Improved methods and apparatus for cortical stimulation mapping during surgical procedures

Abstract

An apparatus and method is provided for intraoperative tissue stimulation during port-based surgery. The apparatus includes an access port and electrical terminals attached to the access port for tissue stimulation. In an alternative embodiment, the apparatus may include an access port, with or without electrical terminals attached to the access port for tissue stimulation, and electrocorticography sensors attached to the access port. The method includes inserting an access port into a tissue, applying an electrical potential to the tissue using electrical terminals attached to the access port, and measuring consequent neural activity using electrocorticography sensors attached to the access port.

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         23 . A method for recording a neural tract direction comprising:
 a. Inserting an access port into a tissue:   b. Applying an electrical potential to the tissue using one or more electrical terminals attached to the access port; wherein the electrical potential is directed from either:
 i. one of the one or more electrical terminals to any other one of the one or more electrical terminals; or 
 ii. a monopolar probe inserted through the access port to the one or more electrical terminals attached to the access port; 
   c. Directing the electrical potential between a first pair of electrical terminals and measuring a first resistance;   d. Directing the electrical potential between a second pair of electrical terminals and measuring a second resistance;   e. Comparing the first resistance and the second resistance to identify a direction of least resistance provided by the first pair of electrical terminals or by the second pair of electrical terminals;   f. Correlating the direction of least resistance to the neural tract direction; and   g. Recording the neural tract direction.   
     
     
         24 . The method of  claim 23 , wherein the electrical potential does not elicit a neural response. 
     
     
         25 . The method of  claim 23 , wherein the neural tract direction is recorded with a surgical navigation system. 
     
     
         26 . The method of  claim 25 , wherein the surgical navigation system includes one or more of:
 a. an imaging data module;   b. an informatics engine;   c. an image data segmentation module; and   d. an automated alignment system.   
     
     
         27 . The method of  claim 26 , wherein one or more of: the electrical potential; the electrical potential location; and the imaging data are recorded in a database. 
     
     
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         31 . A method for intraoperative tissue stimulation and measuring whether there is a functional response to an electrical potential comprising:
 a. Inserting an access port into a tissue; and   b. Applying an electrical potential to the tissue using one or more electrical terminals attached to the access port and:
 i. If there is no functional response, repeating the applying an electrical potential using a higher electrical potential until a predetermined electrical potential is reached; or 
 ii. If there is a functional response, measuring whether there is an epileptic response using an EcoG sensor.