Functional brain mapping: overview of techniques and their application to neurosurgery.

Abstract

Functional brain mapping (FBM) is an integral part of contemporary neurosurgery. It is crucial for safe and optimal resection of brain lesions like gliomas. The eloquent regions of the cortex like motor, somatosensory, Wernicke's, and Broca are usually mapped, either preoperatively or intraoperatively. Since its birth in the nineteenth century, FBM has witnessed immense modernization, radical refinements, and the introduction of novel techniques, most of which are non-invasive. Direct electrical stimulation of the cortex, despite its high invasiveness, remains the technique of choice. Non-invasive techniques like fMRI and magnetoencephalography allow us the convenience of multiple mappings with minimal discomfort to the patients. They are quick, easy to do, and allow thorough study. Different modalities are now being combined to yield better delineations like fMRI and diffusion tensor imaging. This article reviews the physical principles, applications, merits, shortcomings, and latest developments of nine FBM techniques. Other than neurosurgical operations, these techniques have also been applied to studies of stroke, Alzheimer's, and cognition. There are strong indications that the future of brain mapping shall see the non-invasive techniques playing a more dominant role as they become more sensitive and accurate due to advances in physics, refined algorithms, and subsequent validation against invasive techniques.