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Wei XY, Chen H, Guo C, Tan WL, Zhan SH. The Instant and Sustained Effect of Electroacupuncture in Postgraduate Students with Depression: An fMRI Study. Neuropsychiatr Dis Treat 2021; 17:873-883. [PMID: 33776442 PMCID: PMC7989050 DOI: 10.2147/ndt.s307083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTION This study was a primary study to evaluate the instant and sustained effect of electroacupuncture (EA) at GV20 (Baihui) in postgraduate students with mild depression by using a special flexible head coil. METHODS A total of 20 postgraduate students with mild depression underwent EA stimulation at GV20 and 3 phases of resting-state functional magnetic resonance imaging (rs-fMRI) scanning. Phase I: Preparation (before needle insertion); Phase II: during EA; Phase III: 15 minutes after needle removal. The Rs-fMRI data were processed using DPABI and SPSS 25. RESULTS 1) ReHo values showed significantly differences in the right posterior cingulate cortex, right calcarine gyrus, right angular gyrus, right precuneus, right cuneus, and bilateral postcentral gyri among Phase I, Phase II and Phase III; 2) Relative to the Phase I, increased brain activity in the Phase II was observed in the bilateral postcentral gyri, right calcarine gyrus, right cuneus. Compared with the Phase II, decreased brain activity in the Phase III was observed in the right precuneus, right posterior cingulate cortex, right angular gyrus. Relative to the Phase I, Significantly increased brain activity in the Phase III was observed in the right calcarine gyrus, right cuneus, and bilateral postcentral gyri. While decreased ReHo values were found in the right posterior cingulate cortex, right angular gyrus, right precuneus; and 3) Correlation analysis showed that the ReHo values of multiple brain regions in Phase I and Phase III were significantly correlated with the VAS and HRSD-17 scores. CONCLUSION This study focuses on the instant and sustained effect in postgraduate students with depression. Our study showed that instant effect produced by EA stimulation at GV20 firstly induced changes in somatosensory and visual area, and then, sustained effect (Phase III) have a higher intensity and more extensive than instant effects. Meanwhile, we provide a visualization way to study the instant effects of head acupoints by using a flexible head coil.
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Affiliation(s)
- Xiang-Yu Wei
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Hui Chen
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Cui Guo
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Wen-Li Tan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Song-Hua Zhan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
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Tuncer MS, Salvati LF, Grittner U, Hardt J, Schilling R, Bährend I, Silva LL, Fekonja LS, Faust K, Vajkoczy P, Rosenstock T, Picht T. Towards a tractography-based risk stratification model for language area associated gliomas. NEUROIMAGE-CLINICAL 2020; 29:102541. [PMID: 33401138 PMCID: PMC7785953 DOI: 10.1016/j.nicl.2020.102541] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/04/2020] [Accepted: 12/20/2020] [Indexed: 12/26/2022]
Abstract
Injury to major white matter pathways during language-area associated glioma surgery often results in permanent aphasia. DTI-based tractography of language pathways allows to correlate individual tract injury profiles with functional outcome. Infiltration of the AF is particularly associated with functional deterioration. The temporo-parieto-occipital junction and the temporal stem were confirmed as pivotal functional nodes. Standardized DTI-based tractography can help to determine the individual aphasia risk profile before surgery.
Objectives Injury to major white matter pathways during language-area associated glioma surgery often leads to permanent loss of neurological function. The aim was to establish standardized tractography of language pathways as a predictor of language outcome in clinical neurosurgery. Methods We prospectively analyzed 50 surgical cases of patients with left perisylvian, diffuse gliomas. Standardized preoperative Diffusion-Tensor-Imaging (DTI)-based tractography of the 5 main language tracts (Arcuate Fasciculus [AF], Frontal Aslant Tract [FAT], Inferior Fronto-Occipital Fasciculus [IFOF], Inferior Longitudinal Fasciculus [ILF], Uncinate Fasciculus [UF]) and spatial analysis of tumor and tracts was performed. Postoperative imaging and the resulting resection map were analyzed for potential surgical injury of tracts. The language status was assessed preoperatively, postoperatively and after 3 months using the Aachen Aphasia Test and Berlin Aphasia Score. Correlation analyses, two-step cluster analysis and binary logistic regression were used to analyze associations of tractography results with language outcome after surgery. Results In 14 out of 50 patients (28%), new aphasic symptoms were detected 3 months after surgery. The preoperative infiltration of the AF was associated with functional worsening (cc = 0.314; p = 0.019). Cluster analysis of tract injury profiles revealed two areas particularly related to aphasia: the temporo-parieto-occipital junction (TPO; temporo-parietal AF, middle IFOF, middle ILF) and the temporal stem/peri-insular white matter (middle IFOF, anterior ILF, temporal UF, temporal AF). Injury to these areas (TPO: OR: 23.04; CI: 4.11 – 129.06; temporal stem: OR: 21.96; CI: 2.93 – 164.41) was associated with a higher-risk of persisting aphasia. Conclusions Tractography of language pathways can help to determine the individual aphasia risk profile pre-surgically. The TPO and temporal stem/peri-insular white matter were confirmed as functional nodes particularly sensitive to surgical injuries.
