A probabilistic functional atlas based on extraoperative electrocortical stimulation mapping
Bibliographic record
Abstract
Background: Direct electrocortical stimulation (DES) is the clinical gold standard for identifying eloquent cortex and guiding neurosurgical intervention, yet prior intraoperative DES during awake craniotomies have been limited by intraoperative sampling constraints and density-based rather than probabilistic analyses. The probability of typical and atypical cortical organization has not been fully explored, especially in epilepsy populations. We sought to generate a probabilistic atlas of motor, sensory, and language functions using extraoperative DES in a large cohort of patients with epilepsy. Methods: We retrospectively analyzed 2,124 extraoperative DES trials from 125 patients undergoing intracranial monitoring (2008-2023). Positive and negative trials were mapped to Montreal Neurological Institute space, parcellated with the Human Connectome Project atlas, and analyzed using probability mapping, bootstrapped region-of-interest hit probabilities, hierarchical clustering, and kernel density estimation. Mixed-effects models assessed clinical predictors of language disruption. Results: Probabilistic maps revealed regions of increased likelihood for eliciting functional responses in expected sensorimotor and language territories, but also demonstrated marked variability and deviations from expected cortical locations. Language disruption occurred in 338 trials, motor in 520, and sensory in 370. Instead of observing high probabilities and low inter-patient variability isolated to classic perisylvian locations (e.g., Broca's and Wernicke's areas), the likelihood of language disruption followed graded probabilistic gradients with high inter-patient variability. The middle frontal gyrus emerged as a consistent locus of naming and speech arrest. Motor phenomena extended into parietal association cortex. Higher-order experiences, including forced thoughts and feelings of presence, were reproducibly evoked from frontal and temporoparietal sites. Early seizure onset and temporal lobe lesions predicted lower naming disruption probabilities. Conclusions: This extraoperative DES atlas, the largest to date, demonstrates that eloquent cortical functions are organized along probabilistic continua rather than fixed regions. Findings highlight the middle frontal gyrus as a critical language node, extend motor mapping into parietal cortex, and delineate reproducible experiential phenomena. Substantial inter-patient variability underscores the necessity of individualized mapping in surgical planning.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".