Clinical Study
Stereotact Funct Neurosurg 2013;91:314–322
DOI: 10.1159/000350019
Preoperative Magnetoencephalographic
Sensory Cortex Mapping
Ajay Niranjan Erika J.C. Laing Fahad J. Laghari R. Mark Richardson
L. Dade Lunsford 
Department of Neurological Surgery, University of Pittsburgh and UPMC Brain Mapping Center, Pittsburgh, Pa., USA
Key Words
Magnetoencephalography · Sensory evoked field ·
Presurgical mapping · Somatosensory · Brain tumors ·
Epilepsy
Abstract
The use of functional neuroimaging holds the promise of im-
proving neurosurgical outcomes by providing preoperative
localization of critical brain functions. The brain representa-
tion of somatosensory function can be effectively localized
using magnetoencephalography (MEG) in both normal sub-
jects and in patients with tumors, vascular malformation,
and epilepsy. This study investigates the pattern of somato-
sensory localization in 45 patients. Thirty-two of these pa-
tients underwent subsequent resective surgery for brain pa-
thologies. Electrical stimulation of the median nerve was
conducted, and the most prominent somatosensory peak in
the resultant averaged data was localized using the single
equivalent current dipole technique. Results showed that
this peak localized either to the central or postcentral sulcus
of the somatosensory cortex. We found that neither age nor
the presence of brain pathologies had significant effect on
the recognition of the somatosensory cortex. Patients who
underwent surgery after presurgical planning using MEG
suffered no new somatosensory deficits, indicating the valu-
able role of pre-surgical mapping using MEG in the surgical
planning. Copyright © 2013 S. Karger AG, Basel
© 2013 S. Karger AG, Basel
1011–6125/13/0915–0314$38.00/0
E-Mail karger@karger.com
www.karger.com/sfn
Received: May 24, 2012
Accepted after revision: January 20, 2013
Published online: June 22, 2013
Introduction
The outcome of surgery for brain neoplasms, arterio-
venous malformations, and epileptogenic zone located in
eloquent cortical regions is dependent upon a surgeon’s
ability to avoid functionally important cortex. With the
development of high-resolution brain imaging, neuro-
surgeons have relied on anatomical landmarks such as the
central sulcus to guide their surgical approach and the
extent of resection. Identification of functional regions
preoperatively helps in planning safer neurosurgical pro-
cedures. By using preoperative image guided brain map-
ping, postoperative neurological deficits can be reduced
and functional cortex can be preserved. Unfortunately,
localization of eloquent cortex by magnetic resonance
imaging (MRI) is sometimes complicated when normal
anatomy is distorted due to the mass effect created by
brain lesion. Even normal neuroanatomical variability
can add to the complexities of visually identifying the
central sulcus intraoperatively.
The correlation of individual brain anatomy with
its  function is critical for modern neurosurgery. This
correlation can be facilitated by modern functional im-
aging techniques including magnetoencephalogra-
phy (MEG), functional MRI, positron emission tomog-
raphy, single photon emission computed tomography,
transcranial magnetic stimulation and near infrared
spectroscopy.
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Ajay Niranjan
University of Pittsburgh
Associate Professor of Neurosurgery, University of Pittsburgh
Suite B-400, UPMC Presbyterian
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200 Lothrop Street, Pittsburgh, PA 15213 (USA)
E-Mail niranjana @ upmc.edu
 Electrophysiological methods such as EEG and MEG
have been increasingly utilized to localize cortical regions
active during somatosensory stimulation. EEG and MEG
provide excellent temporal resolution, on the order of
milliseconds, offering the opportunity to localize primary
and secondary somatosensory responses separately for
higher specificity.
MEG is a useful noninvasive tool to preoperatively de-
termine functional somatosensory cortex [1–5]. Studies
that compare MEG-derived maps of sensory motor acti-
vation to invasive procedures such as electrocorticogra-
phy indicate high concordance rates [6–9]. MEG addi-
tionally has excellent spatial resolution, sometimes as
good as 2–3 mm for sources in the cerebral cortex [10, 11]
making it an ideal tool to localize somatosensory respons-
es. Advances in computer hardware and software during
the past three decades have further contributed to the
