1
|
Huang W, Lei Y, Cao X, Xu G, Wang X. Development and validation of a nomogram to predict overall survival in patients with glioma: a population-based study. Aging (Albany NY) 2024; 16:10905-10917. [PMID: 38970773 PMCID: PMC11272113 DOI: 10.18632/aging.205967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/29/2024] [Indexed: 07/08/2024]
Abstract
AIM The objective is to investigate the prognostic factors associated with gliomas and to develop and assess a predictive nomogram model connected to survival that may serve as an additional resource for the clinical management of glioma patients. METHOD From 2010 to 2015, participants included in the study were chosen from the Surveillance Epidemiology and End Results (SEER) database. Gliomas were definitively diagnosed in each of them. They were divided into the training group and the validation cohort at random (7/3 ratio) using a random number table. To identify the independent predictive markers for overall survival (OS), Cox regression analysis was utilized. Subsequently, the training cohort's survival-related nomogram predictive model for OS was created by incorporating the fundamental patient attributes. Following that, the training cohort's model underwent internal validation. The nomogram model's authenticity and reliability were assessed through the computation of receiver operating characteristic (ROC) curves and concordance index (C-index). To evaluate the degree of agreement between the observed and predicted values in the training and validation cohorts, calibration plots were created. RESULT Age, primary site, histological type, surgery, chemotherapy, marital status, and grade were the independent predictive factors for OS in the training cohort, according to Cox regression analysis. Moreover, the nomogram model for predicting 1-year, 3-year, and 5-year OS was built using these variables. The C-indexes of OS for glioma patients in the training cohort and internal validation cohort were found to be 0.779 (95% CI=0.769-0.789) and 0.776 (95% CI=0.760-0.792), respectively, according to the results. The ROC curves also demonstrated good discrimination. Additionally, calibration plots demonstrated a fair amount of agreement. CONCLUSIONS In summary, the nomogram prediction model of OS demonstrated a moderate level of reliability in its predictive performance, offering valuable reference data to enable doctors to quickly and easily determine the survival likelihood of patients with gliomas.
Collapse
Affiliation(s)
- Wei Huang
- Department of Internal Medicine, Shenzhen Longhua District Maternity and Child Healthcare Hospital, Shenzhen 518109, China
| | - Yuhe Lei
- Department of Pharmacy, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen 518034, China
| | - Xiongbin Cao
- Department of Neurology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, China
| | - Gengrui Xu
- Department of Pharmacy, Shenzhen Longhua District Central Hospital, Shenzhen 518110, China
| | - Xiaokang Wang
- Department of Pharmacy, Shenzhen Longhua District Central Hospital, Shenzhen 518110, China
| |
Collapse
|
2
|
Pesce A, Palmieri M, Pietrantonio A, Ciarlo S, Salvati M, Pompucci A. Resection of supratentorial high-grade gliomas availing of neuronavigation matched intraoperative ultrasound and Fluorescein: How far is it safe to push the resection? World Neurosurg X 2024; 23:100379. [PMID: 38645511 PMCID: PMC11027571 DOI: 10.1016/j.wnsx.2024.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
Background High-Grade Gliomas are the most common primary brain malignancies and despite the multimodal treatment, and the increasing amount of adjuvant treatment options the overall prognosis remains dismal. The present investigation aims to analyze the safety profile of the use of intraoperative ultrasounds (Io-US) in a homogeneous and matched cohort of patients suffering from High-grade gliomas (HGG) operated on with or without the aid of Io-US and Fluorescein in specific relation to the incidence of neurological and functional status sequelae. Methods and materials A retrospective analysis was performed on 74 patients affected by HGG. 22 patients were treated with Io-US matched with neuronavigational system (Group A); 15 patients were treated both with the use of Io-US and Fluorescein matched with neuronavigational system (Group B); 37 patients were treated with the use of the neuronavigational system only (Group C). Primary endpoints were the extent of resection and functional outcome (measured with Karnofski Performance Status). Results Significative differences were observed in terms of a higher extent of resection in Group B. In a multivariate analysis, this data appears to be independent of the location (eloquent/non-eloquent) of the lesion and from its histology. Regarding functional outcomes, no differences were detected between the two groups. Conclusions The present study is the first that analyzes the simultaneous use of Io-US and Fluorescein, and the results demonstrate that these two instruments together could improve the extent of resection in HGG while ensuring good outcomes in terms of functional status.
Collapse
Affiliation(s)
- Alessandro Pesce
- A.O. “Santa Maria Goretti”, Neurosurgery Division - Latina, Via Lucia Scaravelli, 04100, Latina, LT, Italy
| | - Mauro Palmieri
- Università“La Sapienza” di Roma, Neurosurgery Division - Roma, Viale del Policlinico 155, 00161, Roma, RM, Italy
| | - Andrea Pietrantonio
- A.O. “Santa Maria Goretti”, Neurosurgery Division - Latina, Via Lucia Scaravelli, 04100, Latina, LT, Italy
| | - Silvia Ciarlo
- A.O. “Santa Maria Goretti”, Neurosurgery Division - Latina, Via Lucia Scaravelli, 04100, Latina, LT, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico “Tor Vergata”, University of Rome “Tor Vergata”, 00133, Rome, RM, Italy
| | - Angelo Pompucci
- A.O. “Santa Maria Goretti”, Neurosurgery Division - Latina, Via Lucia Scaravelli, 04100, Latina, LT, Italy
| |
Collapse
|
3
|
Ruella ME, Caffaratti G, Chaves H, Yañez P, Cervio A. Transoperative Magnetic Resonance Imaging in Awake Glioma Surgery: Experience in a Latin American Tertiary-Level Center. World Neurosurg 2024; 186:e65-e74. [PMID: 38417621 DOI: 10.1016/j.wneu.2024.02.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/19/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Analyze the usefulness, efficacy, and safety of transoperative magnetic resonance imaging (tMRI) in glioma surgery in awake patients. METHODS Retrospective, single-center, analytical study of a cohort of patients who underwent awake surgery for gliomas by the same surgeon in a third-level Argentine center, in the period between 2012 and 2022. Only patients with pathology-confirmed gliomas, with 6-month follow-up, who had preoperative and postoperative volumetric magnetic resonance imaging, were included in this sample. Subsequently, we analyzed which patients received surgery with the tMRI protocol and the results using multivariate regression analysis. RESULTS A total of 71 patients were included. A tMRI study was performed on 22 (31%) of these patients. The use of tMRI increased the percentage of resection by 20% (P = 0.03), thereby increasing the possibility of gross total resection. However, using tMRI significantly extended surgical time by 84 minutes (P < 0.001). In 55% of the patients in whom tMRI was performed, the resection was continued after it. The use of tMRI did not increase the rate of infections or the development of surgically associated neurological deficits in the long term, despite the fact that 47% of the patients showed the development of a new deficit or worsening of a previous one during the intraoperative period. CONCLUSIONS The use of tMRI in awake glioma surgery proved to be a safe tool that contributes to increasing the degree of tumor resection, compared to the use of neurophysiological mapping and neuronavigation, at the expense of increased surgical times and costs. We consider tMRI in awake glioma surgery should be used in properly selected cases.
