Targeting Optimal Grasp-Related Cortical Areas for Intracortical Brain-Machine Interfaces after Spinal Cord Injury

Objective: This study aimed to optimize intracortical microelectrode array implantation sites for grasp-related motor decoding by integrating anatomical, functional, and vascular imaging with preoperative 3D modeling. Methods: A participant with C5 tetraplegia underwent anatomical magnetic resonance imaging (MRI), diffusion-weighted imaging, and task-based functional MRI (fMRI) to identify grasp-related cortical regions while avoiding vasculature and speech-critical areas. Quicktome software was used to refine target selection by integrating structural connectivity and functional activation data. A 3D-printed skull and cortical model enabled preoperative planning, including craniotomy and electrode positioning simulations. Electrode placement was validated post-operatively using neural data collected from the implanted arrays during attempted movements of the arm and hand. Results: Functional imaging identified distinct grasp-related activation in anterior intraparietal area (AIP), ventral premotor cortex (PMv), and inferior frontal gyrus (IFG). AIP was selected based on its strong connectivity with motor cortex and distinct functional activation. Subregions 6v and 6r of PMv, which exhibited robust grasp-related activity and were surgically accessible, were chosen over the posterior IFG region, which extended into a sulcus making implantation difficult. Post-surgically, the arrays enabled high-fidelity decoding of arm/hand movements, achieving a combined accuracy of 96%. Conclusion: This study presents a multi-modal approach for optimizing intracortical electrode placement by combining MRI-based anatomical mapping, fMRI-guided functional localization, connectivity information, and 3D surgical modeling. These findings demonstrate an effective method for identifying surgically feasible grasp network implant locations in a paralyzed individual. This is an essential step for brain-machine interface (BMI) systems that use grasp-related brain activity to command devices, such as neuromuscular stimulation systems for restoring upper limb function in individuals with spinal cord injury (SCI).