evolution of MEG by improving the data analysis and re-
ducing the turnaround time of reports. These factors,
coupled with its ability to replicate the measurement if
needed, potentially render MEG the preferable method to
study and to disentangle the cortical representation of
dermatomes in the human brain. In this report we present
our experience in sensory cortex localization for patients
with brain tumors, arteriovenous malformations and ep-
ilepsy, and we assess its effect on patient outcomes after
neurosurgical procedures.
Materials and Methods
Patients Demographics
Forty-five consecutive patients underwent sensory cortex lo-
calization using MEG between September of 2010 and April of
2012. Thirteen had glial neoplasms, 6 had meningiomas, 6 had a
brain metastasis, 1 had a cavernous malformation, 2 arteriove-
nous malformations, and 17 had epilepsy. Ages ranged from 16 to
77 years (mean = 47). Twenty-three patients were female.
Magnetoencephalographic Procedures
MEG was performed prior to surgery on an outpatient basis
(fig.  1). Noninvasive mapping of the somatosensory cortex was
achieved using a whole-head 306 channel Neuromag® Vectorview
System (Elekta Neuromag Oy, Helsinki, Finland), which is con-
tained in a magnetically shielded room (MSR). The MSR is con-
structed from layers of aluminum and μ-metal, an alloy of ex-
tremely high magnetic permeability that is designed to occlude
extraneous electric and magnetic fields. The room is approximate-
ly 4.6 × 3.6 × 3 m in dimension.
The patients were first checked for any abnormal magnetic ac-
tivity by placing them in the unit and recording initial MEG sig-
nals. If any magnetic activity was detected, a degausser was some-
times used to demagnetize the patient. Once a patient was cleared
for MEG recording they were taken to the preparation room where
Magnetoencephalographic Sensory
Cortex Mapping
four head position indicator coils were glued to their scalp using
collodion adhesive. Two bipolar electro-oculography electrodes
were placed above and below the right eye to monitor vertical eye
movements, and diagonally below and to the right of the right eye
and above and to the left of the left eye to monitor horizontal eye
movements. A single bipolar ECG channel was used to record car-
diac activity from the chest. Patients with epilepsy (n = 17) under-
went simultaneous EEG recordings during an MEG epilepsy re-
cording procedure that took place immediately before the mea-
surement of somatosensory evoked fields. Before entering the
MSR for MEG recording, the positions of the head position indica-
tor coils were digitized with the help of a Polhemus Isotrak 3D-
digitizer (Polhemus, Inc., Colchester, Vt., USA) included in the
MEG system. Fiducial landmarks, nasion and left and right preau-
ricular points, were digitized to be utilized for later coregistration
of the MEG and structural MRI data. Additional anatomical points
(up to 150) on the face and scalp were digitized to further facilitate
fusion of MEG data with a reconstructed volumetric MRI image.
During the MEG data acquisition, patients sat comfortably in
an upright sitting position in the MSR with the head positioned in
a helmet containing the 306 MEG sensors. A patient’s head posi-
tion within the sensor array was determined before each MEG re-
cording by registering the position of the four indicator coils that
were attached to the head of the patient. For this purpose, a brief
weak electrical pulse was sent to the coils. The positions of the coils
were identified by the MEG sensors, defining the head position
with respect to the machine’s fixed coordinate system, and allow-
ing for later integration of MEG and MRI data. The knowledge
about head position allowed for post-hoc correction of head move-
ment artifacts. Visual and two-way audio communications with
the patient were maintained throughout the session.
Somatosensory Stimulation Paradigm
Somatosensory stimulation was performed electrically using
bipolar adhesive electrodes placed on the skin over the course of
median nerve at the wrist. The sensory paradigm was delivered us-
ing internally driven Neuromag software (Elekta Neuromag Oy).
Constant current pulses with a duration of 0.2 ms were used. Aver-
age stimulation rate was 1 Hz. The amount of current was deter-
mined for each patient individually by one MEG technician who
gradually increased the voltage while another technician moni-
tored the elicited response until a small thumb twitch was ob-