Collapse
Affiliation(s)
- Mauro E Ruella
- Department of Neurosurgery, Fleni, Buenos Aires, Argentina.
| | | | - Hernan Chaves
- Department of Neuro-Radiology, Fleni, Buenos Aires, Argentina
| | - Paulina Yañez
- Department of Neuro-Radiology, Fleni, Buenos Aires, Argentina
| | - Andrés Cervio
- Department of Neurosurgery, Fleni, Buenos Aires, Argentina
| |
Collapse
|
4
|
Yamamoto A, Kijima N, Utsugi R, Mrakami K, Kuroda H, Tachi T, Hirayama R, Okita Y, Kagawa N, Kishima H. Awake surgery for a deaf patient using sign language: A case report. Surg Neurol Int 2024; 15:167. [PMID: 38840599 PMCID: PMC11152539 DOI: 10.25259/sni_52_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/28/2024] [Indexed: 06/07/2024] Open
Abstract
Background Although awake surgery is the gold standard for resecting brain tumors in eloquent regions, patients with hearing impairment require special consideration during intraoperative tasks. Case Description We present a case of awake surgery using sign language in a 45-year-old right-handed native male patient with hearing impairment and a neoplastic lesion in the left frontal lobe, pars triangularis (suspected to be a low-grade glioma). The patient primarily communicated through sign language and writing but was able to speak at a sufficiently audible level through childhood training. Although the patient remained asymptomatic, the tumors gradually grew in size. Awake surgery was performed for tumors resection. After the craniotomy, the patient was awake, and brain function mapping was performed using tasks such as counting, picture naming, and reading. A sign language-proficient nurse facilitated communication using sign language and the patient vocally responded. Intraoperative tasks proceeded smoothly without speech arrest or verbal comprehension difficulties during electrical stimulation of the tumor-adjacent areas. Gross total tumor resection was achieved, and the patient exhibited no apparent complications. Pathological examination revealed a World Health Organization grade II oligodendroglioma with an isocitrate dehydrogenase one mutant and 1p 19q codeletion. Conclusion Since the patient in this case had no dysphonia due to training from childhood, the task was presented in sign language, and the patient responded vocally, which enabled a safe operation. Regarding awake surgery in patients with hearing impairment, safe tumor resection can be achieved by performing intraoperative tasks depending on the degree of hearing impairment and dysphonia.
Collapse
Affiliation(s)
| | | | - Reina Utsugi
- Department of Neurosurgery, Osaka University, Suita, Japan
| | - Koki Mrakami
- Department of Neurosurgery, Osaka University, Suita, Japan
| | - Hideki Kuroda
- Department of Neurosurgery, Osaka University, Suita, Japan
| | - Tetsuro Tachi
- Department of Neurosurgery, Osaka University, Suita, Japan
| | | | - Yoshiko Okita
- Department of Neurosurgery, Osaka University, Suita, Japan
| | - Naoki Kagawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | | |
Collapse
|
5
|
Veljanoski D, Ng XY, Hill CS, Jamjoom AAB. Theory and evidence-base for a digital platform for the delivery of language tests during awake craniotomy and collaborative brain mapping. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2024; 6:e000234. [PMID: 38756704 PMCID: PMC11097893 DOI: 10.1136/bmjsit-2023-000234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives Build the theoretical and evidence-base for a digital platform (map-OR) which delivers intraoperative language tests during awake craniotomy and facilitates collaborative sharing of brain mapping data. Design Mixed methodology study including two scoping reviews, international survey, synthesis of development guiding principles and a risk assessment using failure modes and effects analysis. Setting The two scoping reviews examined the literature published in the English language. International survey was completed by members of awake craniotomy teams from 14 countries. Main outcome measures Scoping review 1: number of technologies described for language mapping during awake craniotomy. Scoping review 2: barriers and facilitators to adopting novel technology in surgery. International survey: degree of language mapping technology penetration into clinical practice. Results A total of 12 research articles describing 6 technologies were included. The technologies required a range of hardware components including portable devices, virtual reality headsets and large integrated multiscreen stacks. The facilitators and barriers of technology adoption in surgery were extracted from 11 studies and mapped onto the 4 Unified Theory of Acceptance and Use of Technology constructs. A total of 37 awake craniotomy teams from 14 countries completed the survey. Of the responses, 20 (54.1%) delivered their language tests digitally, 10 (27.0%) delivered tests using cards and 7 (18.9%) used a combination of both. The most commonly used devices were tablet computers (67.7%; n=21) and the most common software used was Microsoft PowerPoint (60.6%; n=20). Four key risks for the proposed digital platform were identified, the highest risk being a software and internet connectivity failure during surgery. Conclusions This work represents a rigorous and structured approach to the development of a digital platform for standardized intraoperative language testing during awake craniotomy and for collaborative sharing of brain mapping data. Trial registration number Scoping review protocol registrations in OSF registries (scoping review 1: osf.io/su9xm; scoping review 2: osf.io/x4wsc).
Collapse
Affiliation(s)
| | - Xin Yi Ng
- Department of Medicine, Arrowe Park Hospital, Wirral, UK
| | - Ciaran Scott Hill
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Aimun A B Jamjoom
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Neurosurgery, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
| |
Collapse
|
6
|
Kram L, Neu B, Schroeder A, Wiestler B, Meyer B, Krieg SM, Ille S. Toward a systematic grading for the selection of patients to undergo awake surgery: identifying suitable predictor variables. Front Hum Neurosci 2024; 18:1365215. [PMID: 38756845 PMCID: PMC11096515 DOI: 10.3389/fnhum.2024.1365215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
Background Awake craniotomy is the standard of care for treating language eloquent gliomas. However, depending on preoperative functionality, it is not feasible in each patient and selection criteria are highly heterogeneous. Thus, this study aimed to identify broadly applicable predictor variables allowing for a more systematic and objective patient selection. Methods We performed post-hoc analyses of preoperative language status, patient and tumor characteristics including language eloquence of 96 glioma patients treated in a single neurosurgical center between 05/2018 and 01/2021. Multinomial logistic regression and stepwise variable selection were applied to identify significant predictors of awake surgery feasibility. Results Stepwise backward selection confirmed that a higher number of paraphasias, lower age, and high language eloquence level were suitable indicators for an awake surgery in our cohort. Subsequent descriptive and ROC-analyses indicated a cut-off at ≤54 years and a language eloquence level of at least 6 for awake surgeries, which require further validation. A high language eloquence, lower age, preexisting semantic and phonological aphasic symptoms have shown to be suitable predictors. Conclusion The combination of these factors may act as a basis for a systematic and standardized grading of patients' suitability for an awake craniotomy which is easily integrable into the preoperative workflow across neurosurgical centers.
