A decade of imaging surgeons' brain function (Part I): terminology, techniques and clinical translation

Abstract

Functional neuroimaging has the potential to deepen our understanding of technical and non-technical skill acquisition in surgeons, particularly as established assessment tools leave unanswered questions about inter-operator differences in ability that seem independent of experience. In this first of a two-part article, we aim to utilise our experience in neuroimaging surgeons to orientate the non-specialist reader to the principles of brain imaging. Terminology commonly used in brain imaging research is explained, placing emphasis on the “activation response” to a surgical task and its effect on local cortical haemodynamic parameters (neurovascular coupling). Skills learning and subsequent consolidation and refinement through practice lead to reorganisation of the functional architecture of the brain (known as “neuroplasticity”), evidenced by changes in the strength of regional activation as well as alterations in connectivity between brain regions, culminating in more efficient use of neural resources during task performance. Currently available neuroimaging techniques that either directly (i.e. measure electrical activity) or indirectly (i.e. measure tissue haemodynamics) assess brain function are discussed. Finally, we highlight the important practical considerations when conducting brain imaging research in surgeons.