title: A technique for mapping cortical areas associated with speech arrest.
abstract: BACKGROUND
  Awake craniotomy with cortical stimulation is the standard for language mapping in patients with tumors near or within the language cortex. Reliable identification of the speech cortex is difficult, however, and adjunctive pre- and intraoperative techniques have inconsistent reliability.
  
  
  OBJECTIVE
  We describe a technique based on direct cortical stimulation which localizes speech areas by correlating vocal cord activation in the anesthetized patient with speech arrest in the awake patient.
  
  
  METHODS
  Direct cortical stimulation is applied to the patient and the vocal cords are visualized by fiberoptic endoscopy. The cortical site that produces vocal cord activation is identified. Once the patient is awakened, cortical stimulation is repeated and sites that produce speech arrest are identified.
  
  
  RESULTS
  We have performed this technique in 3 patients and have consistently correlated vocal cord activation with speech arrest in all patients. These areas of activation also correlate with areas of functional MRI BOLD activation obtained from the expressive language paradigms.
  
  
  CONCLUSIONS
  Colocalization of the site of vocal cord activation in the asleep patient to the site of speech arrest in the awake patient represents an adjunct for defining speech areas. This technique is useful for patients unable to tolerate awake craniotomy.
authors.affiliation: Department of Neurosurgery, M.D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Schapiro
authors.forename: David
authors.initials: D
authors.lastname: Ferson
authors.forename: Sujit S
authors.initials: SS
authors.lastname: Prabhu
authors.forename: Sudhakar
authors.initials: S
authors.lastname: Tummula
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wefel
authors.forename: Ganesh
authors.initials: G
authors.lastname: Rao
mesh_terms: D000328:Adult; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000503:physiopathology* / Q000601:surgery; D002540:Cerebral Cortex / Q000503:physiopathology* / Q000601:surgery; D003399:Craniotomy; D005260:Female; D005910:Glioma / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests; D013060:Speech / Q000502:physiology*