A Review of Passive Brain Mapping Techniques in Neurological Surgery

Brain mapping is a quintessential part of neurosurgical practice. Accordingly, much of our understanding of the brain's functional organization, and in particular the motor homunculus, is largely attributable to the clinical investigations of past neurosurgeons. Traditionally mapping was invasive and involved the application of electrical current to the exposed brain to observe focal disruption of function or to elicit overt actions. More recently, a wide variety of techniques have been developed that do not require electrical stimulation and often do not require any explicit participation by the subject. Collectively we refer to these as passive mapping modalities. Here we review the spectrum of passive mapping used by neurosurgeons for mapping and surgical planning that ranges from invasive intracranial recordings to noninvasive imaging as well as regimented task-based protocols to completely task-free paradigms that can be performed intraoperatively while under anesthesia.

Presurgical Functional Cortical Mapping Using Electromagnetic Source Imaging

Preoperative localization of functionally eloquent cortex (functional cortical mapping) is common clinical practice in order to avoid or reduce postoperative morbidity. This review aims at providing a general overview of magnetoencephalography (MEG) and high-density electroencephalography (hdEEG) based methods and their clinical role as compared to common alternatives for functional cortical mapping of (1) verbal language function, (2) sensorimotor cortex, (3) memory, (4) visual, and (5) auditory cortex. We highlight strengths, weaknesses and limitations of these functional cortical mapping modalities based on findings in the recent literature. We also compare their performance relative to other non-invasive functional cortical mapping methods, such as functional Magnetic Resonance Imaging (fMRI), Transcranial Magnetic Stimulation (TMS), and to invasive methods like the intracarotid Amobarbital Test (WADA-Test) or intracranial investigations.

From Structure to Circuits: The Contribution of MEG Connectivity Studies to Functional Neurosurgery

New advances in structural neuroimaging have revealed the intricate and extensive connections within the brain, data which have informed a number of ambitious projects such as the mapping of the human connectome. Elucidation of the structural connections of the brain, at both the macro and micro levels, promises new perspectives on brain structure and function that could translate into improved outcomes in functional neurosurgery. The understanding of neuronal structural connectivity afforded by these data now offers a vista on the brain, in both healthy and diseased states, that could not be seen with traditional neuroimaging. Concurrent with these developments in structural imaging, a complementary modality called magnetoencephalography (MEG) has been garnering great attention because it too holds promise for being able to shed light on the intricacies of functional brain connectivity. MEG is based upon the elemental principle of physics that an electrical current generates a magnetic field. Hence, MEG uses highly sensitive biomagnetometers to measure extracranial magnetic fields produced by intracellular neuronal currents. Put simply then, MEG is a measure of neurophysiological activity, which captures the magnetic fields generated by synchronized intraneuronal electrical activity. As such, MEG recordings offer exquisite resolution in the time and oscillatory domain and, as well, when co-registered with magnetic resonance imaging (MRI), offer excellent resolution in the spatial domain. Recent advances in MEG computational and graph theoretical methods have led to studies of connectivity in the time-frequency domain. As such, MEG can elucidate a neurophysiological-based functional circuitry that may enhance what is seen with MRI connectivity studies. In particular, MEG may offer additional insight not possible by MRI when used to study complex eloquent function, where the precise timing and coordination of brain areas is critical. This article will review the traditional use of MEG for functional neurosurgery, describe recent advances in MEG connectivity analyses, and consider the additional benefits that could be gained with the inclusion of MEG connectivity studies. Since MEG has been most widely applied to the study of epilepsy, we will frame this article within the context of epilepsy surgery and functional neurosurgery for epilepsy.

Artemis 123: development of a whole-head infant and young child MEG system

BACKGROUND

A major motivation in designing the new infant and child magnetoencephalography (MEG) system described in this manuscript is the premise that electrophysiological signatures (resting activity and evoked responses) may serve as biomarkers of neurodevelopmental disorders, with neuronal abnormalities in conditions such as autism spectrum disorder (ASD) potentially detectable early in development. Whole-head MEG systems are generally optimized/sized for adults. Since magnetic field produced by neuronal currents decreases as a function of distance(2) and infants and young children have smaller head sizes (and thus increased brain-to-sensor distance), whole-head adult MEG systems do not provide optimal signal-to-noise in younger individuals. This spurred development of a whole-head infant and young child MEG system - Artemis 123.

