title: A novel tablet computer platform for advanced language mapping during awake craniotomy procedures.
abstract: 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.
authors.affiliation: Physical Sciences, Sunnybrook Research Institute, Toronto;|Department of Medical Biophysics, University of Toronto;
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Morrison
authors.affiliation: Physical Sciences, Sunnybrook Research Institute, Toronto;
authors.forename: Fred
authors.initials: F
authors.lastname: Tam
authors.affiliation: Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada; and.
authors.forename: Marco M
authors.initials: MM
authors.lastname: Garavaglia
authors.affiliation: Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, Massachusetts.
authors.forename: Laleh
authors.initials: L
authors.lastname: Golestanirad
authors.affiliation: Keenan Research Centre.|Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada; and.
authors.forename: Gregory M T
authors.initials: GM
authors.lastname: Hare
authors.affiliation: Keenan Research Centre.|Division of Neurosurgery, and.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cusimano
authors.affiliation: Keenan Research Centre.
authors.forename: Tom A
authors.initials: TA
authors.lastname: Schweizer
authors.affiliation: Keenan Research Centre.|Division of Neurosurgery, and.
authors.forename: Sunit
authors.initials: S
authors.lastname: Das
authors.affiliation: Physical Sciences, Sunnybrook Research Institute, Toronto;|Department of Medical Biophysics, University of Toronto;
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Graham
mesh_terms: D000328:Adult; D001072:Apraxias / Q000175:diagnosis / Q000209:etiology; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005910:Glioma / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D007802:Language; D008279:Magnetic Resonance Imaging; D008297:Male; D008838:Microcomputers; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D056888:Patient Positioning; D011183:Postoperative Complications / Q000175:diagnosis / Q000523:psychology; D012984:Software; D013064:Speech Disorders / Q000175:diagnosis / Q000209:etiology; D014851:Wakefulness; D055815:Young Adult
keywords: DCES = direct cortical electrical stimulation; DVR = digital video recorder; IV = intravenous; LCD = liquid crystal display; SOP = standard operating procedure; brain mapping; brain tumor; fMRI = functional MRI; functional neurosurgery; glioma; language; surgery; surgical technique; tablet computing