Surgical skill acquisition may be facilitated with a safe application of transcranial direct current stimulation (tDCS). A preliminary meta-analysis of randomized control trials showed that tDCS was associated with significantly better improvement in surgical performance than the sham control; however, meta-analysis does not address the mechanistic understanding. It is known from skill learning studies that the hierarchy of cognitive control shows a rostrocaudal axis in the frontal lobe where a shift from posterior to anterior is postulated to mediate progressively abstract, higher-order control. Therefore, optimizing the transcranial electrical stimulation to target surgical task-related brain activation at different stages of motor learning may provide the causal link to the learning behavior. This comment paper presents the computational approach for neuroimaging guided tDCS based on open-source software pipelines and an open-data of functional near-infrared spectroscopy (fNIRS) for complex motor tasks. We performed an fNIRS-based cortical activation analysis using AtlasViewer software that was used as the target for tDCS of the motor complexity-related brain regions using ROAST software. For future studies on surgical skill training, it is postulated that the higher complexity laparoscopic suturing with intracorporeal knot tying task may result in more robust activation of the motor complexity-related brain areas when compared to the lower complexity laparoscopic tasks.

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Abstract—Cerebellar transcranial direct current stimulation (ctDCS) has been shown to facilitate standing balance in stroke survivors where a good general linear model fit was found in the latent space between the mean lobular ctDCS electric field strength with the oxy-hemoglobin concentrations (HbO) from functional near-infrared spectroscopy (fNIRS) and log10-transformed electroencephalogram (EEG) bandpower at the prefrontal cortex (PFC) and the sensorimotor cortex in the responders. Recent works have also found that the infra-slow activity (0.01–0.10 Hz) and delta band (0.5–4 Hz) activity propagated in opposite directions between the cerebellum and cerebral cortex. Therefore, in this study, we tested the feasibility of fNIRS of cerebellum and PFC where infra-slow (0.01–0.10 Hz) PFC HbO activity was used to drive (phase amplitude coupling) 4Hz cerebellar transcranial alternating current stimulation (ctACS) at right lobules VI-CrusI/II-VIIb. We found that 2mA ctDCS evoked similar HbO response across cerebellum and PFC brain regions (a=0.01); however, 2mA ctACS evoked HbO across brain regions that was statistically different (a=0.01). Clinical Relevance—We showed the feasibility of fNIRS of cerebellum and PFC, and fNIRS-driven ctACS at 4Hz that may facilitate cognitive function via the frontoparietal network in cerebellar cognitive affective/Schmahmann syndrome.