Real-Time Delineation of the Central Sulcus with the Spatial Profile of SSEPs Captured with High-Density Ecog Grid.

Cortical mapping is widely employed to define the sensorimotor area and delineate the central sulcus (CS) during awake craniotomies. The approach involves the gold standard somatosensory evoked potentials (SSEPs) recorded with electrocorticogram (ECoG) strip electrodes. However, the evoked response can be misconstrued from the manual peak interpretation due to the poor spatial resolution of the strip electrode or when the electrode does not precisely cover the desired cortical area. This can lead to unintentional damage to the eloquent cortex. We present a soft real-time computer based visualization system that uses recorded SSEPs with a subdural grid to aid in cortical mapping. The neural data during electrical stimulation of the median nerve at 0.6Hz are picked up with a bio-amplifier at 2.4kHz. The stimulation artifact recorded from the bipolar electromyogram (EMG) is used as the stimulation onset. The ECoG data are assessed online with MATLAB Simulink to process and visualize the SSEPs waveform. The visualization system is programmed to display the SSEPs peak activation as a heat map on a 2D grid and projected onto a screen, showcasing the nature of the cortical activities over the contact surface area. Since the grid occupies a large cortical surface, the heatmap is able to delineate the central sulcus. The map can be viewed at any time point along the SSEP trace without the need for peak interpretation. With the goal to provide additional information during cortical mapping and facilitate interpretation of ECoG grid data, we believe that this visualization system will aid in rapid definition of the sensorimotor area during surgical planning. Clinical Relevance- This real-time visualization system can be used to delineate the central sulcus in a short time during awake craniotomies.