METHODS

In addition to describing the design of the Artemis 123, the focus of this manuscript is the use of Artemis 123 to obtain auditory evoked neuromagnetic recordings and resting-state data in young children. Data were collected from a 14-month-old female, an 18-month-old female, and a 48-month-old male. Phantom data are also provided to show localization accuracy.

RESULTS

Examination of Artemis 123 auditory data showed generalizability and reproducibility, with auditory responses observed in all participants. The auditory MEG measures were also found to be manipulable, exhibiting sensitivity to tone frequency. Furthermore, there appeared to be a predictable sensitivity of evoked components to development, with latencies decreasing with age. Examination of resting-state data showed characteristic oscillatory activity. Finally, phantom data showed that dipole sources could be localized with an error less than 0.5 cm.

CONCLUSIONS

Artemis 123 allows efficient recording of high-quality whole-head MEG in infants four years and younger. Future work will involve examining the feasibility of obtaining somatosensory and visual recordings in similar-age children as well as obtaining recordings from younger infants. Thus, the Artemis 123 offers the promise of detecting earlier diagnostic signatures in such neurodevelopmental disorders.

MEG source imaging method using fast L1 minimum-norm and its applications to signals with brain noise and human resting-state source amplitude images

The present study developed a fast MEG source imaging technique based on Fast Vector-based Spatio-Temporal Analysis using a L1-minimum-norm (Fast-VESTAL) and then used the method to obtain the source amplitude images of resting-state magnetoencephalography (MEG) signals for different frequency bands. The Fast-VESTAL technique consists of two steps. First, L1-minimum-norm MEG source images were obtained for the dominant spatial modes of sensor-waveform covariance matrix. Next, accurate source time-courses with millisecond temporal resolution were obtained using an inverse operator constructed from the spatial source images of Step 1. Using simulations, Fast-VESTAL's performance was assessed for its 1) ability to localize multiple correlated sources; 2) ability to faithfully recover source time-courses; 3) robustness to different SNR conditions including SNR with negative dB levels; 4) capability to handle correlated brain noise; and 5) statistical maps of MEG source images. An objective pre-whitening method was also developed and integrated with Fast-VESTAL to remove correlated brain noise. Fast-VESTAL's performance was then examined in the analysis of human median-nerve MEG responses. The results demonstrated that this method easily distinguished sources in the entire somatosensory network. Next, Fast-VESTAL was applied to obtain the first whole-head MEG source-amplitude images from resting-state signals in 41 healthy control subjects, for all standard frequency bands. Comparisons between resting-state MEG sources images and known neurophysiology were provided. Additionally, in simulations and cases with MEG human responses, the results obtained from using conventional beamformer technique were compared with those from Fast-VESTAL, which highlighted the beamformer's problems of signal leaking and distorted source time-courses.

No somatotopy of sensorimotor alpha-oscillation responses to differential finger stimulation

The somatotopic layout of the primary somatosensory cortex is known for its fine spatial structure as delineated in single cell recordings and macroscopic EEG evoked responses. While a gross somatotopic layout has been revealed also for neuronal oscillations responding to sensorimotor stimulation of distant body parts (e.g. hand vs. foot), it is still unclear whether these oscillatory dynamics exhibit fine spatial layout comparable to those found in evoked responses. In twelve healthy subjects we applied electric stimuli to the first (D1) and fifth finger (D5) of the same hand while performing high-density electroencephalography. We used Common Spatial Pattern analysis to optimally extract components showing the strongest Event-Related Desynchronization (ERD) in neuronal alpha oscillations. In agreement with the previous studies, dipole locations of Somatosensory Evoked Potentials (SEPs) confirmed the existence of spatially distinct representations of each finger. In contrast, dipole locations of alpha-ERD patterns did not yield spatially different source locations, indicating that the stimulation of different fingers most likely resulted in oscillatory activity of overlapping neuronal populations. When both fingers were stimulated simultaneously the SEP dipole strength was found increased in comparison to a stimulation of either finger alone, in agreement with spatially distinct SEP to finger stimulation. The strength of ERD, on the other hand, was the same regardless of whether either one or both fingers were stimulated. Our findings might reflect anatomical constraints on the sequential temporal activation of fingers' skin where almost simultaneous activation of many fingers usually occurs in everyday activities, such as grasping or holding objects. Such simultaneity is unlikely to benefit from slow amplitude modulation of alpha oscillations, which would rather be beneficial for contrasting somatosensory processing of distinct body parts.