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Affiliation(s)
- Mehmet Salih Tuncer
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany
| | - Juliane Hardt
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany; Hochschule Hannover - University of Applied Sciences and Arts, Fakultät III, Department Information and Communication, Medical Information Management, Hannover, Germany
| | - Ralph Schilling
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany
| | - Ina Bährend
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Neurosurgery, Vivantes-Klinikum Neukölln, Berlin, Germany
| | - Luca Leandro Silva
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lucius S Fekonja
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Cluster of Excellence: "Matters of Activity. Image Space Material", Humboldt University, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Tizian Rosenstock
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany.
| | - Thomas Picht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Cluster of Excellence: "Matters of Activity. Image Space Material", Humboldt University, Berlin, Germany
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Gobbo M, De Pellegrin S, Bonaudo C, Semenza C, Della Puppa A, Salillas E. Two dissociable semantic mechanisms predict naming errors and their responsive brain sites in awake surgery. DO80 revisited. Neuropsychologia 2020; 151:107727. [PMID: 33338472 DOI: 10.1016/j.neuropsychologia.2020.107727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022]
Abstract
How do we choose words, and what affects the selection of a specific term? Naming tests such as the DO80 are frequently used to assess language function during brain mapping in awake surgery. The present study aimed to explore whether specific semantic errors become more probable under the stimulation of specific brain areas. Moreover, it meant to determine whether specific semantic characteristics of the items may evoke specific types of error. A corpus-based qualitative semantic analysis of the DO80 items, and the emitted naming errors to those items during direct cortical electrostimulation (DCE) revealed that the number of hyperonyms (i.e. 'vehicle' for car') of an item predicted the emission of a synonym ('automobile' for 'car'). This association occurred mainly in frontal tumor patients, which was corroborated by behavior to lesion analyses. In contrast, the emission of co-hyponyms was associated with tumors located in temporal areas. These two behavior-lesion associations thus dissociated, and were also dependent on item semantic characteristics. Co-hyponym errors might generate from the disruption in a temporal semantic-to-lexical process, and the production of synonyms could be the result of an impairment in a frontal lexical-selection mechanism. A hypothesis on the lexical selection mechanisms exerted by the inferior frontal gyrus is proposed. Crucially, the present data suggest the need for more restrictive naming tasks, with items conditioned by tumor location.
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Affiliation(s)
- Marika Gobbo
- UOC Neurologic Clinic, University Hospital of Padova, Padova, Italy.
| | | | - Camilla Bonaudo
- Neurosurgery, Department of NEUROFARBA, University Hospital of Careggi, University of Florence, Florence, Italy
| | - Carlo Semenza
- Department of Neurosciences, University of Padova, Padova, Italy; IRCCS San Camillo Hospital, Venice, Italy
| | - Alessandro Della Puppa
- Neurosurgery, Department of NEUROFARBA, University Hospital of Careggi, University of Florence, Florence, Italy
| | - Elena Salillas
- Department of Neurosciences, University of Padova, Padova, Italy.
