cortiQ — rapid cortical mapping
cortiQ is a new way of brain mapping for the operating room and neuro monitoring unit that is used with epilepsy or brain tumor patients. cortiQ determines functional areas as those whose electrocorticographic (ECoG) activity increases with tasks such as motor movement or speech production. cortiQ allows neurologists and neurosurgeons to localize eloquent brain areas and provides additional information for surgical resection with a low risk of neurological deficits. cortiQ software can readily be used in addition to traditional mapping procedures such as electrical cortical stimulation (ECS) mapping or fMRI.
- real-time brain mapping in the operating room or neuro monitoring unit
- minimize hospital time and costs
- rapid mapping procedure
- customizable for individual surgical needs
- optimize surgical procedures
- reduce risks for patients
- can be used in very young patients, too
BRAIN MAPPING WITH ECoG
After successful implantation of cortiQ ECoG electrodes, there are two ways of how to perform the brain mapping: intra-operative or bedside. These two approaches open many more opportunities with a minimal risk for the patient.
A brand new feature of cortiQ is the real-time 3D visualization of brain activity.
"I use cortiQ in to find and interpret functional activity in the brain at the bed-side, and during awake craniotomy for brain surgery in real time. This system applies novel mapping techniques, revealing hidden brain functions that are active when the patient performs semantic, motor, visual, auditory, tactile, attentional, and/or other tasks. Because of cortiQ, I reduced electrical cortical stimulations (ECS) to minimize related seizures and shorten clinical examinations. By not using cortiQ, I would miss an opportunity to improve existing brain mapping procedures and learn the bigger picture.”
Kyousuke Kamada, PhD, MD
Hokashin Group Megumino Hospital, Sapporo, Japan
Diagnosis: Epilepsy or Brain Tumor
Epilepsy is a common neurological disorder that affects a large portion of the world population. Many of the affected people can control epileptic seizures with the use of medication, but for around 15–20% of this population, medication is not effective, and some of these patients choose surgery. Brain cancer is another reason for brain surgery. There are various types of brain tumors, and the aim of the surgery is to remove the tumor (or at least parts of it).
Treatment: Brain Surgery
For patients who suffer from epilepsy or brain tumors, brain surgery is often part of the treatment. However, the overall goal of brain surgery is to remove affected brain tissue causing as little damage as possible to the healthy and eloquent brain areas.
Brain Analysis: ECS and fMRI
Functional brain mapping of the cortex is an essential step when planning resective brain surgeries. Mapping techniques like electrical cortical stimulation (ECS) and functional magnetic resonance imaging (fMRI) are well-established in clinical practice. However, these procedures have disadvantages, since ECS is time consuming, can trigger seizures, and fMRI is not always reliable.
ECoG with grids and stereo EEG
A passive brain mapping procedure based on electrocorticographic (ECoG) signals is a fast and precise mapping technique without the risk of causing pain or seizures. ECoG has repeatedly demonstrated that it can accurately identify cortical regions related to receptive and expressive language functions, motor functions and the somatosensory system in the brain. For that reasons, g.tec medical engineering developed the cortiQ rapid cortical mapping system.
Brain Mapping with cortiQ
cortiQ is a new rapid functional mapping technique of the cortex using the Electrocorticogram (EcoG) for patients who suffer from epilepsy with intractable seizure disorders or brain tumors. cortiQ helps surgeons identify functional brain regions with high-gamma activity before surgical resection. cortiQ maps the brain regions related to a certain task that the patient is performing. Neurosurgeons will be able to use and modify cortiQ paradigms based on individual surgical needs. For example, if pathological tissue is close to the motor area, cortiQ will ask the patient to move arms, feet or even lips. The brain activity patterns produced during these movements will be transmitted in real-time to cortiQ, notifying the neurosurgeon what parts are important for a certain movement and therefore should remain untouched.
Unlike ECS, cortiQ does not produce artificial seizures and cannot produce pain. However, ECS might be required in some cases. Therefore, cortiQ can identify neural areas that are “active” in a task decided by the surgeon and thereby provide a fast pre-screening mechanism that might be used for optimized ECS mapping and surgical removal of affected tissue.
During brain surgery, invasive electrode grids are placed on the cortex or are inserted into the brain covering the specific areas that need to be mapped.
The patient performs preprogrammed tasks, e.g. moving limbs, listening to a story, calculating or speaking, which support the neurosurgeon to get a better understanding of the individual functional regions of the brain.
cortiQ creates a real-time mapping of the brain, showing what brain areas are active during a specific task.
Use Case: Bedside
The bedside case usually requires two surgeries. In the first surgery, electrodes will be implanted and functional real-time mappings are performed at the bedside. Validation with ECS can be done at the beside, too. In the second surgery, electrodes will be removed and the affected brain tissue will be resected.
Benefits for Neurosurgeons
cortiQ allows neurosurgeons to produce an individual real-time map (mental activity profile) for each patient and to plan surgery better, with more detailed information and less preparatory work. cortiQ maps cortical functions in neuro monitoring before the surgery and in the operating room during tumor or epilepsy resection.
Benefits for Patients
cortiQ helps to reduce risk for patients because important “eloquent” brain areas get identified in order to avoid damage during the surgery. The procedure takes less hospital time and reduces surgery and recovery costs.
cortiQ Mobile Mapping Service
cortiQ was created to optimize surgical procedures by minimizing the burden and risks for the patient, the time to prepare and perform the surgery, all this also resulting in a reduced hospital time and overall costs.
g.tec medical engineering offers a cortiQ mobile mapping service with patients during surgery or bedside at clinics.
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“cortiQ mapping is based on passive recordings and statistical evaluations of ECoG, rather than on active electrical stimulation and visual observation of behavior. It can be used to map motor, expressive or receptive language, and other functions, and has been shown to have good concordance to results from other imaging techniques. Brain mapping can be achieved in minutes with adults or children, and performed in the extraoperative or intraoperative scenario.”
Christoph Guger, PhD
g.tec medical engineering GmbH, Austria
Medical Advisory Board and Users of cortiQ
The advisory board consists of international key experts in the fields of neuroscience, neurology and neurosurgery who are continuously contributing their experiences and clinical needs into the research, development and application of cortiQ rapid cortical mapping by using the system in their clinical and research environment. These experts have a crucial interest in optimizing surgical procedures and minimizing the numerous risks of brain surgery.
Yale-New Haven Hospital,
New Haven, USA
Boston Children's Hospital,
Epilepsy & Clinical Neurophysiology
Instituto Neurologico Mediterraneo
Shaare Zedek Medical Center
Florida Hospital for Children,
Mayo Clinic Florida,
St. Joseph's Hospital
g.tec medical engineering GmbH,
Epilepsie Zentrum Berlin-Brandenburg,
g.tec medical engineering Spain
Albany Medical College,
Albany, New York, USA
g.tec neurotechnology USA
Albany, New York, USA
Department of Neurosurgery
Oregon Health & Science University
Department of Neurology and
Asahikawa Medical University,
Hakushin Group Megumino Hospital,
Eastern China University,
Shanghai Jiao Tong University,