367 Localization of critical speech areas in glioma-infiltrated brain cortex using local neuronal field potentials via electrocorticography (ECOG)

Abstract

Objectives/Goals: The standard care for malignant gliomas includes maximal tumor resection, but challenges arise near functional (speech) areas. Direct cortical stimulation (DCS) identifies functional (nonresectable) cortex. We aim to identify electrophysiologic (via subdural electrode recordings [ECOG]) biomarkers of DCS-positive (functional) areas. Methods/Study Population: Our lab maintains one of the largest datasets of electrophysiology analysis of glioma infiltrated brain cortex in the USA. Recordings of intraoperative brain mapping were analyzed to identify cortical sites that were found to be positive (functional) during DCS. DCS positive and negative (nonfunctional) sites were aligned to corresponding subdural electrodes. Future analysis: We plan to compare the temporal and spectral electrophysiologic variations associated with cortical sites found to be DCS positive versus negative during brain mapping. We plan to train machine learning classifiers that utilize these electrophysiologic biomarkers to discriminate between DCS positive and negative sites. Results/Anticipated Results: In total, our database comprised of 110 resections with brain mapping (DCS) and ECOG, including 4 patients who underwent a second procedure for resection. Eight patients were excluded as their resections were for brain metastases, not glioma. Our final cohort was comprised of 98 glioma resections, including 4 patients who underwent surgery twice for recurrence. During these resections, a total of 1393 sites were mapped via DCS for language function (including picture naming, word reading, and sentence syntax tasks). Of these 1393 sites, 100 sites were found to be DCS positive (7.1% positivity rate). (Currently in the process of conducting analysis comparing electrophysiologic features and biomarkers of DCS positive versus negative sites.) Discussion/Significance of Impact: This research is ongoing. Identifying electrophysiologic biomarkers of critical DCS-positive regions may provide a durable alternative to stimulation mapping. Due to its resource intensity, DCS has access barriers. Future neurosurgeons may use biomarkers from subdural electrode recordings to plan safer cortical resections.