Collapse
Affiliation(s)
- Leonie Kram
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| | - Beate Neu
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Axel Schroeder
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Benedikt Wiestler
- Section of Diagnostic and Interventional Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sandro M. Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| |
Collapse
|
7
|
Radwan AM, Emsell L, Vansteelandt K, Cleeren E, Peeters R, De Vleeschouwer S, Theys T, Dupont P, Sunaert S. Comparative validation of automated presurgical tractography based on constrained spherical deconvolution and diffusion tensor imaging with direct electrical stimulation. Hum Brain Mapp 2024; 45:e26662. [PMID: 38646998 PMCID: PMC11033921 DOI: 10.1002/hbm.26662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/27/2024] [Accepted: 03/08/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVES Accurate presurgical brain mapping enables preoperative risk assessment and intraoperative guidance. This cross-sectional study investigated whether constrained spherical deconvolution (CSD) methods were more accurate than diffusion tensor imaging (DTI)-based methods for presurgical white matter mapping using intraoperative direct electrical stimulation (DES) as the ground truth. METHODS Five different tractography methods were compared (three DTI-based and two CSD-based) in 22 preoperative neurosurgical patients undergoing surgery with DES mapping. The corticospinal tract (CST, N = 20) and arcuate fasciculus (AF, N = 7) bundles were reconstructed, then minimum distances between tractograms and DES coordinates were compared between tractography methods. Receiver-operating characteristic (ROC) curves were used for both bundles. For the CST, binary agreement, linear modeling, and posthoc testing were used to compare tractography methods while correcting for relative lesion and bundle volumes. RESULTS Distance measures between 154 positive (functional response, pDES) and negative (no response, nDES) coordinates, and 134 tractograms resulted in 860 data points. Higher agreement was found between pDES coordinates and CSD-based compared to DTI-based tractograms. ROC curves showed overall higher sensitivity at shorter distance cutoffs for CSD (8.5 mm) compared to DTI (14.5 mm). CSD-based CST tractograms showed significantly higher agreement with pDES, which was confirmed by linear modeling and posthoc tests (PFWE < .05). CONCLUSIONS CSD-based CST tractograms were more accurate than DTI-based ones when validated using DES-based assessment of motor and sensory function. This demonstrates the potential benefits of structural mapping using CSD in clinical practice.
Collapse
Affiliation(s)
- Ahmed Mohamed Radwan
- KU Leuven, Department of Imaging and PathologyTranslational MRILeuvenBelgium
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
| | - Louise Emsell
- KU Leuven, Department of Imaging and PathologyTranslational MRILeuvenBelgium
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
- KU Leuven, Department of Neurosciences, NeuropsychiatryLeuvenBelgium
- KU Leuven, Department of Geriatric PsychiatryUniversity Psychiatric Center (UPC)LeuvenBelgium
| | - Kristof Vansteelandt
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
- KU Leuven, Department of Neurosciences, NeuropsychiatryLeuvenBelgium
- KU Leuven, Department of Geriatric PsychiatryUniversity Psychiatric Center (UPC)LeuvenBelgium
| | - Evy Cleeren
- UZ Leuven, Department of NeurologyLeuvenBelgium
- UZ Leuven, Department of NeurosurgeryLeuvenBelgium
| | | | - Steven De Vleeschouwer
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
- UZ Leuven, Department of NeurosurgeryLeuvenBelgium
- KU Leuven, Department of NeurosciencesResearch Group Experimental Neurosurgery and NeuroanatomyLeuvenBelgium
| | - Tom Theys
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
- UZ Leuven, Department of NeurosurgeryLeuvenBelgium
- KU Leuven, Department of NeurosciencesResearch Group Experimental Neurosurgery and NeuroanatomyLeuvenBelgium
| | - Patrick Dupont
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
- KU Leuven, Laboratory for Cognitive NeurologyDepartment of NeurosciencesLeuvenBelgium
| | - Stefan Sunaert
- KU Leuven, Department of Imaging and PathologyTranslational MRILeuvenBelgium
- KU Leuven, Leuven Brain Institute (LBI), Department of NeurosciencesLeuvenBelgium
- UZ Leuven, Department of RadiologyLeuvenBelgium
| |
Collapse
|
8
|
Caffaratti G, Ruella M, Villamil F, Keller G, Savini D, Cervio A. Experience in awake glioma surgery in a South American center. Correlation between intraoperative evaluation, extent of resection and functional outcomes. World Neurosurg X 2024; 22:100357. [PMID: 38469388 PMCID: PMC10926357 DOI: 10.1016/j.wnsx.2024.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Gliomas are the second most frequent primary brain tumors. Surgical resection remains a crucial part of treatment, as well as maximum preservation of neurological function. For this reason awake surgery has an important role.The objectives of this article are to present our experience with awake surgery for gliomas in a South American center and to analyze how intraoperative functional findings may influence the extent of resection and neurological outcomes. Materials and methods Retrospective single center study of a cohort of adult patients undergoing awake surgery for brain glioma, by the same neurosurgeon, between 2012 and 2022 in the city of Buenos Aires, Argentina. Results A total of 71 patients were included (mean age 34 years, 62% males). Seventy seven percent of tumors were low grade, with average extent of resection reaching 94% of preoperative volumetric assessment. At six months follow up, 81.7% of patients presented no motor or language deficit.Further analysis showed that having a positive mapping did not have a negative impact in the extent of resection, but was associated with short term postoperative motor and language deficits, among other variables, with later improvement. Conclusion Awake surgery for gliomas is a safe procedure, with the proper training. In this study it was observed that guiding the resection by negative mapping did not worsen the results and that positive subcortical mapping correlated with short term postoperative neurological deficits with posterior improvement within six months in most cases.
Collapse
Affiliation(s)
| | - Mauro Ruella
- Department of Neurosurgery, Fleni, Buenos Aires, Argentina
| | | | - Greta Keller
- Department of Cognitive Neurology, Neuropsychology and Neuropsychiatry, Fleni, Buenos Aires, Argentina
| | - Darío Savini
- Department of Neurophysiology, Fleni, Buenos Aires, Argentina
| | - Andrés Cervio
- Department of Neurosurgery, Fleni, Buenos Aires, Argentina
| |
Collapse
|
9
|
Carbone F, Colamaria A, Corvino S, Sacco M, Iaconetta G, Corrivetti F, Di Maria D, Catapano G, Fochi NP, Leone A, Spetzger U, de Notaris M. Multimodal Use of Contact Endoscopy in Neurosurgery: Case Series with Technical Note and Literature Review. World Neurosurg 2024; 182:e657-e665. [PMID: 38070736 DOI: 10.1016/j.wneu.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Originally adopted for the cytological screening of cervical and uterine cancer, contact endoscopy (CE) is now widely used in several fields of oncological surgery. The CE method, with magnification power up to 150x, was designed to enhance visualization and identify microscopic changes indicative of precancerous and cancerous lesions at early stages. In this pilot study, we evaluated the multimodal applications of CE during different endoscopic intracranial neurosurgical procedures. METHODS Twenty patients with skull base lesions underwent surgery using different minimally invasive endoscopic approaches (endonasal, transorbital, and supraorbital). CE was used to distinguish the pathology from the surrounding healthy tissue by positioning the endoscope either in proximity or directly onto the target tissue. Special attention was given to the visualization of the margins of the lesion to differentiate compression/displacement from infiltration of the normal surrounding tissue. RESULTS With its unprecedented range of magnification, CE could clearly identify the microvascular pattern and cytological architecture of a tissue not detectable by simple white light endoscopy, with no reported damage due to heat transmission or iatrogenic injuries. All the lesions diagnosed as "presumed neoplastic tissue" by CE were confirmed by histopathology. The most promising results were observed in surgeries for meningioma and pituitary adenoma, as these lesions exhibit distinctive microvascular networks. CONCLUSIONS CE represents a new and effective technique for the in vivo identification of pathological microvascular and tissue features, allowing preservation of normal tissue during different endoscopic approaches. The use of CE could improve diagnostic accuracy and assist in intraoperative decision-making, becoming a key tool in various applications in neurosurgical field.