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Grande KM, Ihnen SKZ, Arya R. Electrical Stimulation Mapping of Brain Function: A Comparison of Subdural Electrodes and Stereo-EEG. Front Hum Neurosci 2020; 14:611291. [PMID: 33364930 PMCID: PMC7750438 DOI: 10.3389/fnhum.2020.611291] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Despite technological and interpretative advances, the non-invasive modalities used for pre-surgical evaluation of patients with drug-resistant epilepsy (DRE), fail to generate a concordant anatomo-electroclinical hypothesis for the location of the seizure onset zone in many patients. This requires chronic monitoring with intracranial electroencephalography (EEG), which facilitates better localization of the seizure onset zone, and allows evaluation of the functional significance of cortical regions-of-interest by electrical stimulation mapping (ESM). There are two principal modalities for intracranial EEG, namely subdural electrodes and stereotactic depth electrodes (stereo-EEG). Although ESM is considered the gold standard for functional mapping with subdural electrodes, there have been concerns about its utility with stereo-EEG. This is mainly because subdural electrodes allow contiguous sampling of the dorsolateral convexity of cerebral hemispheres, and permit delineation of the extent of eloquent functional areas on the cortical surface. Stereo-EEG, while having relatively sparse sampling on the cortical surface, offers the ability to access the depth of sulci, mesial and basal surfaces of cerebral hemispheres, and deep structures such as the insula, which are largely inaccessible to subdural electrodes. As stereo-EEG is increasingly the preferred modality for intracranial monitoring, we find it opportune to summarize the literature for ESM with stereo-EEG in this narrative review. Emerging evidence shows that ESM for defining functional neuroanatomy is feasible with stereo-EEG, but probably requires a different approach for interpretation and clinical decision making compared to ESM with subdural electrodes. We have also compared ESM with stereo-EEG and subdural electrodes, for current thresholds required to evoke desired functional responses vs. unwanted after-discharges. In this regard, there is preliminary evidence that ESM with stereo-EEG may be safer than ESM with subdural grids. Finally, we have highlighted important unanswered clinical and scientific questions for ESM with stereo-EEG in the hope to encourage future research and collaborative efforts.
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Affiliation(s)
- Krista M. Grande
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Sarah K. Z. Ihnen
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Ravindra Arya
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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105
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Albuquerque LAF, Diógenes GS, Pessoa FC. Challenges in Starting an Awake Craniotomy Project in a Low-Resource Public Health System. World Neurosurg 2020; 146:277-279. [PMID: 33279624 DOI: 10.1016/j.wneu.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Lucas Alverne F Albuquerque
- Department of Neurosurgery, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil; Department of Neurology, Universidade de Campinas, Campinas, São Paulo, Brazil.
| | | | - Fátima C Pessoa
- Speech therapist, Hospital Geral de Fortaleza, Fortaleza, Brazil
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106
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Duffau H. Can Non-invasive Brain Stimulation Be Considered to Facilitate Reoperation for Low-Grade Glioma Relapse by Eliciting Neuroplasticity? Front Neurol 2020; 11:582489. [PMID: 33304307 PMCID: PMC7693634 DOI: 10.3389/fneur.2020.582489] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/19/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors, ” National Institute for Health and Medical Research (INSERM), U1191 Laboratory, Institute of Functional Genomics, University of Montpellier, Montpellier, France
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107
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Giampiccolo D, Howells H, Bährend I, Schneider H, Raffa G, Rosenstock T, Vergani F, Vajkoczy P, Picht T. Preoperative transcranial magnetic stimulation for picture naming is reliable in mapping segments of the arcuate fasciculus. Brain Commun 2020; 2:fcaa158. [PMID: 33543136 PMCID: PMC7846168 DOI: 10.1093/braincomms/fcaa158] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 11/14/2022] Open
Abstract
In preoperative planning for neurosurgery, both anatomical (diffusion imaging tractography) and functional tools (MR-navigated transcranial magnetic stimulation) are increasingly used to identify and preserve eloquent language structures specific to individuals. Using these tools in healthy adults shows that speech production errors occur mainly in perisylvian cortical sites that correspond to subject-specific terminations of the major language pathway, the arcuate fasciculus. It is not clear whether this correspondence remains in oncological patients with altered tissue. We studied a heterogeneous cohort of 30 patients (fourteen male, mean age 44), undergoing a first or second surgery for a left hemisphere brain tumour in a language-eloquent region, to test whether speech production errors induced by preoperative transcranial magnetic stimulation had consistent anatomical correspondence to the arcuate fasciculus. We used navigated repetitive transcranial magnetic stimulation during picture naming and recorded different perisylvian sites where transient interference to speech production occurred. Spherical deconvolution diffusion imaging tractography was performed to map the direct fronto-temporal and indirect (fronto-parietal and parieto-temporal) segments of the arcuate fasciculus in each patient. Speech production errors were reported in all patients when stimulating the frontal lobe, and in over 90% of patients in the parietal lobe. Errors were less frequent in the temporal lobe (54%). In all patients, at least one error site corresponded to a termination of the arcuate fasciculus, particularly in the frontal and parietal lobes, despite distorted anatomy due to a lesion and/or previous resection. Our results indicate that there is strong correspondence between terminations of the arcuate fasciculus and speech errors. This indicates that white matter anatomy may be a robust marker for identifying functionally eloquent cortex, particularly in the frontal and parietal lobe. This knowledge may improve targets for preoperative mapping of language in the neurosurgical setting.
