Intraoperative optical intrinsic signal imaging: a clinical tool for functional brain mapping.

Optical imaging of intrinsic signals (OIS) is a well-established neuroimaging modality by which functional cortical activity is mapped by detecting activity-related changes in cortical light reflectance. Light reflectance changes are detected by a charged-coupled device camera that captures images of the exposed cortex both at rest and during activity. Although to date OIS has only been used for research purposes, intraoperative OIS (iOIS) holds promise as a clinical mapping tool. In general, iOIS demonstrates good spatial correlation with electrocortical stimulation mapping (ECSM) and other electrophysiological modalities. Additionally, iOIS offers high spatial resolution (in microns), does not make contact with the surface of the brain, and introduces no potentially harmful compounds. Moreover, mapping is relatively rapid. The authors review the potential contribution of iOIS to the intraoperative environment. Specifically, they review iOIS methodology, discuss signal origin, compare OIS with other functional mapping modalities, and explain its potential benefits and limitations. They propose that iOIS may, in the future, be used in conjunction with ECSM to improve the resolution and accuracy of intraoperative mapping, decrease total time of intraoperative mapping, and possibly improve neurological outcomes. Additional studies will be required to quantify the sensitivity and specificity of optical maps relative to ECSM before it can be implemented clinically.