First-in-human experience performing high-resolution cortical mapping using a novel microelectrode array containing 1024 electrodes

<i>Objective.</i>Localization of function within the brain and central nervous system is an essential aspect of clinical neuroscience. Classical descriptions of functional neuroanatomy provide a foundation for understanding the functional significance of identifiable anatomic structures. However, individuals exhibit substantial variation, particularly in the presence of disorders that alter tissue structure or impact function. Furthermore, functional regions do not always correspond to identifiable structural features. Understanding function at the level of individual patients-and diagnosing and treating such patients-often requires techniques capable of correlating neural activity with cognition, behavior, and experience in anatomically precise ways.<i>Approach</i>. Recent advances in brain-computer interface technology have given rise to a new generation of electrophysiologic tools for scalable, nondestructive functional mapping with spatial precision in the range of tens to hundreds of micrometers, and temporal resolutions in the range of tens to hundreds of microseconds. Here we describe our initial intraoperative experience with novel, thin-film arrays containing 1024 surface microelectrodes for electrocorticographic mapping in a first-in-human study.<i>Main results</i>. Eight patients undergoing standard electrophysiologic cortical mapping during resection of eloquent-region brain tumors consented to brief sessions of concurrent mapping (micro-electrocorticography) using the novel arrays. Four patients underwent motor mapping using somatosensory evoked potentials (SSEPs) while under general anesthesia, and four underwent awake language mapping, using both standard paradigms and the novel microelectrode array. SSEP phase reversal was identified in the region predicted by conventional mapping, but at higher resolution (0.4 mm) and as a contour rather than as a point. In Broca's area (confirmed by direct cortical stimulation), speech planning was apparent in the micro-electrocorticogram as high-amplitude beta-band activity immediately prior to the articulatory event.<i>Significance</i>. These findings support the feasibility and potential clinical utility of incorporating micro-electrocorticography into the intraoperative workflow for systematic cortical mapping of functional brain regions.