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Affiliation(s)
- Davide Giampiccolo
- Department of Neurosurgery, Verona University Hospital, University of Verona, Verona, Italy
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
| | | | - Ina Bährend
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
| | - Heike Schneider
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
| | - Giovanni Raffa
- Department of Neurosurgery, Messina University Hospital, Italy
| | - Tizian Rosenstock
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
| | - Francesco Vergani
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
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108
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Duffau H. Functional Mapping before and after Low-Grade Glioma Surgery: A New Way to Decipher Various Spatiotemporal Patterns of Individual Neuroplastic Potential in Brain Tumor Patients. Cancers (Basel) 2020; 12:E2611. [PMID: 32933174 PMCID: PMC7565450 DOI: 10.3390/cancers12092611] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022] Open
Abstract
Intraoperative direct electrostimulation mapping (DEM) is currently the gold-standard for glioma surgery, since functional-based resection allows an optimization of the onco-functional balance (increased resection with preserved quality of life). Besides intrasurgical awake mapping of conation, cognition, and behavior, preoperative mapping by means of functional neuroimaging (FNI) and transcranial magnetic stimulation (TMS) has increasingly been utilized for surgical selection and planning. However, because these techniques suffer from several limitations, particularly for direct functional mapping of subcortical white matter pathways, DEM remains crucial to map neural connectivity. On the other hand, non-invasive FNI and TMS can be repeated before and after surgical resection(s), enabling longitudinal investigation of brain reorganization, especially in slow-growing tumors like low-grade gliomas. Indeed, these neoplasms generate neuroplastic phenomena in patients with usually no or only slight neurological deficits at diagnosis, despite gliomas involving the so-called "eloquent" structures. Here, data gained from perioperative FNI/TMS mapping methods are reviewed, in order to decipher mechanisms underpinning functional cerebral reshaping induced by the tumor and its possible relapse, (re)operation(s), and postoperative rehabilitation. Heterogeneous spatiotemporal patterns of rearrangement across patients and in a single patient over time have been evidenced, with structural changes as well as modifications of intra-hemispheric (in the ipsi-lesional and/or contra-lesional hemisphere) and inter-hemispheric functional connectivity. Such various fingerprints of neural reconfiguration were correlated to different levels of cognitive compensation. Serial multimodal studies exploring neuroplasticity might lead to new management strategies based upon multistage therapeutic approaches adapted to the individual profile of functional reallocation.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Montpellier University Medical Center, 34295 Montpellier, France; ; Tel.: +33-4-67-33-66-12; Fax: +33-4-67-33-69-12
- Institute of Functional Genomics, INSERM U-1191, University of Montpellier, 34298 Montpellier, France
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109
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Duffau H. What Direct Electrostimulation of the Brain Taught Us About the Human Connectome: A Three-Level Model of Neural Disruption. Front Hum Neurosci 2020; 14:315. [PMID: 32848678 PMCID: PMC7427088 DOI: 10.3389/fnhum.2020.00315] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/16/2020] [Indexed: 11/13/2022] Open
Abstract
For a long time, the relevance of the information provided by direct electrostimulation (DES) for mapping brain functions was debated. Recently, major advances in intraoperative DES for guiding resection of cerebral tumors in awake patients enabled the validation of this method and its increased utilization in basic neurosciences. Indeed, in addition to the cortical stimulation used for many decades in epilepsy surgery, axonal mapping was developed thanks to DES of the white matter tracts, giving original insights into the neural connectivity. Moreover, functional results collected during intrasurgical mapping have been correlated with neuropsychological performances before and after DES-guided resection, and with perioperative neuroimaging data. Thus, it was evidenced that DES offers the unique opportunity to identify both cortical and subcortical structures critical for cerebral functions. Here, the first aim is to propose a three-level model of DES-generated functional disruption, able to explain the behavioral consequences elicited during awake