served. Patients were polled to ensure that the stimulation level was
not uncomfortable. A minimum of 200 epochs were recorded for
all stimulations. Stimulations were made either to the median
nerve contralateral to the site of the brain anomaly (n = 16), or for
both median nerves (n = 29). If recording from both median
nerves, the data collection was done separately for the left and right
sides in consecutive acquisitions during a single MEG session.
During MEG recordings, patients were asked to remain motionless
and avoid blinking or eye movements, aided by maintaining their
gaze on a fixation mark placed on a screen placed in front of them.
Neuroanatomic MRI Acquisition
High-resolution MRI was acquired in order to provide the
brain anatomical detail needed for both MRI coregistration as well
as eventual surgical neuronavigation. For brain tumors and vascu-
lar malformations a contrast-enhanced 3D spoiled gradient–re-
called acquisition in steady state (SPGR) sequence with 2-mm ax-
ial images covering the entire head was obtained. For patients with
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Stereotact Funct Neurosurg 2013;91:314–322 315
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DOI: 10.1159/000350019
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a b
c d
Fig. 1. Example of the MEG signals and their source equivalent
from a patient with a right parietal glioblastoma. a View of the en-
tire 306 sensor helmet (nose pointing upwards) shows somatosen-
sory evoked magnetic fields distributed in the left parietal region
of the helmet. b Butterfly plot of the same responses, with all pari-
etal channels overlaid by left or right hemisphere, shows that the
primary peak of activity to electrical stimulation of the right me-
dian nerve is elicited predominantly in the left hemisphere (fT re-
fers to femtoteslas). The peak for this patient occurs approximate-
medically intractable epilepsy, a brain volume imaging (BRAVO)
sequence with 1.2-mm-thick axial images that covered the entire
head was obtained. The acquisition field of view was kept broad
enough to include the nose and the cranial vertex, both of which
are crucial for coregistration with MEG data. MRIs were trans-
ferred through the ethernet system to the MEG workstations.
Data Analysis
Sensory evoked fields (SEF) are the magnetic fields generated
by activation of sensory cortex in response to external stimulation.
Evoked fields were recorded at a sampling rate of 1,000 Hz and
316 Stereotact Funct Neurosurg 2013;91:314–322
DOI: 10.1159/000350019
Color version available online
Left
–200 fT
42 ms
Right
–200 fT
ly 42 ms after stimulation. c The magnetic field pattern of the hel-
met at the peak response is shown, with blue (light gray) indicating
the magnetic flux into the head, and red (dark gray) out of the
head. The center of the arrow depicts the location of the ECD, the
arrow’s direction indicates the current orientation, and the arrow
size indicates the strength of the ECD. d The SEF source projected
onto an axial MRI can be used for intraoperative guidance. In this
example, the peak SEF activity at 42 ms after stimulation localizes
to this patient’s postcentral sulcus, anterior to the brain tumor.
then preprocessed using a bandpass filter of 1–40 Hz. Data from
23 patients was also down sampled by a factor of 4–250 Hz. Trials
with eye blinks or any other form of distortion from a noise source
were rejected before averaging. The averaging time window con-
sisted of 200 ms proceeding and 1,000 ms following each individ-
ual stimulation utilizing the preceding 200 ms for baseline correc-
tion. The average number of trials for each SEF was 176 (SD =
41.6). Once averaged, the evoked fields were reviewed and source
modeling was applied to the MEG data. Data analysis was per-
formed using the Elekta Neuromag Toolbox® and MNE Suite
from the Harvard Martinos Center.
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 Utilizing the Neuromag software, the single equivalent dipole Table 1. MEG parameters of somatosensory localization
model was used to identify the presumed neuronal source. Single
equivalent current dipole (ECD) modeling was based on a spher- All Latency Goodness Confidence Confidence
ical head model, which is computationally simplest. This model is of peak of fit volume mm3 volumes after
effective for localizing early post-stimulus neuronal activity and ms % removal of
works well for simple sensory stimuli that elicit focal activity in outliers mm3