Collapse
Affiliation(s)
- Francesco Carbone
- Department of Neurosurgery - Karlsruher Neurozentrum, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany; Division of Neurosurgery, University of Foggia, Foggia, Italy
| | | | - Sergio Corvino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University Federico II, Naples, Italy
| | - Matteo Sacco
- Division of Neurosurgery, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giorgio Iaconetta
- Division of Neurosurgery, School of Medicine "Scuola Medica Salernitana", University of Salerno, Fisciano, Italy
| | - Francesco Corrivetti
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL 1, Roma, Italy
| | | | - Giuseppe Catapano
- Division of Neurosurgery, "Ospedale del Mare" Hospital, Naples, Italy
| | | | - Augusto Leone
- Department of Neurosurgery - Karlsruher Neurozentrum, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany; Faculty of Human Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Uwe Spetzger
- Department of Neurosurgery - Karlsruher Neurozentrum, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Matteo de Notaris
- Department of Neuroscience, Neurosurgery Operative Unit, "San Pio" Hospital, Benevento, Italy
| |
Collapse
|
10
|
Kram L, Ohlerth AK, Ille S, Meyer B, Krieg SM. CompreTAP: Feasibility and reliability of a new language comprehension mapping task via preoperative navigated transcranial magnetic stimulation. Cortex 2024; 171:347-369. [PMID: 38086145 DOI: 10.1016/j.cortex.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/01/2023] [Accepted: 09/25/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Stimulation-based language mapping approaches that are used pre- and intraoperatively employ predominantly overt language tasks requiring sufficient language production abilities. Yet, these production-based setups are often not feasible in brain tumor patients with severe expressive aphasia. This pilot study evaluated the feasibility and reliability of a newly developed language comprehension task with preoperative navigated transcranial magnetic stimulation (nTMS). METHODS Fifteen healthy subjects and six brain tumor patients with severe expressive aphasia unable to perform classic overt naming tasks underwent preoperative nTMS language mapping based on an auditory single-word Comprehension TAsk for Perioperative mapping (CompreTAP). Comprehension was probed by button-press responses to auditory stimuli, hence not requiring overt language responses. Positive comprehension areas were identified when stimulation elicited an incorrect or delayed button press. Error categories, case-wise cortical error rate distribution and inter-rater reliability between two experienced specialists were examined. RESULTS Overall, the new setup showed to be feasible. Comprehension-disruptions induced by nTMS manifested in no responses, delayed or hesitant responses, searching behavior or selection of wrong target items across all patients and controls and could be performed even in patients with severe expressive aphasia. The analysis agreement between both specialists was substantial for classifying comprehension-positive and -negative sites. Extensive left-hemispheric individual cortical comprehension sites were identified for all patients. Apart from one case presenting with transient worsening of aphasic symptoms, pre-existing language deficits did not aggravate if results were used for subsequent surgical planning. CONCLUSION Employing this new comprehension-based nTMS setup allowed to identify language relevant cortical sites in all healthy subjects and severely aphasic patients who were thus far precluded from classic production-based mapping. This pilot study, moreover, provides first indications that the CompreTAP mapping results may support the preservation of residual language function if used for subsequent surgical planning.
Collapse
Affiliation(s)
- Leonie Kram
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany; Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Germany
| | - Ann-Katrin Ohlerth
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany; Neurobiology of Language Department, Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands
| | - Sebastian Ille
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany; TUM Neuroimaging Center, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany; Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany; TUM Neuroimaging Center, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany; Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Germany.
| |
Collapse
|
11
|
Ramakrishnan PK, Saeed F, Thomson S, Corns R, Mathew RK, Sivakumar G. Awake craniotomy for high-grade gliomas - a prospective cohort study in a UK tertiary-centre. Surgeon 2024; 22:e3-e12. [PMID: 38008681 DOI: 10.1016/j.surge.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Studies from the UK reporting on awake craniotomy (AC) include a heterogenous group of patients which limit the evaluation of the true impact of AC in high-grade glioma (HGG) patients. This study aims to report solely the experience and outcomes of AC for HGG surgery from our centre. METHODS A prospective review of all patients who underwent AC for HGG from 2013 to 2019 were performed. Data on patient characteristics including but not limited to demographics, pre- and post-operative Karnofsky performance status (KPS), tumour location and volume, type of surgery, extent of resection (EOR), tumour histopathology, intra- and post-operative complications, morbidity, mortality, disease recurrence, progression-free survival (PFS) and overall survival (OS) from the time of surgery were collected. RESULTS Fifteen patients (6 males; 9 females; 17 surgeries) underwent AC for HGG (median age = 55 years). Two patients underwent repeat surgeries due to disease recurrence. Median pre- and post-operative KPS score was 90 (range:80-100) and 90 (range:60-100), respectively. The EOR ranges from 60 to 100 % with a minimum of 80 % achieved in 81.3 % cases. Post-operative complications include focal seizures (17.6 %), transient aphasia/dysphasia (17.6 %), permanent motor deficit (11.8 %), transient motor deficit (5.9 %) and transient sensory disturbance (5.9 %). There were no surgery-related mortality or post-operative infection. The median PFS and OS were 13 (95%CI 5-78) and 30 (95%CI 21-78) months, respectively. CONCLUSION This is the first study in the UK to solely report outcomes of AC for HGG surgery. Our data demonstrates that AC for HGG in eloquent region is safe, feasible and provides comparable outcomes to those reported in the literature.
Collapse
Affiliation(s)
- Piravin Kumar Ramakrishnan
- Department of Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Fozia Saeed
- Department of Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Simon Thomson
- Department of Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Robert Corns
- Department of Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Ryan K Mathew
- Department of Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, United Kingdom; School of Medicine, University of Leeds, Woodhouse, Leeds LS2 9JT, United Kingdom.
| | - Gnanamurthy Sivakumar
- Department of Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, United Kingdom.
| |
Collapse
|
12
|
Young JS, Morshed RA, Hervey-Jumper SL, Berger MS. The surgical management of diffuse gliomas: Current state of neurosurgical management and future directions. Neuro Oncol 2023; 25:2117-2133. [PMID: 37499054 PMCID: PMC10708937 DOI: 10.1093/neuonc/noad133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Indexed: 07/29/2023] Open
Abstract
After recent updates to the World Health Organization pathological criteria for diagnosing and grading diffuse gliomas, all major North American and European neuro-oncology societies recommend a maximal safe resection as the initial management of a diffuse glioma. For neurosurgeons to achieve this goal, the surgical plan for both low- and high-grade gliomas should be to perform a supramaximal resection when feasible based on preoperative imaging and the patient's performance status, utilizing every intraoperative adjunct to minimize postoperative neurological deficits. While the surgical approach and technique can vary, every effort must be taken to identify and preserve functional cortical and subcortical regions. In this summary statement on the current state of the field, we describe the tools and technologies that facilitate the safe removal of diffuse gliomas and highlight intraoperative and postoperative management strategies to minimize complications for these patients. Moreover, we discuss how surgical resections can go beyond cytoreduction by facilitating biological discoveries and improving the local delivery of adjuvant chemo- and radiotherapies.