surgery, i.e., (i) DES of an input/output unimodal (e.g., somatosensory or motor) network inducing "positive" responses (as involuntary movement); (ii) DES of a distributed specialized network inducing a within-system disruption leading to specific "negative" disorders (e.g., exclusive language deficit with no other disorders); (iii) DES generating an inter-system disruption leading to more complex behavioral disturbances (e.g., the inability to perform dual-task while each function can be performed separately). Second, in light of this model, original findings gained from DES concerning the human connectome, complementary to those provided by functional neuroimaging (FNI), are reviewed. Further longitudinal multimodal investigations are needed to explore neuroplasticity mechanisms.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Montpellier University Medical Center, Montpellier, France.,Institute of Functional Genomics, INSERM U-1191, University of Montpellier, Montpellier, France
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Duffau H. Why brain radiation therapy should take account of the individual structural and functional connectivity: Toward an irradiation "à la carte". Crit Rev Oncol Hematol 2020; 154:103073. [PMID: 32827878 DOI: 10.1016/j.critrevonc.2020.103073] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 07/26/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022] Open
Abstract
Although radiation therapy (RT) is a main treatment of brain tumors, delayed cerebral toxicity may lead to cognitive deteriorations with adverse effects on quality of life. Despite technological advances in RT, the concept of brain connectome has not yet been incorporated in the strategy of irradiation. Because white matter tracts represent the main limitation of neuroplasticity, tumor surgery is increasingly performed with awake cortical-subcortical mapping. Here, the purpose is to reinforce the link between cognitive neurosciences and neurooncology, which is critical for neurosurgeons but also for medical oncologists, especially brain radiation oncologists. The goal is to optimize RT planning by sparing individual critical neural networks. A redefinition of "organs at risk" should be proposed, beyond the few structures (such as brainstem, optic pathway, pituitary gland, hippocampi) which are classically preserved for brain radiation, by considering the structural and functional connectivity in order to evolve toward a RT "à la carte".
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Montpellier University Medical Center, Montpellier 34295, France; Institute for Neuroscience of Montpellier, INSERM U-1051, Hôpital Saint Eloi, Montpellier 34298, France.
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111
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Albuquerque LAF, Almeida JP, de Macêdo Filho LJM, Joaquim AF, Duffau H. Extent of resection in diffuse low-grade gliomas and the role of tumor molecular signature-a systematic review of the literature. Neurosurg Rev 2020; 44:1371-1389. [PMID: 32770298 DOI: 10.1007/s10143-020-01362-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 01/06/2023]
Abstract
There is a lack of class I evidence concerning the impact of surgery in the treatment of diffuse low-grade glioma; the early maximal resection with preservation of eloquent brain areas has been accepted as the first therapeutic option. We performed a systematic review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and protocol. Inclusion criteria: only case series with at least 100 patients containing supratentorial hemispheric diffuse low-grade glioma (according to any of the WHO classification used in papers published between 2000 to 2019), with pre- and postoperative MRI study were included in the qualitative and quantitative analyses. The extent of resection should be defined based on MRI at least in two categories and correlated with patients' outcomes (with univariate or multivariate analyses) using overall survival (OS) or malignant progression-free survival (MPFS). A total of 18 series with 4386 patients, published in 20 papers, were included in this systematic review. All the series that evaluates the relation between the extent of resection (EOR) and OS showed a statistically significant improvement of OS at univariate and/or multivariate analyzes with a greater EOR. Six studies showed a statistically significant improvement of MPFS with a greater EOR. We demonstrate that when a more rigorous analysis of EOR is performed, a benefit of a more aggressive resection on OS and MPFS is observed. Our review about EOR in different molecular groups of DLGG also suggests a benefit of maximum safe resection for all different subtypes, even though "radical surgery" may be associated with better OS and MPFS in tumors with a more aggressive signature.
