Endovascular brain mapping: A strategy for intraoperative visualization of brain parenchyma functionality

Within the field of cognitive neuroscience, brain mapping strategies aim to localizeneurological function within specific regions of the human brain. The burgeoning fieldsof functional magnetic resonance imaging (fMRI) and functional electrophysiology seekto map the human brain with ever-improving resolution. However, these functionalstrategies do not enable real-time, intraoperative discrimination of functional and nonfunctionalbrain parenchyma with precise, well-defined margins, as are necessary forsurgical guidance and resection. To address the need for an intraoperative brain mappingstrategy aimed specifically at neurosurgical guidance at resection, we have developed anovel brain mapping technique that we term preoperative endovascular brain mapping(PEBM). PEBM combines a super-selective, intraarterial approach with the delivery ofvisually detectable contrast agents to identify specific regions of functional and nonfunctionalbrain before and during craniotomy for brain resections. Our novel approachaims to avoid additional postoperative neurological deficits which would occur iffunctional brain parenchyma is inadvertently injured during an aggressive resection.Endovascular brain mapping aims to preserve brain function by providing a means ofdirect volumetric surgical guidance in real-time, whereby non-functional tissues aredelineated by sharp, visible margins and can therefore be safely resected. The successfulimplementation of PEBM is highly dependent upon the proper selection and use ofimaging probes, and we have developed a number of novel multimodal chemistriesspecifically aimed at PEBM. In this chapter, we will describe the PEBM technique indetail by highlighting its use in various small animal models, as well as our ongoingdevelopment of novel imaging probes suitable for PEBM.