Advertisement

Intraoperative Cortical Mapping: Basic Concepts, Indications, and Anesthesia Considerations

  • J. Arthur Saus
  • Charles Fox
  • Harish Siddaiah
  • Alan David Kaye
  • Scott Francis Davis
  • Bharat Guthikonda
Chapter

Abstract

The eloquent area of the brain is responsible for written and verbal communication. Functional neuroimaging indicates that interindividual variation exists with the anatomical location of the eloquent area of the brain. Some patients have shown significant contribution from areas located near, but outside of, the traditionally recognized eloquent area. Classically, these areas adjacent to or near the eloquent area were thought to have little impact on written or oral language skills, and many neurosurgeons, in the past, underestimated the impact of operating in these areas. Now, each patient is known to have a unique eloquent area. This necessitates intraoperative cortical mapping to more accurately identify functioning before removing brain tissues in patients undergoing epilepsy or brain tumor surgery in areas near this region of the brain. The goal of intraoperative cortical mapping is to maximize surgical resection in the eloquent area while minimizing the incidence of permanent disabilities. This chapter is intended to provide you with the concepts, indications, and anesthetic considerations important to intraoperative cortical mapping and to prepare you for further reading of more advanced texts and primary literature on this topic.

Keywords

Depression Attenuation Titration Respiration Epinephrine Cortical mapping Stimulation Eloquent cortex Brain tumor Epilepsy ECoG 

References

  1. 1.
    Lederer S. Subjected to science: human experimentation in America before the Second World War. Baltimore: John Hopkins University Press; 1995. p. 7–9.Google Scholar
  2. 2.
    Kruggel F, Brückner MK, Arendt T, Wiggins CJ, von Cramon DY. Analyzing the neocortical fine-structure. Med Image Anal. 2003;7(3):251–64.CrossRefGoogle Scholar
  3. 3.
    Johansson C, Lansner A. Towards cortex sized artificial neural systems. Neural Netw. 2007;20:48–61.CrossRefGoogle Scholar
  4. 4.
    Mountcastle V. The columnar organization of the neocortex. Brain. 1997;120(4):701–22.CrossRefGoogle Scholar
  5. 5.
    Buxhoeveden DP, Casanova MF. The minicolumn hypothesis in neuroscience. Brain. 2002;125:935–51.CrossRefGoogle Scholar
  6. 6.
    Reis J, Rosenow F. Eloquent cortex and tract: overview and noninvasive evaluation methods. In: Luders H, editor. Textbook of epilepsy surgery. London: Informa; 2008. p. 869–80.Google Scholar
  7. 7.
    Berger MS, Rostomily RC. Low grade gliomas: functional mapping resection strategies, extent of resection, and outcome. J Neuro-Oncol. 1997;34:85–101.CrossRefGoogle Scholar
  8. 8.
    Berger MS, Deliganis AV, Dobbins J, Keles GE. The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer. 1994;74:1784–91.CrossRefGoogle Scholar
  9. 9.
    Keles GE, Anderson B, Berger MS. The effect of extent of resection on time to tumor progression and survival in patients with glioblastoma multiforme of the cerebral hemisphere. Surg Neurol. 1999;52:371–9.CrossRefGoogle Scholar
  10. 10.
    Keles GE, Lamborn KR, Berger MS. Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome. J Neurosurg. 2001;95:735–45.CrossRefGoogle Scholar
  11. 11.
    Berger MS. Functional mapping-guided resection of low-grade gliomas. Clin Neurosurg. 1995;42:437–45.PubMedGoogle Scholar
  12. 12.
    Berger MS, Kincaid J, Ojemann GA, Lettich E. Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors. Neurosurgery. 1989;25:786–92.CrossRefGoogle Scholar
  13. 13.
    Black PM, Ronner SF. Cortical mapping for defining the limits of tumor resection. Neurosurgery. 1987;20:914–9.CrossRefGoogle Scholar
  14. 14.
    Kim S, McCutcheon I, Suki D, Weinberg JS, Sawaya R, Lang FF, et al. Awake craniotomy for brain tumors near eloquent cortex: correlation of intraoperative mapping with neurological outcomes in 309 consecutive patients. Neurosurgery. 2000;64:836–46.CrossRefGoogle Scholar
  15. 15.
    Ranks RA, Aglio LS, Gugino LD, Black PM. Craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving eloquent cortex. J Neuro-Oncol. 2000;49:131–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • J. Arthur Saus
    • 1
  • Charles Fox
    • 2
  • Harish Siddaiah
    • 1
  • Alan David Kaye
    • 3
    • 4
    • 5
  • Scott Francis Davis
    • 6
  • Bharat Guthikonda
    • 7
  1. 1.Ochsner LSU Health, Department of AnesthesiologyShreveportUSA
  2. 2.Department of Anesthesiology, Louisiana StateUniversity Health Sciences Center ShreveportShreveportUSA
  3. 3.Departments of Anesthesiology and Pharmacology, Toxicology, and NeurosciencesLSU School of MedicineShreveportUSA
  4. 4.LSU School of MedicineDepartment of AnesthesiologyNew OrleansUSA
  5. 5.Tulane School of MedicineNew OrleansUSA
  6. 6.Department of AnesthesiologyLouisiana State University School of Medicine, Tulane University School of MedicineNew OrleansUSA
  7. 7.LSU Health Sciences Center, Department of NeurosurgeryShreveportUSA

Personalised recommendations