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Affiliation(s)
- Lucas Alverne F Albuquerque
- Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Ceará, Brazil. .,Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil.
| | - João Paulo Almeida
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Andrei F Joaquim
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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112
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Plasticity of the Primary Motor Cortex in Patients with Primary Brain Tumors. Neural Plast 2020; 2020:3648517. [PMID: 32714384 PMCID: PMC7354670 DOI: 10.1155/2020/3648517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 01/21/2023] Open
Abstract
There are two neuron-level mechanisms proposed to underlie neural plasticity: recruiting neurons nearby to support the lost function (ipsilesional plasticity) and uncovering latent pathways that can assume the function that was lost (contralesional plasticity). While both patterns have been demonstrated in patient groups following injury, the specific mechanisms underlying each mode of plasticity are poorly understood. In a retrospective case series of 13 patients, we utilize a novel paradigm that analyzes serial fMRI scans in patients harboring intrinsic brain tumors that vary in location and growth kinetics to better understand the mechanisms underlying these two modes of plasticity in the human primary motor cortex. Twelve patients in our series had some degree of primary motor cortex plasticity, an area previously thought to have limited plasticity. Patients harboring smaller lesions with slower growth kinetics and increasing distance from the primary motor region demonstrated recruitment of ipsilateral motor regions. Conversely, larger, faster-growing lesions in close proximity to the primary motor region were associated with activation of the contralesional primary motor cortex, along with increased activation of the supplementary motor area. These data increase our understanding of the adaptive abilities of the brain and may lead to improved treatment strategies for those suffering from motor loss secondary to brain injuries.
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Rech F, Wassermann D, Duffau H. New insights into the neural foundations mediating movement/language interactions gained from intrasurgical direct electrostimulations. Brain Cogn 2020; 142:105583. [DOI: 10.1016/j.bandc.2020.105583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
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Zigiotto L, Annicchiarico L, Corsini F, Vitali L, Falchi R, Dalpiaz C, Rozzanigo U, Barbareschi M, Avesani P, Papagno C, Duffau H, Chioffi F, Sarubbo S. Effects of supra-total resection in neurocognitive and oncological outcome of high-grade gliomas comparing asleep and awake surgery. J Neurooncol 2020; 148:97-108. [PMID: 32303975 DOI: 10.1007/s11060-020-03494-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/09/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Awake surgery is an established technique for resection of low-grade gliomas, while its possible benefit for resection of high-grade gliomas (HGGs) needs further confirmations. This retrospective study aims to compare overall survival, extent of resection (EOR) and cognitive outcome in two groups of HGGs patients submitted to asleep or awake surgery. METHODS Thirty-three patients submitted to Gross Total Resection of contrast-enhancing area of HGGs were divided in two homogeneous groups: awake (AWg; N = 16) and asleep surgery (ASg; N = 17). All patients underwent to an extensive neuropsychological assessment before surgery (time_1), 1-week (time_2) and 4-months (time_3) after surgery. We performed analyses to assess differences in cognitive performances between groups, cognitive outcomes in each group and EOR. A comparison of overall survival (OS) between the two groups was conducted. RESULTS Statistical analyses showed no differences between groups at time_2 and time_3 in each cognitive domain, excluding selective attention that resulted higher in the AWg before surgery. Regarding cognitive outcomes, we found a reversible worsening of memory and constructional praxis, and a significant recovery at time_3, similar for both groups. Assessment of time_3 in respect to time_1 never showed differences (all ps > .074). Moreover we found a significant lower level of tumor infiltration after surgery for AWg (p < .05), with an influence on OS (p < .05). Indeed, patients of AWg showed a significant longer OS in comparison to those in the ASg (p < .01). This result was confirmed even considering only wildtype Glioblastoma (p < .05). CONCLUSION These results indicate that awake surgery, and in general a supra-total resection of enhancing area, can improve OS in HGGs patients, preserving neuro-cognitive profile and quality of life.
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Affiliation(s)
- Luca Zigiotto
- Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), 9, Largo Medaglie D'Oro, 38122, Trento, Italy
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Luciano Annicchiarico
- Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), 9, Largo Medaglie D'Oro, 38122, Trento, Italy
| | - Francesco Corsini
- Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), 9, Largo Medaglie D'Oro, 38122, Trento, Italy
| | - Luca Vitali
- Department of Intensive Care I, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Roberta Falchi
- Department of Intensive Care I, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Chiara Dalpiaz
- Department of Intensive Care I, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Umberto Rozzanigo
- Department of Radiology, Division of Neuroradiology, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Mattia Barbareschi
- Department of Histopathology, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Paolo Avesani
- Neuroinformatics Lab (NiLab), Fondazione Bruno Kessler (FBK), Trento, Italy
| | - Costanza Papagno
- Centro Di Riabilitazione Neurocognitiva (CeRiN), CIMeC, University of Trento, Trento, Italy
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Hugues Duffau
- Department of Neurosurgery, Hopital Gui de Chauliac, University of Montpellier, Montpellier, France
| | - Franco Chioffi
- Department of Neurosurgery, "Azienda Ospedaliera di Padova", Padua, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), 9, Largo Medaglie D'Oro, 38122, Trento, Italy.