Collapse
Affiliation(s)
- Jacob S Young
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Ramin A Morshed
- Department of Neurological Surgery, University of California, San Francisco, USA
| | | | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, USA
| |
Collapse
|
13
|
Kram L, Neu B, Schröder A, Meyer B, Krieg SM, Ille S. Improving specificity of stimulation-based language mapping in stuttering glioma patients: A mixed methods serial case study. Heliyon 2023; 9:e21984. [PMID: 38045205 PMCID: PMC10692765 DOI: 10.1016/j.heliyon.2023.e21984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/29/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
Objective Stimulation-based language mapping relies on identifying stimulation-induced language disruptions, which preexisting speech disorders affecting the laryngeal and orofacial speech system can confound. This study ascertained the effects of preexisting stuttering on pre- and intraoperative language mapping to improve the reliability and specificity of established language mapping protocols in the context of speech fluency disorders. Method Differentiation-ability of a speech therapist and two experienced nrTMS examiners between stuttering symptoms and stimulation-induced language errors during preoperative mappings were retrospectively compared (05/2018-01/2021). Subsequently, the impact of stuttering on intraoperative mappings was evaluated in all prospective patients (01/2021-12/2022). Results In the first part, 4.85 % of 103 glioma patients stuttered. While both examiners had a significant agreement for misclassifying pauses in speech flow and prolongations (Κ ≥ 0.50, p ≤ 0.02, respectively), less experience resulted in more misclassified stuttering symptoms. In one awake surgery case within the second part, stuttering decreased the reliability of intraoperative language mapping.Comparison with Existing Method(s): By thoroughly differentiating speech fluency symptoms from stimulation-induced disruptions, the reliability and proportion of stuttering symptoms falsely attributed to stimulation-induced language network disruptions can be improved. This may increase the consistency and specificity of language mapping results in stuttering glioma patients. Conclusions Preexisting stuttering negatively impacted language mapping specificity. Thus, surgical planning and the functional outcome may benefit substantially from thoroughly differentiating speech fluency symptoms from stimulation-induced disruptions by trained specialists.
Collapse
Affiliation(s)
- Leonie Kram
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Germany
| | - Beate Neu
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Axel Schröder
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Sandro M. Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Germany
| |
Collapse
|
14
|
Pertichetti M, Corbo D, Belotti F, Saviola F, Gasparotti R, Fontanella MM, Panciani PP. Neuropsychological Evaluation and Functional Magnetic Resonance Imaging Tasks in the Preoperative Assessment of Patients with Brain Tumors: A Systematic Review. Brain Sci 2023; 13:1380. [PMID: 37891749 PMCID: PMC10605177 DOI: 10.3390/brainsci13101380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Current surgical treatment of gliomas relies on a function-preserving, maximally safe resection approach. Functional Magnetic Resonance Imaging (fMRI) is a widely employed technology for this purpose. A preoperative neuropsychological evaluation should accompany this exam. However, only a few studies have reported both neuropsychological tests and fMRI tasks for preoperative planning-the current study aimed to systematically review the scientific literature on the topic. METHODS PRISMA guidelines were followed. We included studies that reported both neuropsychological tests and fMRI. Exclusion criteria were: no brain tumors, underage patients, no preoperative assessment, resting-state fMRI only, or healthy sample population/preclinical studies. RESULTS We identified 123 papers, but only 15 articles were included. Eight articles focused on language; three evaluated cognitive performance; single papers studied sensorimotor cortex, prefrontal functions, insular cortex, and cerebellar activation. Two qualitative studies focused on visuomotor function and language. According to some authors, there was a strong correlation between performance in presurgical neuropsychological tests and fMRI. Several papers suggested that selecting well-adjusted and individualized neuropsychological tasks may enable the development of personalized and more efficient protocols. The fMRI findings may also help identify plasticity phenomena to avoid unintentional damage during neurosurgery. CONCLUSIONS Most studies have focused on language, the most commonly evaluated cognitive function. The correlation between neuropsychological and fMRI results suggests that altered functions during the neuropsychological assessment may help identify patients who could benefit from an fMRI and, possibly, functions that should be tested. Neuropsychological evaluation and fMRI have complementary roles in the preoperative assessment.
Collapse
Affiliation(s)
- Marta Pertichetti
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili Hospital, 25123 Brescia, Italy (M.M.F.); (P.P.P.)
| | - Daniele Corbo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (D.C.); (F.S.); (R.G.)
| | - Francesco Belotti
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili Hospital, 25123 Brescia, Italy (M.M.F.); (P.P.P.)
| | - Francesca Saviola
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (D.C.); (F.S.); (R.G.)
| | - Roberto Gasparotti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (D.C.); (F.S.); (R.G.)
- Neuroradiology Unit, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Marco Maria Fontanella
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili Hospital, 25123 Brescia, Italy (M.M.F.); (P.P.P.)
| | - Pier Paolo Panciani
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili Hospital, 25123 Brescia, Italy (M.M.F.); (P.P.P.)
| |
Collapse
|
15
|
Staub-Bartelt F, Rapp M, Sabel M. Resection of Eloquent Located Brain Tumors by Mapping Only-A Feasibility Study. Brain Sci 2023; 13:1366. [PMID: 37891736 PMCID: PMC10605432 DOI: 10.3390/brainsci13101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Patients with eloquently located cerebral lesions require surgery that usually employs mapping and monitoring techniques for the preservation of motor and language function. However, in many cases, mapping only might be sufficient, reducing the need for technical and personnel logistics. Here, we report our experiences using a device that can be operated by the surgeon independently, providing mapping techniques but omitting monitoring techniques. METHODS For monopolar and bipolar cortical/subcortical stimulation, pre-set programs were available and intraoperatively used-two enabling EMG real-time tracking of eight muscles for monopolar (cortical/subcortical) mapping, and two programs for 60 Hz stimulation, one with EMG and one without. Motor mapping was performed under continuous observation of the screened EMG signal and acoustic feedback by the surgeon. For the 60 Hz stimulation, a standard bipolar stimulation probe was connected through a second port. The preoperative application of the subdermal EMG needles, as well as the intraoperative handling of the device, were performed by the surgeons independently. Postoperatively, an evaluation of the autonomous handling and feasibility of the device for the chosen test parameters was conducted. RESULTS From 04/19-09/21, 136 procedures in patients with eloquently located cerebral lesions were performed by using the "mapping-only" device. Mapping was performed in 82% of the monopolar cases and in 42% of the bipolar cases. Regarding the setup and sufficiency for the cortical/subcortical mapping, the device was evaluated as independently usable for motor and language mapping in 129 procedures (95%). Gross total resection was achieved, or functional limit throughout resection was reached, in 79% of the patients. 13 patients postoperatively suffered from a new neurological deficit. At the 3-6-month follow-up, three patients showed persistent deficit (2%). All of them had language disturbances. The setup time for the device was less than 7 min. CONCLUSIONS The device was evaluated as sufficient in over 90% of cases concerning monopolar and bipolar mapping, and the setup and handling was sufficient in all patients. With the present data we show that in well-selected cases, a very simple system providing mapping only is sufficient to achieve gross total resection with the preservation of functionality.
