A novel tablet computer platform for advanced language mapping during awake craniotomy procedures

被引:13
作者
Morrison, Melanie A. [1 ,2 ]
Tam, Fred [1 ]
Garavaglia, Marco M. [5 ]
Golestanirad, Laleh [6 ]
Hare, Gregory M. T. [3 ,5 ]
Cusimano, Michael D. [3 ,4 ]
Schweizer, Tom A. [3 ]
Das, Sunit [3 ,4 ]
Graham, Simon J. [1 ,2 ]
机构
[1] Sunnybrook Res Inst, Phys Sci, Toronto, ON, Canada
[2] Univ Toronto, Dept Med Biophys, Toronto, ON, Canada
[3] St Michaels Hosp, Keenan Res Ctr, 30 Bond St, Toronto, ON M5B 1W8, Canada
[4] St Michaels Hosp, Div Neurosurg, 30 Bond St, Toronto, ON M5B 1W8, Canada
[5] St Michaels Hosp, Dept Anesthesia, 30 Bond St, Toronto, ON M5B 1W8, Canada
[6] Harvard Univ, Sch Med, Athinoula A Martinos Ctr Biomed Imaging, Boston, MA USA
关键词
brain mapping; brain tumor; functional neurosurgery; glioma; language; surgery; tablet computing; surgical technique; DIRECT CORTICAL STIMULATION; TUMOR SURGERY; FMRI; RESECTION; MRI; NEUROONCOLOGY; AREAS;
D O I
10.3171/2015.4.JNS15312
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
A computerized platform has been developed to enhance behavioral testing during intraoperative language mapping in awake craniotomy procedures. The system is uniquely compatible with the environmental demands of both the operating room and preoperative functional MRI (fMRI), thus providing standardized testing toward improving spatial agreement between the 2 brain mapping techniques. Details of the platform architecture, its advantages over traditional testing methods, and its use for language mapping are described. Four illustrative cases demonstrate the efficacy of using the testing platform to administer sophisticated language paradigms, and the spatial agreement between intraoperative mapping and preoperative fMRI results. The testing platform substantially improved the ability of the surgeon to detect and characterize language deficits. Use of a written word generation task to assess language production helped confirm areas of speech apraxia and speech arrest that were inadequately characterized or missed with the use of traditional paradigms, respectively. Preoperative fMRI of the analogous writing task was also assistive, displaying excellent spatial agreement with intraoperative mapping in all 4 cases. Sole use of traditional testing paradigms can be limiting during awake craniotomy procedures. Comprehensive assessment of language function will require additional use of more sophisticated and ecologically valid testing paradigms. The platform presented here provides a means to do so.
引用
收藏
页码:938 / 944
页数:7
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