groups of cortical neurons organized tangentially to the scalp sur-
face. The ECD that provided the strongest detected signal and Median 47.6 96.2 35.95 NA
best satisfied the single dipole model within the poststimulus la- Average 56.4 95.3 211.7 NA
tency range from 0 to 165 ms was chosen to represent the neuro- SD 22 3 513 NA
nal source in the final data set. A single dipole was selected to Minimum 22.3 84.7 1.5 NA
represent the most dominant sharp wave or peak within the time Maximum 162.3 99.4 3,248.4 NA
window of interest. The dipole selection criteria included the fol- Central sulcus
lowing 3 elements: (1) a well-formed dipolar field configuration Median 46.85 96 33.5 24.2
(dense and symmetrical magnetic field patterns), (2) goodness-of- Average 53.1 94.7 287.4 88.8
fit >90%, and (3) smallest possible 95% confidence volume within SD 17.9 3.5 657.9 1.5
which the dipole has been placed, ideally less than 3,000 mm3. In Minimum 22.3 84.7 1.5 497.6
the case of noisy data from 2 patients, a dipole was featured that Maximum 88 99.4 3,248.4 128.3
was just shy of meeting the goodness-of-fit requirement (specifi-
cally 84.7 and 86%). One other patient with noisy data produced Postcentral gyrus
a dipole with a confidence volume just larger than 3,000 mm3 Median 54.6 96.7 38 35.2
(specifically 3,248.4 mm3). Average 59.8 96 131.8 44.5
The source localization was computed in reference to a Carte- SD 25.4 2 279.9 2.5
sian coordinate system defined by a set of three anatomical land- Minimum 28.4 91 2.5 202.9
marks (fiducial points): the right and left pre-auricular areas and Maximum 162.3 99 1,396.7 42.7
the nasion. Coregistration of the MEG-derived sources with high-
resolution anatomical images formed the final magnetic source
images. Coregistration was achieved by identifying the three fidu-
cial landmarks on 3D MR images and manually fitting the land-
mark points as well as the upwards of 150 additional points to the side of stimulation (38 central sulcus, 36 postcentral sul-
surface of the skull. MEG data coregistered with the patient’s MRI cus). To test for differences in quality measures between
was uploaded to the hospital imaging PACS system (iSite, Phillips these two localization areas, data was split by its location
Medical System, Foster City, Calif., USA). The coregisterd data in
turn was downloaded into the workstation of the neuronavigation and further analyses were completed. The localizations
system (Stryker Navigation, Kalamazoo, Mich., USA) in the oper- parameters are listed in table 1. A two-tailed t test assum-
ating room. ing unequal variances was completed, with a null hypoth-
esis that there would be no difference between the quality
measures of the central sulcus and the postcentral sulcus
Results localization. The time point at which peak activity oc-
curred was found to be no different (p = 0.19), as was the
Overall Dipole Results 95% confidence volume (p = 0.18); however, the good-
In total, 74 primary somatosensory responses were lo- ness-of-fit value was found to be significantly different
calized using the single equivalent current dipole model (p = 0.04). Figure 3 illustrates these findings.
(16 from unilateral stimulation (contralateral to brain le-
sion) only, and 29 from bilateral stimulation). Across all Data Refinement
of these, the average time of peak activity (within the time Because there were very large standard deviations for
range of 0–165 ms) occurred at 56.4 ms (SD = 21.9 ms), the 95% confidence volume, outliers were detected and
the average goodness-of-fit value was 95.3% (SD = 2.9%), removed for a secondary analysis. Outliers were deter-
and the average confidence volume was 211.7 mm3 (SD = mined specific to each range of values, for central and
512.9 mm3). postcentral localizations. Four outliers above the value
605.95 mm3 were detected in the central sulcus localiza-
Differences in Localization tions, while five outliers above the value 215 mm3 were
Figure 2 depicts the localization of the dipole plotted detected in the postcentral sulcus localizations. Following
onto the structural MRIs of a patient. Cortical representa- their removal, the average confidence volume for the cen-
tion was found on either the posterior edge of the central tral sulcus was 86.6 mm3 (SD = 128.3 mm3), and for the
sulcus or in the postcentral sulcus, contralateral to the postcentral sulcus was 33.5 mm3 (SD = 42.5 mm3). A two-
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Cortex Mapping DOI: 10.1159/000350019