Collapse
|
16
|
Cui M, Liu Y, Zhou C, Chen H, Gao X, Liu J, Guo Q, Guan B, Ma X. Resection of high-grade glioma involving language areas assisted by multimodal techniques under general anesthesia: a retrospective study. Chin Neurosurg J 2023; 9:25. [PMID: 37691110 PMCID: PMC10494413 DOI: 10.1186/s41016-023-00340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Multimodal techniques-assisted resection of glioma under general anesthesia (GA) has been shown to achieve similar clinical outcomes as awake craniotomy (AC) in some studies. In this study, we aim to validate the use of multimodal techniques can achieve the maximal safe resection of high-grade glioma involving language areas (HGILAs) under GA. METHODS HGILAs cases were reviewed and collected between January 2009 and December 2020 in our center. Patients were separated into multimodal group (using neuronavigation, intraoperative MRI combined with direct electrical stimulation [DES] and neuromonitoring [IONM]) and conventional group (neuronavigation alone) and clinical outcomes were compared between groups. Studies of HGILAs were reviewed systematically and the meta-analysis results of previous (GA or AC) studies were compared with our results. RESULTS Finally, there were 263 patients in multimodal group and 137 patients in conventional group. Compared to the conventional group, the multimodal group achieved the higher median EOR (100% versus 94.32%, P < 0.001) and rate of gross total resection (GTR) (73.8% versus 36.5%, P < 0.001) and the lower incidence of permanent language deficit (PLD) (9.5% versus 19.7%, P = 0.004). The multimodal group achieved the longer median PFS (16.8 versus 10.3 months, P < 0.001) and OS (23.7 versus 15.7 months, P < 0.001) than the conventional group. The multimodal group achieved a higher rate of GTR than the cohorts in previous multimodal studies under GA and AC (73.8% versus 55.7% [95%CI 32.0-79.3%] versus 53.4% [35.5-71.2%]). The multimodal group had a lower incidence of PLD than the cohorts in previous multimodal studies under GA (9.5% versus 14.0% [5.8-22.1%]) and our incidence of PLD was a little higher than that of previous multimodal studies under AC (9.5% versus 7.5% [3.7-11.2%]). Our multimodal group also achieved a relative longer survival than previous studies. CONCLUSIONS Surgery assisted by multimodal techniques can achieve maximal safe resection for HGILAs under GA. Further prospective studies are needed to compare GA with AC for HGILAs.
Collapse
Affiliation(s)
- Meng Cui
- Department of Emergency, the Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
- Department of Neurosurgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
| | - Yukun Liu
- Department of Neurosurgery, Chinese Air Force Medical Center, Beijing, China
| | - Chunhui Zhou
- Department of Neurosurgery, the Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hewen Chen
- Department of Neurosurgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xin Gao
- Department of Neurosurgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jiayu Liu
- Department of Neurosurgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qingbao Guo
- Department of Neurosurgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Bing Guan
- Department of Health Economics, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
| | - Xiaodong Ma
- Department of Neurosurgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
| |
Collapse
|
17
|
Elia A, Young JS, Simboli GA, Roux A, Moiraghi A, Trancart B, Al-Adli N, Aboubakr O, Bedioui A, Leclerc A, Planet M, Parraga E, Benevello C, Oppenheim C, Chretien F, Dezamis E, Berger MS, Zanello M, Pallud J. A Preoperative Scoring System to Predict Function-Based Resection Limitation Due to Insufficient Participation During Awake Surgery. Neurosurgery 2023; 93:678-690. [PMID: 37018385 DOI: 10.1227/neu.0000000000002477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/06/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Failure in achieving a function-based resection related to the insufficient patient's participation is a drawback of awake surgery. OBJECTIVE To assess preoperative parameters predicting the risk of patient insufficient intraoperative cooperation leading to the arrest of the awake resection. METHODS Observational, retrospective, multicentric cohort analysis enrolling 384 (experimental dataset) and 100 (external validation dataset) awake surgeries. RESULTS In the experimental data set, an insufficient intraoperative cooperation occurred in 20/384 patients (5.2%), leading to awake surgery failure in 3/384 patients (ie, no resection, 0.8%), and precluded the achievement of the function-based resection in 17/384 patients (ie, resection limitation, 4.4%). The insufficient intraoperative cooperation significantly reduced the resection rates (55.0% vs 94.0%, P < .001) and precluded a supratotal resection (0% vs 11.3%, P = .017). Seventy years or older, uncontrolled epileptic seizures, previous oncological treatment, hyperperfusion on MRI, and mass effect on midline were independent predictors of insufficient cooperation during awake surgery ( P < .05). An Awake Surgery Insufficient Cooperation score was then assessed: 96.9% of patients (n = 343/354) with a score ≤2 presented a good intraoperative cooperation, while only 70.0% of patients (n = 21/30) with a score >2 presented a good intraoperative cooperation. In the experimental data set, similar date were found: 98.9% of patients (n = 98/99) with a score ≤2 presented a good cooperation, while 0% of patients (n = 0/1) with a score >2 presented a good cooperation. CONCLUSION Function-based resection under awake conditions can be safely performed with a low rate of insufficient patient intraoperative cooperation. The risk can be assessed preoperatively by a careful patient selection.
Collapse
Affiliation(s)
- Angela Elia
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia , Italy
- Université Paris Cité, Paris , France
| | - Jacob S Young
- Department of Neurological Surgery, University of California, San Francisco, California , USA
| | - Giorgia Antonia Simboli
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Université Paris Cité, Paris , France
| | - Alexandre Roux
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Université Paris Cité, Paris , France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris , France
| | - Alessandro Moiraghi
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Université Paris Cité, Paris , France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris , France
| | - Bénédicte Trancart
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Université Paris Cité, Paris , France
| | - Nadeem Al-Adli
- Department of Neurological Surgery, University of California, San Francisco, California , USA
| | - Oumaima Aboubakr
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Université Paris Cité, Paris , France
| | - Aziz Bedioui
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Université Paris Cité, Paris , France
- Department of Neurosurgery, Centre Hospitalier Universitaire Caen, Caen , France
| | - Arthur Leclerc
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Université Paris Cité, Paris , France
- Department of Neurosurgery, Centre Hospitalier Universitaire Caen, Caen , France
| | - Martin Planet
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Université Paris Cité, Paris , France
| | - Eduardo Parraga
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Université Paris Cité, Paris , France
| | - Chiara Benevello
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Université Paris Cité, Paris , France
| | - Catherine Oppenheim
- Université Paris Cité, Paris , France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris , France
- Department of Neuroradiology, Sainte-Anne Hospital, Paris , France
| | - Fabrice Chretien
- Université Paris Cité, Paris , France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris , France
- Department of Neuropathology, Sainte-Anne Hospital, Paris , France
| | - Edouard Dezamis
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Université Paris Cité, Paris , France
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, California , USA
| | - Marc Zanello
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Université Paris Cité, Paris , France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris , France
| | - Johan Pallud
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris , France
- Université Paris Cité, Paris , France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris , France
| |
Collapse
|
18
|
Bai H, Jiang C. Editorial: Advances in surgical approaches for the treatment of glioma. Front Oncol 2023; 13:1236341. [PMID: 37496655 PMCID: PMC10368180 DOI: 10.3389/fonc.2023.1236341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023] Open
|
19
|
Al-Adli NN, Young JS, Sibih YE, Berger MS. Technical Aspects of Motor and Language Mapping in Glioma Patients. Cancers (Basel) 2023; 15:cancers15072173. [PMID: 37046834 PMCID: PMC10093517 DOI: 10.3390/cancers15072173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
Gliomas are infiltrative primary brain tumors that often invade functional cortical and subcortical regions, and they mandate individualized brain mapping strategies to avoid postoperative neurological deficits. It is well known that maximal safe resection significantly improves survival, while postoperative deficits minimize the benefits associated with aggressive resections and diminish patients’ quality of life. Although non-invasive imaging tools serve as useful adjuncts, intraoperative stimulation mapping (ISM) is the gold standard for identifying functional cortical and subcortical regions and minimizing morbidity during these challenging resections. Current mapping methods rely on the use of low-frequency and high-frequency stimulation, delivered with monopolar or bipolar probes either directly to the cortical surface or to the subcortical white matter structures. Stimulation effects can be monitored through patient responses during awake mapping procedures and/or with motor-evoked and somatosensory-evoked potentials in patients who are asleep. Depending on the patient’s preoperative status and tumor location and size, neurosurgeons may choose to employ these mapping methods during awake or asleep craniotomies, both of which have their own benefits and challenges. Regardless of which method is used, the goal of intraoperative stimulation is to identify areas of non-functional tissue that can be safely removed to facilitate an approach trajectory to the equator, or center, of the tumor. Recent technological advances have improved ISM’s utility in identifying subcortical structures and minimized the seizure risk associated with cortical stimulation. In this review, we summarize the salient technical aspects of which neurosurgeons should be aware in order to implement intraoperative stimulation mapping effectively and safely during glioma surgery.
