Brain mapping is critical in reducing risk for cognitive morbidity in epilepsy and brain tumor surgery. Mapping using functional MRI, and extra- and intraoperative electrical stimulation, requires a high level of expertise in functional neuroanatomy but also an understanding of individual patient characteristics that can impact mapping results and post-operative outcome. Patients can vary considerably with respect to their cognitive status going into surgery. The neuroanatomy of the disease, age and developmental level, and cultural and language differences can all influence patients' performance during brain mapping and impact surgical decision making. The purpose of this session is to discuss the importance of taking a highly individualized approach to brain mapping, focusing on anatomical considerations and individual patient differences in task selection and data interpretation. We will cover language mapping in patients who speak more than one language. Practical information will be provided to help guide informed task selection through illustrative case presentations that highlight the need for individualized brain mapping.

Upon conclusion of this course, learners will be able to:

1. 1. Discuss informed task selection based on cortical and subcortical functional neuroanatomy

2. 2. Explain how functional maps change with normal development and factors that should be considered when interpreting results for presurgical planning

3. 3. Assess differences between the bilingual and monolingual brain, factors that modulate the neuroanatomical representation of language in bilinguals and strategies in mapping multiple languages for surgical planning