• Hussam Metwali, Mathijs Raemaekers, Katja Kniese, and Amir Samii.
• International Neuroscience Institute, Department of Neurosurgery, Hannover, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany. Electronic address: drhussamm@yahoo.com.
• World Neurosurg. 2020 Jan 1; 133: e197-e204.

ObjectiveTo evaluate the functional connectivity (FC) and resting-state networks (RSNs) in patients under anesthesia operated for resection of intracerebral lesions.MethodsWe performed intraoperative resting-state functional magnetic resonance imaging (irs-fMRI) in 24 patients under anesthesia before and after lesion resection. Correlation matrices were established for each session (a total 48 of sessions). We analyzed the changes in overall FC and in FC of the healthy and operated hemispheres between the first and second sessions. We tested the correlation between changes in FC and clinical outcomes and the duration, rate, and total dosage of anesthesia. We also performed a group analysis to detect topographic changes in RSNs in patients under anesthesia. A single-subject analysis was performed to detect clinically relevant RSNs in each patient.ResultsFC decreased significantly in the second session, as did interhemispheric connectivity. The decrease in the pathological hemisphere was significant and significantly greater than the decrease in the intrahemispheric connectivity of the healthy hemisphere. The change in FC was not correlated with clinical outcome or with the duration, rate, or dosage of anesthesia. Group analysis showed topographic changes in RSNs, especially in high-level networks such as default mode and salience networks. Identification of clinically relevant networks was also possible.ConclusionsFC and RSNs could be identified under anesthesia and used for extended brain mapping. Further studies are needed to optimize the depth of hypnosis to stabilize FC between sessions.Copyright © 2019 Elsevier Inc. All rights reserved.

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