity and improved post-surgical outcome. Neurosurgeons need to identify critical language areas in the human brain to avoid causing a language problem when removing tumors and other brain abnormalities. The current method to accomplish this requires a 60 year old approach that has serious side-effects such as causing a seizure in the operating room. We propose to apply a novel method of brain electrical analysis to replace the traditional method employed. If successful the results would lead to safer and more effective neurosurgical procedures.