Neuroimaging Guided Transcranial Electrical Stimulation in Enhancing Surgical Skill Acquisition. Comment on Hung et al. The Efficacy of Transcranial Direct Current Stimulation in Enhancing Surgical Skill Acquisition: A Preliminary Meta-Analysis of Randomized Controlled Trials. Brain Sci. 2021, 11, 707.

Pushpinder Walia,Kavya Narendra Kumar,Anirban Dutta

doi:10.3390/brainsci11081078

Pushpinder Walia, Kavya Narendra Kumar + Show 1 more

Open Access

https://doi.org/10.3390/brainsci11081078

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Abstract

Surgical skill acquisition may be facilitated with a safe application of transcranial direct current stimulation (tDCS). A preliminary meta-analysis of randomized control trials showed that tDCS was associated with significantly better improvement in surgical performance than the sham control; however, meta-analysis does not address the mechanistic understanding. It is known from skill learning studies that the hierarchy of cognitive control shows a rostrocaudal axis in the frontal lobe where a shift from posterior to anterior is postulated to mediate progressively abstract, higher-order control. Therefore, optimizing the transcranial electrical stimulation to target surgical task-related brain activation at different stages of motor learning may provide the causal link to the learning behavior. This comment paper presents the computational approach for neuroimaging guided tDCS based on open-source software pipelines and an open-data of functional near-infrared spectroscopy (fNIRS) for complex motor tasks. We performed an fNIRS-based cortical activation analysis using AtlasViewer software that was used as the target for tDCS of the motor complexity-related brain regions using ROAST software. For future studies on surgical skill training, it is postulated that the higher complexity laparoscopic suturing with intracorporeal knot tying task may result in more robust activation of the motor complexity-related brain areas when compared to the lower complexity laparoscopic tasks.

Highlights

Surgical skill acquisition may be facilitated with a safe application of transcranial electrical stimulation [1]
Transcranial direct current stimulation, a transcranial electrical stimulation (tES) modality, has been shown to facilitate surgical skill learning when applied to cortical targets, including the primary motor cortex [2,3], the supplementary motor area [2], and the prefrontal cortex [4]
Prior work has shown that transcranial direct current stimulation (tDCS) facilitated complex motor tasks performed during surgical skill training, including laparoscopic technical skills training [5] and tumor resection in neurosurgery [6]

Summary

Introduction

Transcranial direct current stimulation (tDCS), a tES modality, has been shown to facilitate surgical skill learning when applied to cortical targets, including the primary motor cortex [2,3], the supplementary motor area [2], and the prefrontal cortex [4]. FNIRS-guided tDCS is proposed to target subject-specific endogenous PFC activation related to the prefrontal-caudate network-level mechanisms to be effective [23].

Results

Conclusion