Collapse
Affiliation(s)
- Nadeem N. Al-Adli
- Department of Neurological Surgery, University of California, San Francisco, CA 94131, USA
- School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
| | - Jacob S. Young
- Department of Neurological Surgery, University of California, San Francisco, CA 94131, USA
| | - Youssef E. Sibih
- School of Medicine, University of California, San Francisco, CA 94131, USA
| | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, CA 94131, USA
| |
Collapse
|
20
|
Manfield J, Waqar M, Mercer D, Ehsan S, Bambrough J, Ibrahim N, Sivarajan K, Bailey M, Karabatsou K, Coope D, Ponnusamy A, Phang I, D'Urso PI. Multimodal mapping and monitoring is beneficial during awake craniotomy for intra-cranial tumours: results of a dual centre retrospective study. Br J Neurosurg 2023; 37:182-187. [PMID: 34918613 DOI: 10.1080/02688697.2021.2016622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The combination of awake craniotomy with multimodal neurophysiological mapping and monitoring in intra-axial tumour resection is not well described, but may have theoretical benefits which we sought to investigate. METHODS All patients undergoing awake craniotomy for tumour resection with cortical and/or subcortical stimulation together with one or more of electrocorticography (ECoG/EEG), motor or somatosensory evoked potentials were identified from the operative records of two surgeons at two centres over a 5 year period. Patient, operative and outcome data were collated. Statistical analysis was performed to evaluate factors predictive of intra-operative seizures and surgical outcomes. RESULTS 83 patients with a median age 50 years (18-80 years) were included. 80% had gliomas (37% low grade) and 13% metastases. Cortical mapping was negative in 35% (language areas) and 24% (motor areas). Complete or near total resection was achieved in 80% with 5% severe long-term neurological deficits. Negative cortical mapping was combined with positive subcortical mapping in 42% with no significant difference in extent of resection rates to patients undergoing positive cortical mapping (p = 0.95). Awake mapping could not be completed in 14%, but with no compromise to extent of resection (p = 0.55) or complication rates (p = 0.09). Intraoperative seizures occurred in 11% and were significantly associated with intra-operative EEG spikes (p = 0.003). CONCLUSIONS Awake multi-modal monitoring is a safe and well tolerated technique. It provides preservation of extent of resection and clinical outcomes in cases of aborted awake craniotomy. Negative cortical mapping in combination with positive subcortical mapping was also shown to be safe, although not hitherto well described. Electrocorticography further enables the differentiation of seizure activity from true positive mapping, and the successful treatment of spikes prior to full clinical seizures occurring.
Collapse
Affiliation(s)
- James Manfield
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences (MCCN), Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Mueez Waqar
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences (MCCN), Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Deborah Mercer
- Department of Neurophysiology, MCCN, Salford Royal Hospital, Manchester, UK
| | - Sheeba Ehsan
- Department of Neurophysiology, MCCN, Salford Royal Hospital, Manchester, UK
| | - Jacki Bambrough
- Department of Neurophysiology, MCCN, Salford Royal Hospital, Manchester, UK
| | - Nadir Ibrahim
- Department of Anaesthesia, MCCN, Salford Royal Hospital, Manchester, UK
| | - Kris Sivarajan
- Department of Anaesthesia, MCCN, Salford Royal Hospital, Manchester, UK
| | - Matt Bailey
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences (MCCN), Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Konstantina Karabatsou
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences (MCCN), Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - David Coope
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences (MCCN), Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Athi Ponnusamy
- Department of Neurophysiology, MCCN, Salford Royal Hospital, Manchester, UK
| | - Isaac Phang
- Department of Neurosurgery, Royal Preston Hospital. Lancashire teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Pietro Ivo D'Urso
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences (MCCN), Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
21
|
Mansouri A, Ibrahim S, Bello L, Martino J, Velasquez C. The current state of the art of primary motor mapping for tumor resection: A focused survey. Clin Neurol Neurosurg 2023; 229:107685. [PMID: 37105067 DOI: 10.1016/j.clineuro.2023.107685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/14/2023] [Accepted: 03/18/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Cortical and subcortical motor mapping has advanced the notion of maximal safe resection of intra-axial brain tumours, thereby preserving neurological functions as well as improving survival. Despite being an age-old and established neurosurgical procedure across the world, the strategy and techniques involved in motor mapping have a gamut of variation due to a lack of defined standard protocols. METHODS We disseminated a structured survey among focused group of neurosurgeons with established practices involving brain mapping. It consisted of 40 questions, split into five sections assessing the practice description, general approach for motor mapping, preference for asleep versus awake mapping, operative techniques and approach to representative tumor cases. Practice-patterns during primary motor mapping for brain tumours were analysed from responses of 51 neurosurgeons. RESULTS 60.8 % felt that any lesion even near (without infiltration) was suffice to define "involvement" of the cortical/subcortical motor pathways. 82.4 % felt that motor mapping was necessary for brain tumours involving motor pathways, irrespective of the tumor histology or patient age. 90.2 % opined that tumor location was the predominant factor affecting their choice between awake or asleep mapping. 31.4 % believed that all cases should be performed awake unless patient-related medical, psychological, or anaesthetic contraindications exist, whereas 45.1 % felt that all cases should be performed asleep unless language mapping is required. MRI, DTI-based tractography and intra-operative fluorescence were the most commonly employed surgical adjuncts. CONCLUSIONS The data from this survey may serve as a preliminary foundation for a more standardized approach to patient selection and the approach to motor mapping for brain tumors.