Feasibility of clinical magnetoencephalography (MEG) functional mapping in the presence of dental artefacts

OBJECTIVE

To evaluate the viability of MEG source reconstruction in the presence of large interference due to orthodontic material.

METHODS

We recorded the magnetic fields following a simple hand movement and following electrical stimulation of the median nerve (somatosensory evoked field -SEF). These two tasks were performed twice, once with and once without artificial dental artefacts. Temporal Signal Space Separation (tSSS) was applied to spatially filter the data and source reconstruction was performed according to standard procedures for pre-surgical mapping of eloquent cortex, applying dipole fitting to the SEF data and beamforming to the hand movement data.

RESULTS

Comparing the data with braces to the data without braces, the observed distances between the activations following hand movement in the two conditions were on average 6.4 and 4.5 mm for the left and right hand, respectively, whereas the dipole localisation errors for the SEF were 4.1 and 5.4 mm, respectively. Without tSSS it was generally not possible to obtain reliable dipole fit or beamforming results when wearing braces.

CONCLUSION

We confirm that tSSS is a required and effective pre-processing step for data recorded with the Elekta-MEG system. Moreover, we have shown that even the presence of large interference from orthodontic material does not significantly alter the results from dipole localisation or beamformer analysis, provided the data are spatially filtered by tSSS.

SIGNIFICANCE

State-of-the-art signal processing techniques enable the use of MEG for pre-surgical evaluation in a much larger clinical population than previously thought possible.

Slowing of M1 oscillations in brain tumor patients in resting state and during movement

OBJECTIVE

Brain tumors may severely disrupt the structure and function of the brain. While abnormal low-frequency activity can be found around tumor borders, disrupted structural connectivity may also impinge on neural activity in distant brain regions and other frequency bands. We investigated how glioma in patients with normal motor functioning affects activity in primary motor areas (M1).

METHODS

Using magnetoencephalography in 12 patients with unilateral glioma located around the central sulcus, we studied activity in bilateral M1s in resting state and during movement with focus on motor-related mu (8-12Hz) and beta rhythms (15-30Hz). Principal component analysis served to test for differences in spectral content.

RESULTS

A shift was found towards lower frequencies for M1 in the tumor hemisphere compared to M1 in the healthy hemisphere, caused by an increase in mu and decrease in beta power. This pattern was observed both in resting state and during movement.

CONCLUSIONS

This 'slowing' of brain oscillations in M1 resembles findings in patients with monohemispheric stroke and Parkinson's disease. A loss of intra-cortical connectivity may account for these findings, possibly supplemented by tumor-induced changes in neurotransmitter systems.

SIGNIFICANCE

Motor functioning may be unaffected by a spectral shift of mu and beta oscillations.

White matter maturation in visual and motor areas predicts the latency of visual activation in children

In humans, white matter maturation is important for the improvement of cognitive function and performance with age. Across studies the variables of white matter maturity and age are highly correlated; however, the unique contributions of white matter to information processing speed remain relatively unknown. We investigated the relations between the speed of the visually-evoked P100m response and the biophysical properties of white matter in 11 healthy children performing a simple, visually-cued finger movement. We found that: (1) the latency of the early, visually-evoked response was related to the integrity of white matter in both visual and motor association areas and (2) white matter maturation in these areas accounted for the variations in visual processing speed, independent of age. Our study is a novel investigation of spatial-temporal dynamics in the developing brain and provides evidence that white matter maturation accounts for age-related decreases in the speed of visual response. Developmental models of cortical specialization should incorporate the unique role of white matter maturation in mediating changes in performance during tasks involving visual processing.