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Catalino MP, Yao S, Green D, Laws ER, Golby AJ, Tie Y. Mapping cognitive and emotional networks in neurosurgical patients using resting-state functional magnetic resonance imaging. Neurosurg Focus 2020; 48:E9. [PMID: 32006946 PMCID: PMC7712886 DOI: 10.3171/2019.11.focus19773] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/13/2019] [Indexed: 01/15/2023]
Abstract
Neurosurgery has been at the forefront of a paradigm shift from a localizationist perspective to a network-based approach to brain mapping. Over the last 2 decades, we have seen dramatic improvements in the way we can image the human brain and noninvasively estimate the location of critical functional networks. In certain patients with brain tumors and epilepsy, intraoperative electrical stimulation has revealed direct links between these networks and their function. The focus of these techniques has rightfully been identification and preservation of so-called "eloquent" brain functions (i.e., motor and language), but there is building momentum for more extensive mapping of cognitive and emotional networks. In addition, there is growing interest in mapping these functions in patients with a broad range of neurosurgical diseases. Resting-state functional MRI (rs-fMRI) is a noninvasive imaging modality that is able to measure spontaneous low-frequency blood oxygen level-dependent signal fluctuations at rest to infer neuronal activity. Rs-fMRI may be able to map cognitive and emotional networks for individual patients. In this review, the authors give an overview of the rs-fMRI technique and associated cognitive and emotional resting-state networks, discuss the potential applications of rs-fMRI, and propose future directions for the mapping of cognition and emotion in neurosurgical patients.
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Affiliation(s)
- Michael P Catalino
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
- Department of Neurosurgery, University of North Carolina Hospitals, Chapel Hill, NC
| | - Shun Yao
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Deborah Green
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Edward R Laws
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
| | - Yanmei Tie
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School Boston, MA
- Corresponding Author: Yanmei Tie, Ph.D., Assistant Professor, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, 8016G, 60 Fenwood Road, Boston, MA 02115, USA, , Tel: 617-732-8249
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Sarubbo S, Tate M, De Benedictis A, Merler S, Moritz-Gasser S, Herbet G, Duffau H. A normalized dataset of 1821 cortical and subcortical functional responses collected during direct electrical stimulation in patients undergoing awake brain surgery. Data Brief 2019; 28:104892. [PMID: 31886348 PMCID: PMC6921148 DOI: 10.1016/j.dib.2019.104892] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023] Open
Abstract
In this data article, we provide the dataset which served as the basis for our related research article “Mapping critical cortical hubs and white matter pathways by direct electrical stimulation: an original functional atlas of the human brain” [1], which represents the first probabilistic cortical and subcortical atlas of critical structures mediating human brain functions based on direct electrical stimulation (DES) in patients undergoing awake brain surgery. 1162 cortical and 659 subcortical DES-derived responses were recorded during testing of 16 functional domains in 256 patients undergoing awake surgery. Normalized [Montreal Neurological Institute (MNI) 152] spatial coordinates for cortical and subcortical responses, and probabilistic heat maps for each functional domain, were computed using methods previously developed by our group [2,3]. Source data, including the MNI-normalized coordinates of all 1821 DES-derived cortical and subcortical data points, and multi-planar (MNI-152, T1 1mm) videos showing the probabilistic distribution of each functional domain are provided. This novel dataset can improve and refine our understanding about the functional anatomy of critical brain networks, and these data are made available for medical and neuroscience applications.
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Affiliation(s)
- Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab Project, Azienda Provinciale per i Servizi Sanitari (APSS), 9 Largo Medaglie d'Oro, 38122, Trento, Italy
| | - Matthew Tate
- Departments of Neurosurgery and Neurology, Northwestern University, Feinberg School of Medicine, 420 E Superior St, 60611, Chicago, IL, USA
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS, 4 Piazza Sant'Onofrio, 00165, Rome, Italy
| | | | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, Montpellier University Medical Center, 80 Av Augustin Fliche, Montpellier, France
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, Montpellier University Medical Center, 80 Av Augustin Fliche, Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, Montpellier University Medical Center, 80 Av Augustin Fliche, Montpellier, France
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