Spatial-Temporal Functional Mapping Combined With Cortico-Cortical Evoked Potentials in Predicting Cortical Stimulation Results

An update on tests used for intraoperative monitoring of cognition during awake craniotomy

PURPOSE

Mapping higher-order cognitive functions during awake brain surgery is important for cognitive preservation which is related to postoperative quality of life. A systematic review from 2018 about neuropsychological tests used during awake craniotomy made clear that until 2017 language was most often monitored and that the other cognitive domains were underexposed (Ruis, J Clin Exp Neuropsychol 40(10):1081-1104, 218). The field of awake craniotomy and cognitive monitoring is however developing rapidly. The aim of the current review is therefore, to investigate whether there is a change in the field towards incorporation of new tests and more complete mapping of (higher-order) cognitive functions.

METHODS

We replicated the systematic search of the study from 2018 in PubMed and Embase from February 2017 to November 2023, yielding 5130 potentially relevant articles. We used the artificial machine learning tool ASReview for screening and included 272 papers that gave a detailed description of the neuropsychological tests used during awake craniotomy.

RESULTS

Comparable to the previous study of 2018, the majority of studies (90.4%) reported tests for assessing language functions (Ruis, J Clin Exp Neuropsychol 40(10):1081-1104, 218). Nevertheless, an increasing number of studies now also describe tests for monitoring visuospatial functions, social cognition, and executive functions.

CONCLUSIONS

Language remains the most extensively tested cognitive domain. However, a broader range of tests are now implemented during awake craniotomy and there are (new developed) tests which received more attention. The rapid development in the field is reflected in the included studies in this review. Nevertheless, for some cognitive domains (e.g., executive functions and memory), there is still a need for developing tests that can be used during awake surgery.

Spatiotemporal patterns of cortical microstructural maturation in children and adolescents with diffusion MRI

Neocortical maturation is a dynamic process that proceeds in a hierarchical manner; however, the spatiotemporal organization of cortical microstructure with diffusion MRI has yet to be fully defined. This study characterized cortical microstructural maturation using diffusion MRI (fwe-DTI and NODDI multi-compartment modeling) in a cohort of 637 children and adolescents between 8 and 21 years of age. We found spatially heterogeneous developmental patterns broadly demarcated into functional domains where NODDI metrics increased and fwe-DTI metrics decreased with age. Using non-negative matrix factorization, we found cortical regions that correspond to lower-order sensory regions mature earlier than higher-order association regions. Our findings corroborate previous histological and neuroimaging studies that show spatially-varying patterns of cortical maturation that may reflect unique developmental processes of cytoarchitectonically-determined regional patterns of change.

Explainable Fuzzy Clustering Framework Reveals Divergent Default Mode Network Connectivity Dynamics in Schizophrenia

Dynamic functional network connectivity (dFNC) analysis of resting state functional magnetic resonance imaging data has yielded insights into many neurological and neuropsychiatric disorders. A common dFNC analysis approach uses hard clustering methods like k-means clustering to assign samples to states that summarize network dynamics. However, hard clustering methods obscure network dynamics by assuming (1) that all samples within a cluster are equally like their assigned centroids and (2) that samples closer to one another in the data space than to their centroids are well-represented by their centroids. In addition, it can be hard to compare subjects, as in some cases an individual may not manifest a state strongly enough to enter a hard cluster. Approaches that allow a dimensional approach to connectivity patterns (e.g., fuzzy clustering) can mitigate these issues. In this study, we present an explainable fuzzy clustering framework by combining fuzzy c-means clustering with several explainability metrics. We apply our framework for schizophrenia (SZ) default mode network analysis, identifying 5 states and characterizing those states with a new explainability approach. While also showing that features typically used in hard clustering can be extracted in our framework, we present a variety of unique features to quantify state dynamics and identify effects of SZ upon network dynamics. We further uncover relationships between symptom severity and interactions of the precuneus with the anterior and posterior cingulate cortex. Given the ease of implementing our framework and its enhanced insight into network dynamics, it has great potential for use in future dFNC studies.

Intraoperative localization and preservation of reading in ventral occipitotemporal cortex

OBJECTIVE

Resective surgery in language-dominant ventral occipitotemporal cortex (vOTC) carries the risk of causing impairment to reading. Because it is not on the lateral surface, it is not easily accessible for intraoperative mapping, and extensive stimulation mapping can be time-consuming. Here the authors assess the feasibility of using task-based electrocorticography (ECoG) recordings intraoperatively to help guide stimulation mapping of reading in vOTC.

METHODS

In 11 patients undergoing extraoperative, intracranial seizure mapping, the authors recorded induced broadband gamma activation (70-150 Hz) during a visual category localizer. In 2 additional patients, whose pathologies necessitated resections in language-dominant vOTC, task-based functional mapping was performed intraoperatively using subdural ECoG alongside direct cortical stimulation.

RESULTS

Word-responsive cortex localized using ECoG showed a high sensitivity (72%) to stimulation-induced reading deficits, and the confluence of ECoG and stimulation-positive sites appears to demarcate the visual word form area. Intraoperative task-based ECoG mapping was possible in < 3 minutes, providing a high signal quality, and initial intraoperative data analysis took < 3 minutes, allowing for rapid assessment of broad areas of cortex. Cortical areas critical for reading were mapped and successfully preserved, while also enabling pathological tissue to be completely removed.

CONCLUSIONS

Eloquent cortex in ventral visual cortex can be rapidly mapped intraoperatively using ECoG. This method acts to guide high-probability targets for stimulation with limited patient participation and can be used to avoid iatrogenic dyslexia following surgery.

Significance of event related causality (ERC) in eloquent neural networks

Neural activity emerges and propagates swiftly between brain areas. Investigation of these transient large-scale flows requires sophisticated statistical models. We present a method for assessing the statistical confidence of event-related neural propagation. Furthermore, we propose a criterion for statistical model selection, based on both goodness of fit and width of confidence intervals. We show that event-related causality (ERC) with two-dimensional (2D) moving average, is an efficient estimator of task-related neural propagation and that it can be used to determine how different cognitive task demands affect the strength and directionality of neural propagation across human cortical networks. Using electrodes surgically implanted on the surface of the brain for clinical testing prior to epilepsy surgery, we recorded electrocorticographic (ECoG) signals as subjects performed three naming tasks: naming of ambiguous and unambiguous visual objects, and as a contrast, naming to auditory description. ERC revealed robust and statistically significant patterns of high gamma activity propagation, consistent with models of visually and auditorily cued word production. Interestingly, ambiguous visual stimuli elicited more robust propagation from visual to auditory cortices relative to unambiguous stimuli, whereas naming to auditory description elicited propagation in the opposite direction, consistent with recruitment of modalities other than those of the stimulus during object recognition and naming. The new method introduced here is uniquely suitable to both research and clinical applications and can be used to estimate the statistical significance of neural propagation for both cognitive neuroscientific studies and functional brain mapping prior to resective surgery for epilepsy and brain tumors.