Objective: To investigate the feasibility and clinical utility of using passive electrocorticography (ECoG) for online spatial-temporal functional mapping (STFM) of language cortex in patients being monitored for epilepsy surgery.Methods: We developed and tested an online system that exploits ECoG's temporal resolution to display the evolution of statistically significant high gamma (70-110 Hz) responses across all recording sites activated by a discrete cognitive task. We illustrate how this spatial-temporal evolution can be used to study the function of individual recording sites engaged during different language tasks, and how this approach can be particularly useful for mapping eloquent cortex.Results: Using electrocortical stimulation mapping (ESM) as the clinical gold standard for localizing language cortex, the average sensitivity and specificity of online STFM across 7 patients were 69.9% and 83.5%, respectively. Moreover, relative to regions of interest where discrete cortical lesions have most reliably caused language impairments in the literature, the sensitivity of STFM was significantly greater than that of ESM, while its specificity was also greater than that of ESM, though not significantly so. Functional human brain mapping is commonly performed during or prior to invasive brain surgery for the treatment of drug-refractory epilepsy 1,2 and brain tumors. 3 The current gold standard, electrocortical stimulation mapping (ESM), is time-consuming 4,5 and often induces afterdischarges or seizures. 4,6,7 Additionally, it is difficult to rule out distant effects through diaschisis or action potentials evoked by stimulation.7-9 These limitations have long motivated the investigation of passive electrocorticographic (ECoG) recordings as a tool for rapidly and safely mapping cortical function prior to resective surgery.
10-12Here we introduce and test the feasibility and clinical utility of an online trial-based system for spatial-temporal functional mapping (STFM) of language cortex. High-gamma (HG, ; power changes have been demonstrated to be a robust and reliable index of task-related activation of cortical populations of neurons with high spatial and temporal specificity.13,14 The STFM system builds upon previous passive ECoG mapping software [15][16][17][18] by providing a trialbased framework for online display and statistical validation of HG dynamics.In 7 patients, estimates of the system's sensitivity and specificity for language mapping, relative to the benchmark of ESM, were the same or better than previous reports.18-21 Moreover, we found that relative to predefined language cortex boundaries, the sensitivity and specificity of *These authors contributed equally to this work.