Cortico-cortical evoked potential and language mapping: A meta-analysis.

• Language localization tasks may have limited utility if they rely on patient participation. • CCEP presents a language localization technique that is more reliable in patients who provide limited participation, including children. • CCEP can be used intra-operatively to map the eloquent language centers with more precise temporal and spatial resolution than previous language mapping techniques. • CCEP reliably predicts language outcomes following resective surgery. • There is a lack of robust, high-quality evidence from randomized controlled trials. The purpose of this meta-analysis was to determine the best available evidence for the use of cortico-cortical evoked potential (CCEP) for language mapping. PubMed/Medline/Google Scholar/Cochrane and Scopus electronic databases were searched for articles using CCEP for language mapping. CCEP data was obtained including the area of the cortex generating CCEP, resection data, and post-resection language outcomes. Inclusion criteria were clinical articles reporting the use of CCEP in language regions of the brain, reporting language outcomes and whether there was final resection of the cortex, studies with more than five patients, and studies in either English or Spanish. Review articles, systematic reviews, meta-analyses, or case series with less than five patients were excluded. Seven studies with a total of 59 patients were included in this meta-analysis. The presence of CCEPs from stimulation of Broca's area or posterior perisylvian region in the resection predicts language deficits after surgery. The diagnostic odds ratio shows values greater than 0 perioperatively (0.69–5.82) and after six months (1.38–11), supporting a high likelihood of a language deficit if the presence of CCEPs from stimulation of Broca's area or posterior perisylvian region are included in the resection and vice versa. The True Positive rate varied between 0.38 and 0.87. This effect decreases after six months to 0.61 (0.30–0.86). However, the True Negative rate increased from 0.53 (0.32–0.79) to 0.71 (0.55–0.88). This meta-analysis supports the utility of CCEP to predict the probability of having long-term language deficits after surgery.. [ABSTRACT FROM AUTHOR]