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 a
Fig. 2. Representative source locations for the somatosensory re-
sponses of 2 patients. Arrows point to a black circle, whose size
is equivalent to the 95% confidence volume of the patient’s pri-
mary somatosensory dipole. a Somatosensory cortex localization
at the central sulcus anterior to the left fronto-parietal astrocy-
tailed t test assuming unequal variances of the remaining
data found a significant difference between the confi-
dence volumes of central and postcentral sulcus localiza-
tions, with central sulcus localizations having statistically
larger confidence volumes (p = 0.08). Figure 3 depicts the
confidence volume values with outliers removed.
Effect of Age
Because some of the background literature suggested
that age can play a role in the latency of the somatosen-
sory peaks, a brief exploration of the effect of age was
completed. Figure 4 shows a scatter plot of peak latency
by patient age, revealing no association between age and
the somatosensory peak latency. A two-tailed t test as-
318 Stereotact Funct Neurosurg 2013;91:314–322
DOI: 10.1159/000350019
toma in a 47-year-old female. b Postcentral sulcus localization
anterior to the right parietal glioblastoma in a 59-year-old fe-
male. Both patients underwent image-guided surgery after pre-
surgical brain mapping and suffered no postoperative somato-
sensory deficits.
suming unequal variances was completed on the data as
separated into age groups. Groups were split by age in two
separate ways. First, comparing age groups above and be-
low the median age of 47 revealed no statistical difference
in the peak SEF latencies of these groups (p = 0.27). A
second split wherein patients were grouped above and
below the age 35 also revealed no significant difference in
peak SEF latencies (p = 0.47).
Effect of Brain lesion
Previous literature suggests that SEFs may be larger in
magnitude in the hemisphere that contains a mass lesion,
compared to the nonaffected hemisphere [12]. Of this pa-
tient group, 8 patients had lesions near the central sulcus.
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 Latency of peak activity Goodness of fit
140 100
Latency of peak activity (ms)
120
80
100
60

