Abstract
Direct electrical stimulation (DES) has been widely applied in both guidance of lesion resection and scientific research; however, the design and selection of intraoperative cognitive mapping tasks have not been updated in a very long time. We introduce updated mapping tasks for language and non-language functions and provide recommendations for optimal design and selection of intraoperative mapping tasks. In addition, with DES becoming more critical in current neuroscientific research, a task design that has not been widely used in DES yet (subtraction and conjunction paradigms) was introduced for more delicate mapping of brain functions especially for research purposes. We also illustrate the importance of designing a common task series for DES and other non-invasive mapping techniques. This review gives practical updated guidelines for advanced application of DES in clinical and neuroscientific research.
Highlights
The role of white matter tracts in cognitive function has been confirmed by multiple studies and Fernandez Coello et al (2013) proposed that plasticity of white matter tracts made them more crucial in brain function protection. These tracts mark the boundary of lesion resection; applying subcortical electrical stimulation to identify these fiber tracts is as important as cortical mapping
Except for the rare studies based on repeated brain mapping in cases with glioma recurrence (Krieg et al, 2014; Southwell et al, 2016), findings on brain plasticity are mainly derived from non-invasive techniques including functional MRI (fMRI), transcranial magnetic stimulation (TMS), and positron emission tomography (PET)
In spite of the increasing number of institutes applying direct electrical stimulation (DES) in the clinical context, the design and selection of mapping tasks vary among institutions
Summary
The persevering efforts of Penfield (Penfield and Boldrey, 1937; Penfield, 1958), Ojemann (Ojemann et al, 1989), Duffau (Tate et al, 2014; Rech et al, 2019), Berger (Sanai et al, 2008), and other neurosurgeons (Roux et al, 2003, 2004; Démonet et al, 2011; Wu et al, 2011) in awake surgery coupled with direct electrical stimulation (DES) led to the wide application of DES in identifying the “eloquent area” before lesion resection due to its high effectiveness and reliability. DES disturbs temporarily and reversibly the neural activity in a limited brain area or neural network. This method largely avoids the influence of functional reorganization after focal brain damage and provides a causal link between neural substrates and cognitive functions (Desmurget et al, 2013; Vaidya et al, 2019). Following in the footsteps of Penfield’s famous cortical homunculus research, other higher-order cognitive functions have been investigated using DES in the past decades pushing forward the frontiers of neuroscience (Sanai et al, 2008; Tate et al, 2014; Rech et al, 2019)
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