The new methodology, described in the cover article of the July issue of the prestigious journal Epilepsy & Behavior, identifies in real time areas of the brain important for preserving language and motor functions during brain tissue resections in a safer and less expensive manner than previous approaches. Potential applications could include brain surgery to remove troublesome tissue linked to seizures, as well as to remove tumors, congenital lesions, and vascular abnormalities.
The title of the article is “A practical procedure for real-time functional mapping of eloquent cortex using electrocorticographic signals in humans.” Peter Brunner, a graduate student at the Wadsworth Center of the New York State Department of Health who implemented critical components of the software used in the new procedure, was first author on the study.
The research was led by Gerwin Schalk, Ph.D., associate professor of neurology at Albany Medical College and research scientist at the Wadsworth Center, and Anthony Ritaccio, M.D., the J. Spencer Standish professor of neurology and neurosurgery and director of the epilepsy and human brain mapping program at Albany Medical Center. The new mapping system uses recordings of electrical activity from the brain (electrocorticography, or ECoG) and advanced software technologies that the group has been testing for the past several years—specifically, BCI2000 and SIGFRIED (SIGnal Modeling for Real-Time Identification and Event Detection).
Planning for resective brain surgery—a procedure that removes a portion or the whole part of abnormal brain tissue—depends greatly on the location of the abnormal areas. Areas of importance for language, movement, sensation and other brain functions may be nearby. The creation of a “brain map” to spare those vital areas in close proximity to the lesion is critical.
To test the system, 10 patients underwent the new mapping procedure in addition to the current standard approach—known as electrical cortical stimulation (ECS)–prior to having partial brain tissue resection to correct seizures. Using ECoG, platinum electrode arrays were implanted in the patients’ skulls just below the dura—the outermost layer of membranes that surround the brain and spinal cord. Patients were then asked to execute a certain task—to elevate their hand, or repeat a phrase—and the electrodes recorded signals directly from the brain surface using the BCI2000 software. The SIGFRIED system identified the location of electrical activity that changed with that task in real time and at the patient’s bedside.
In comparison to traditional methodologies—including ECS, which is currently known to be the gold standard in brain mapping—passive ECoG recordings are safer, can be rapidly applied, are less expensive, and the technology is relatively simple to operate. In addition, the results of the new mapping system proved to be substantially consistent with those provided by the ECS method and in fact, identified a larger number of stimulated portions of the brain.
The research was done in collaboration with scientists and clinicians at Washington University School of Medicine in St. Louis, Mo., the University of Wisconsin at Madison, the University Medical Center Utrecht in Utrecht, The Netherlands, and Graz University of Technology in Graz, Austria. Albany Medical Center is organizing an international symposium to share information about their methodologies and innovations later this year. This technology is currently under further evaluation at a number of epilepsy centers in the United States and Europe.
Albany Medical Center is northeastern New York’s only academic health sciences center. It consists of Albany Medical College, Albany Medical Center Hospital and the Albany Medical Center Foundation, Inc. Additional information about Albany Medical Center can be found at www.amc.edu.
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