G-Fit (%)
80

60 40
40
20
20

0 0
a Central sulcus Postcentral sulcus b Central sulcus Postcentral sulcus

Outliers included 95% confidence volume Outliers excluded 95% confidence volume
1,000 1,000
Confidence volume (mm3)

Confidence volume (mm3)

800 800

600 600

400 400

200 200

0 0
c Central sulcus Postcentral sulcus d Central sulcus Postcentral sulcus

Fig. 3. Graphs representing the quality measure of the dipoles re-
ported for central and postcentral localizations. Peak latency and
an initial analysis of the confidence volume showed no statistical
difference. The goodness-of-fit parameter was statistically higher
for postcentral sulcus localizations than central sulcus localiza-
tions, though both were well above a minimum 90% goodness-of-
fit requirement. There were several outliers in the size of confi-
dence volumes, so after correction for outliers, it is seen on the
rightmost graph that the size of the confidence volume from the
postcentral sulcus is significantly smaller than those generated
from the central sulcus, indicating slightly but significantly more
precise localizations for activities elicited in the postcentral sulcus.

Only 5 of these patients have data for both left and right
140
side stimulations, and of those 5, 2 patients had parasagit-
120
Latency of peak activity (ms)

tal tumors that crossed the midline, i.e. the tumor affected
both hemispheres. In 2 of these patients there was a large 100
hemispheric asymmetry in the magnitude of the SEF re- 80
sponse; however, the direction of the asymmetry was op-
posite that of previous findings. In both patients, the mag- 60

