title: Intraoperative optical imaging of intrinsic signals: a reliable method for visualizing stimulated functional brain areas during surgery.
abstract: OBJECTIVE
  Intraoperative optical imaging (IOI) is an experimental technique used for visualizing functional brain areas after surgical exposure of the cerebral cortex. This technique identifies areas of local changes in blood volume and oxygenation caused by stimulation of specific brain functions. The authors describe a new IOI method, including innovative data analysis, that can facilitate intraoperative functional imaging on a routine basis. To evaluate the reliability and validity of this approach, they used the new IOI method to demonstrate visualization of the median nerve area of the somatosensory cortex.
  
  
  METHODS
  In 41 patients with tumor lesions adjacent to the postcentral gyrus, lesions were surgically removed by using IOI during stimulation of the contralateral median nerve. Optical properties of the cortical tissue were measured with a sensitive camera system connected to a surgical microscope. Imaging was performed by using 9 cycles of alternating prolonged stimulation and rest periods of 30 seconds. Intraoperative optical imaging was based on blood volume changes detected by using a filter at an isosbestic wavelength (λ = 568 nm). A spectral analysis algorithm was used to improve computation of the activity maps. Movement artifacts were compensated for by an elastic registration algorithm. For validation, intraoperative conduction of the phase reversal over the central sulcus and postoperative evaluation of the craniotomy site were used.
  
  
  RESULTS
  The new method and analysis enabled significant differentiation (p < 0.005) between functional and nonfunctional tissue. The identification and visualization of functionally intact somatosensory cortex was highly reliable; sensitivity was 94.4% and specificity was almost 100%. The surgeon was provided with a 2D high-resolution activity map within 12 minutes. No method-related side effects occurred in any of the 41 patients.
  
  
  CONCLUSIONS
  The authors' new approach makes IOI a contact-free and label-free optical technique that can be used safely in a routine clinical setup. Intraoperative optical imaging can be used as an alternative to other methods for the identification of sensory cortex areas and offers the added benefit of a high-resolution map of functional activity. It has great potential for visualizing and monitoring additional specific functional brain areas such as the visual, motor, and speech cortex. A prospective national multicenter clinical trial is currently being planned.
authors.affiliation: Department of Neurosurgery, University Hospital Carl Gustav Carus;
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Sobottka
authors.forename: Tobias
authors.initials: T
authors.lastname: Meyer
authors.forename: Matthias
authors.initials: M
authors.lastname: Kirsch
authors.forename: Edmund
authors.initials: E
authors.lastname: Koch
authors.forename: Ralf
authors.initials: R
authors.lastname: Steinmeier
authors.forename: Ute
authors.initials: U
authors.lastname: Morgenstern
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schackert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000503:physiopathology / Q000601:surgery*; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000503:physiopathology / Q000601:surgery; D004558:Electric Stimulation; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D059907:Functional Neuroimaging / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*