Intraoperative optical imaging in neurosurgery

Review of functional and clinical relevance of intrinsic signal optical imaging in human brain mapping

Intrinsic signal optical imaging (ISOI) within the first decade of its use in humans showed its capacity as a precise functional mapping tool. It is a powerful tool that can be used intraoperatively to help a surgeon to directly identify functional areas of the cerebral cortex. Its use is limited to the intraoperative setting as it requires a craniotomy and durotomy for direct visualization of the brain. It has been applied in humans to study language, somatosensory and visual cortices, cortical hemodynamics, epileptiform activity, and lesion delineation. Despite studies showing clear evidence of its usefulness in clinical care, its clinical use in humans has not grown. Impediments imposed by imaging in a human operating room setting have hindered such work. However, recent studies have been aimed at overcoming obstacles in clinical studies establishing the benefits of its use to patients. This review provides a description of ISOI and its use in human studies with an emphasis on the challenges that have hindered its widespread use and the recent studies that aim to overcome these hurdles. Clinical studies establishing the benefits of its use to patients would serve as the impetus for continued development and use in humans.