Mapping of the cortical spinal tracts using magnetoencephalography and diffusion tensor tractography in pediatric brain tumor patients

Prior to resection of a cerebral brain tumor, mapping of the functional and structural anatomy of the adjacent tissue is essential to reduce the risk of damage to descending and ascending pathways. We investigated the effectiveness of concurrent magnetoencephalography (MEG) and diffusion tensor imaging (DTI) tractography to delineate the motor cortex and associated corticospinal tract (CST) in a case series of children with brain tumors seen for pre-surgical evaluation. Using activation points generated from MEG to launch tractography, we delineated the CST of four patients and eight control subjects. Displacement of the CST was considerably larger in children with tumors located in the center of the hemisphere than in children whose tumors were more posteriorly located. Our findings suggest that the use of concurrent MEG and DTI may be an effective tool in the pre-surgical evaluation of eloquent cortex and associated white matter tracts in pediatric brain tumor patients.

Topographical organization of mu and Beta band activity associated with hand and foot movements in patients with perirolandic lesions

To study the topographical organization of mu and beta band event-related desynchronization (ERD) associated with voluntary hand and foot movements, we used magnetoencephalographic (MEG) recordings from 19 patients with perirolandic lesions. Synthetic aperture magnetometry (SAM) was used to detect and localize changes in the mu (7 - 11 Hz) and beta (13 - 30 Hz) frequency bands associated with repetitive movements of the hand and foot and overlaid on individual coregistered magnetic resonance (MR) images. Hand movements showed homotopic and contralateral ERD at the sensorimotor (S/M) cortex in the majority of cases for mu and to a lesser extent for beta rhythms. Foot movements showed an increased heterotopic distribution with bilateral and ipsilateral ERD compared to hand movements. No systematic topographical segregation between mu and beta ERD could be observed. In patients with perirolandic lesions, the mu and beta band spatial characteristics associated with hand movements retain the expected functional-anatomical boundaries to a large extent. Foot movements have altered patterns of mu and beta band ERD, which may give more insight into the differential functional role of oscillatory activity in different voluntary movements.

Neuromagnetic imaging of movement-related cortical oscillations in children and adults: age predicts post-movement beta rebound

We measured visually-cued motor responses in two developmentally separate groups of children and compared these responses to a group of adults. We hypothesized that if post-movement beta rebound (PMBR) depends on developmentally sensitive processes, PMBR will be greatest in adults and progressively decrease in children performing a basic motor task as a function of age. Twenty children (10 young children 4-6 years; 10 adolescent children 11-13 years) and 10 adults all had MEG recorded during separate recordings of right and left index finger movements. Beta band (15-30 Hz) event-related desynchronization (ERD) of bi-lateral sensorimotor areas was observed to increase significantly from both contralateral and ipsilateral MI with age. Movement-related gamma synchrony (60-90 Hz) was also observed from contralateral MI for each age group. However, PMBR was significantly reduced in the 4-6 year group and, while more prominent, remained significantly diminished in the adolescent (11-13 year) age group as compared to adults. PMBR measures were weak or absent in the youngest children tested and appear maximally from bilateral MI in adults. Thus PMBR may reflect an age-dependent inhibitory process of the primary motor cortex which comes on-line with normal development. Previous studies have shown PMBR may be observed from MI following a variety of movement-related tasks in adult participants - however, the origin and purpose of the PMBR is unclear. The current study shows that the expected PMBR from MI observed from adults is increasingly diminished in adolescent and young children respectively. A reduction in PMBR from children may reflect reduced motor cortical inhibition. Relatively less motor inhibition may facilitate neuronal plasticity and promote motor learning in children.

Magnetoencephalography

Although magnetoencephalography (MEG) may not be familiar to many pediatric radiologists, it is an increasingly available neuroimaging technique both for evaluating normal and abnormal intracranial neural activity and for functional mapping. By providing spatial, temporal, and time-frequency spectral information, MEG affords patients with epilepsy, intracranial neoplasia, and vascular malformations an opportunity for a sensitive and accurate non-invasive preoperative evaluation. This technique can optimize selection of surgical candidates as well as increase confidence in preoperative counseling and prognosis. Research applications that appear promising for near-future clinical translation include the evaluation of children with autism spectrum disorder, traumatic brain injury, and schizophrenia.