nitude of the somatosensory response was larger for the 40

hemisphere opposite the one affected by a brain tumor. 20

0
Clinical Outcomes 10 20 30 40 50 60 70 80
Ten epilepsy patients are still awaiting surgery. One Age of patient
patient with a cavernous malformation and 1 patient
with motor cortex arteriovenous malformations elected
Fig. 4. Peak latency by patient age. Scatter plot showing that con-
conservative management. Thirty-two patients under- trary to suggestions from prior literature, age appeared to have no
went craniotomy. Their surgical access routes were effect on the latency of the somatosensory peak generated in this
planned specifically to avoid regions identified by the so- population of patients.
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matosensory MEG analysis. Surgical outcomes found
100% retention of somatosensory function for these pa-
tients, though three patients suffered temporary motor
(fewer than 4 months) deficits. Two other patients expe-
rienced significant improvements in their motor capa-
bilities after surgery.
Discussion
We began using MEG for the purpose of localizing
critical brain regions prior to surgery in September of
2010. Although there were several previous reports docu-
menting sensory cortex localization using MEG, no con-
sistent paradigm for data acquisition has been recom-
mended. A literature review revealed that prior MEG
studies of somatosensory localization were performed by
stimulating the lips [13], tongue [14], mouth [13], ears
[15], fingers [16, 17], toes [18], and median [19] and tib-
ial nerves [20]. In order to stimulate sensory cortex a va-
riety of methods have been used, such as electric current,
air pressure, heat and cold. We chose to use electrical me-
dian nerve stimulation, as this has been associated with
the most robust sensory response of the brain, and was
preferred over touch in most studies of the cortical repre-
sentation of dermatomes to localize the sensory cortex
[21, 22]. This approach maximizes the signal to noise ra-
tio and we believe enhances our ability to successfully lo-
calize the somatosensory cortex in individual patients. In
all 45 of our patients were able to obtain robust somato-
sensory localizations.
The literature suggests that electrical stimulation of
the median nerve in normal subjects typically elicits an
early peak at approximately 20 ms as well as a middle
peak at 30–40 ms. Our results found the largest, most ro-
bust somatosensory peak at an average time point of
56 ms. Given the latency, the peak localized in this patient
population likely represents the middle somatosensory
peak [23]. Even so, our average of 56 ms represents a lon-
ger latency measurement compared to such measure-
ments in the general population. A stimulus delivery de-
lay of approximately 10 ms partially accounts for this dif-
ference. In addition, in this clinical application with
patients with structural brain lesions we suspect that the
SEF delay is related to the effect of brain pathology. Spe-
cifically, elderly populations, epileptic and tumor pa-
tients have all been shown to elicit middle peak SEFs with
a longer latency.
Localization of the central sulcus is important in the
assessment of patients with mass lesions in or near that
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region of critical brain function. The sulcus itself may be
distorted by the presence of the mass. Our findings of the
strongest peak at approximately 56 ms in some patients
localized to the contralateral central sulcus, while in oth-
ers it localized to the contralateral postcentral sulcus. One
possibility for the discrepancy between the sites of local-
ization could be that what is actually being localized is
functionally different. It is possible that such differences
in detection of the central and postcentral localizations
may be related to functionally distinct but different loca-
tions in different patients. It is also possible that the pa-
tient’s structural lesion displaces the cortical representa-
tion. Of the 28 patients who received bilateral stimula-
tion, 9 showed a split where one side of stimulation
elicited the contralateral central sulcus, while stimulation
of the other side localized to the contralateral postcentral
sulcus. Of the 9 patients who showed a split depending on
the side of stimulation, we could identify no clinical fea-
ture (such as the diagnosis or handedness) that explained
the difference. In contrast, 19 patients revealed consistent
sites of localization, either contralateral central or post-
central, for both sides.
Single equivalent current dipole analyses are the pri-
mary method by which clinical studies of SEF have been
reported [24]. Our findings of the most robust somato-
sensory peak provided excellent results, finding an aver-
age goodness-of-fit to be 95.3% and average confidence
volume to be 211.7 mm3. Analyses were also completed
assessing these values across the localization of the central
vs. the precentral sulcus. When separated by location of
the dipole, the postcentral sulcal localizations had a small
but significant improvement on goodness-of-fit. With
additional data processing, it became clear that localiza-
tions to the postcentral sulcus yielded statistically tighter,
more specific confidence volumes. In this clinical appli-
cation experience, the single equivalent current dipole
analysis provided a robust middle somatosensory re-
sponse with excellent goodness-of-fit and confidence vol-
ume measurements. This method made identification of
central and postcentral sulci highly reliable.
Many of the somatosensory evoked potential studies
acquired with EEG have focused on age-related changes in
peak latency, identifying increases in latency for some of
the somatosensory components as a function of age [25–
28]. In contrast, most MEG studies have not examined
differences related to age, although the MEG response to
median nerve stimulation is well characterized. Huttunen
et al. [29] performed a MEG study using a single dipole fit
at three time points corresponding to the first three peaks
of the somatosensory response and then compared the
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age-related changes of the source latency to the previously
reported somatosensory evoked potential results. These
investigators found that the N20m latency depended on
age, but P35m and P60m latencies did not. Stephen et al.
[30] in a MEG study of somatosensory responses noted
that for the contralateral primary sensory cortex, there was
a small increase in the first peak latency for the elderly, but
no difference with age in the latencies of later peaks.
In the present study, we did not find any age-related
effect on latency. It is possible that an increase in latency
could be seen in a normal population. The present study
was performed on patients with brain pathologies. More-
over, our goal was to localize the somatosensory cortex;
therefore, we selected the largest peak and not the first
sensory peak. In most studies with a normal population
there was no difference in amplitude or latencies of later
peaks. Our efforts are focused on assessing the value of
preoperative MEG prior to neurosurgical procedures
such as craniotomy or stereotactic radiosurgery. The in-
tegration of brain function data into the neuronavigation
software facilitates preoperative planning and reduces
morbidity [7]. The integration of MEG data with a neu-
ronavigation system for intraoperative use has also been
used at other centers [31, 32]. MEG-based functional
neuronavigation facilitates resection of cortical tumors
that affect the sensory and motor cortex [7]. The results
of the present study add additional data in support of pre-
operative functional localization using MEG. All patients
who underwent surgery had 100% retention of somato-
sensory function even when their tumor was within or
adjacent to sensory motor cortex.
Conclusion
MEG is a valuable tool for preoperative localization of
somatosensory cortex even in the presence of a mass le-
sion in that area of the brain. Currently, the use of MEG
for preoperative evaluations of the functional brain re-
gions requires significant manpower in order to obtain
the data and then coregister it with the MR images. In the
future, software development may significantly reduce
the post MEG acquisition processing time. The analysis
methods for generating useful MEG data in the clinical
arena are still evolving. Our efforts using the single equiv-
alent current dipole technique now allows our neurosur-
gical colleagues to incorporate MEG functional localiza-
tions into the surgical operating theater. Further work
will include refinements in analysis techniques and ex-
pansion into methods to reliably localize visual, auditory,
motor, and speech regions of the brain.
Disclosure Statement
Dr. Lunsford is a stockholder and consultant with AB Elekta.

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