Collapse
Affiliation(s)
- Alireza Mansouri
- Department of Neurosurgery, Penn State Health, Hershey, PA, United States
| | - Sufyan Ibrahim
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Mi-lano, Milano, Italy
| | - Juan Martino
- Department of Neurological Surgery and Spine Unit, Hospital Universitario Marqués de Valdecilla & Instituto de Investigación Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
| | - Carlos Velasquez
- Department of Neurological Surgery and Spine Unit, Hospital Universitario Marqués de Valdecilla & Instituto de Investigación Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
| |
Collapse
|
22
|
Cui M, Guo Q, Chi Y, Zhang M, Yang H, Gao X, Chen H, Liu Y, Ma X. Predictive model of language deficit after removing glioma involving language areas under general anesthesia. Front Oncol 2023; 12:1090170. [PMID: 36741717 PMCID: PMC9892894 DOI: 10.3389/fonc.2022.1090170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/19/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose To establish a predictive model to predict the occurrence of language deficit for patients after surgery of glioma involving language areas (GILAs) under general anesthesia (GA). Methods Patients with GILAs were retrospectively collected in our center between January 2009 and December 2020. Clinical variables (age, sex, aphasia quotient [AQ], seizures and KPS), tumor-related variables (recurrent tumor or not, volume, language cortices invaded or not, shortest distance to language areas [SDLA], supplementary motor area or premotor area [SMA/PMA] involved or not and WHO grade) and intraoperative multimodal techniques (used or not) were analyzed by univariate and multivariate analysis to identify their association with temporary or permanent language deficits (TLD/PLD). The predictive model was established according to the identified significant variables. Receiver operating characteristic (ROC) curve was used to assess the accuracy of the predictive model. Results Among 530 patients with GILAs, 498 patients and 441 patients were eligible to assess TLD and PLD respectively. The multimodal group had the higher EOR and rate of GTR than conventional group. The incidence of PLD was 13.4% in multimodal group, which was much lower than that (27.6%, P<0.001) in conventional group. Three factors were associated with TLD, including SDLA (OR=0.85, P<0.001), preoperative AQ (OR=1.04, P<0.001) and multimodal techniques used (OR=0.41, P<0.001). Four factors were associated with PLD, including SDLA (OR=0.83, P=0.001), SMA/PMA involved (OR=3.04, P=0.007), preoperative AQ (OR=1.03, P=0.002) and multimodal techniques used (OR=0.35, P<0.001). The optimal shortest distance thresholds in detecting the occurrence of TLD/PLD were 1.5 and 4mm respectively. The optimal AQ thresholds in detecting the occurrence of TLD/PLD were 52 and 61 respectively. The cutoff values of the predictive probability for TLD/PLD were 23.7% and 16.1%. The area under ROC curve of predictive models for TLD and PLD were 0.70 (95%CI: 0.65-0.75) and 0.72 (95%CI: 0.66-0.79) respectively. Conclusion The use of multimodal techniques can reduce the risk of postoperative TLD/PLD after removing GILAs under general anesthesia. The established predictive model based on clinical variables can predict the probability of occurrence of TLD and PLD, and it had a moderate predictive accuracy.
Collapse
Affiliation(s)
- Meng Cui
- Department of Emergency, The Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China,Medical School of Chinese People's Liberation Army, Beijing, China,*Correspondence: Meng Cui, ; Xiaodong Ma,
| | - Qingbao Guo
- Medical School of Chinese People's Liberation Army, Beijing, China,Department of Neurosurgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yihong Chi
- Department of Information Technology, Xian Janssen Pharmaceutical Ltd., Beijing, China
| | - Meng Zhang
- Department of Neurosurgery, The Second Hospital of Southern District of Chinese People's Liberation Army Navy, Sanya, China
| | - Hui Yang
- Medical School of Chinese People's Liberation Army, Beijing, China,Department of Neurosurgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xin Gao
- Medical School of Chinese People's Liberation Army, Beijing, China,Department of Neurosurgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hewen Chen
- Medical School of Chinese People's Liberation Army, Beijing, China,Department of Neurosurgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yukun Liu
- Medical School of Chinese People's Liberation Army, Beijing, China,Department of Neurosurgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaodong Ma
- Medical School of Chinese People's Liberation Army, Beijing, China,Department of Neurosurgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China,*Correspondence: Meng Cui, ; Xiaodong Ma,
| |
Collapse
|
23
|
Miller JJ, Gonzalez Castro LN, McBrayer S, Weller M, Cloughesy T, Portnow J, Andronesi O, Barnholtz-Sloan JS, Baumert BG, Berger MS, Bi WL, Bindra R, Cahill DP, Chang SM, Costello JF, Horbinski C, Huang RY, Jenkins RB, Ligon KL, Mellinghoff IK, Nabors LB, Platten M, Reardon DA, Shi DD, Schiff D, Wick W, Yan H, von Deimling A, van den Bent M, Kaelin WG, Wen PY. Isocitrate dehydrogenase (IDH) mutant gliomas: A Society for Neuro-Oncology (SNO) consensus review on diagnosis, management, and future directions. Neuro Oncol 2023; 25:4-25. [PMID: 36239925 PMCID: PMC9825337 DOI: 10.1093/neuonc/noac207] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Isocitrate dehydrogenase (IDH) mutant gliomas are the most common adult, malignant primary brain tumors diagnosed in patients younger than 50, constituting an important cause of morbidity and mortality. In recent years, there has been significant progress in understanding the molecular pathogenesis and biology of these tumors, sparking multiple efforts to improve their diagnosis and treatment. In this consensus review from the Society for Neuro-Oncology (SNO), the current diagnosis and management of IDH-mutant gliomas will be discussed. In addition, novel therapies, such as targeted molecular therapies and immunotherapies, will be reviewed. Current challenges and future directions for research will be discussed.
Collapse
Affiliation(s)
- Julie J Miller
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - L Nicolas Gonzalez Castro
- Harvard Medical School, Boston, MA, USA
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Samuel McBrayer
- Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, 6000 Harry Hines Blvd, Dallas, Texas, 75235, USA
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | | | - Jana Portnow
- Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ovidiu Andronesi
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jill S Barnholtz-Sloan
- Informatics and Data Science (IDS), Center for Biomedical Informatics and Information Technology (CBIIT), Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), Bethesda, MD, USA
| | - Brigitta G Baumert
- Cantonal Hospital Graubunden, Institute of Radiation-Oncology, Chur, Switzerland
| | - Mitchell S Berger
- Department of Neurosurgery, University of California-San Francisco, San Francisco, California, USA
| | - Wenya Linda Bi
- Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Ranjit Bindra
- Department of Therapeutic Radiology, Brain Tumor Center, Yale School of Medicine, New Haven, CT, USA
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan M Chang
- Department of Neurosurgery, University of California-San Francisco, San Francisco, California, USA
| | - Joseph F Costello
- Department of Neurosurgery, University of California-San Francisco, San Francisco, California, USA
| | - Craig Horbinski
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Northwestern Medicine Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Raymond Y Huang
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Robert B Jenkins
- Individualized Medicine Research, Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, Minnesota 55901, USA
| | - Keith L Ligon
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ingo K Mellinghoff
- Department of Neurology, Evnin Family Chair in Neuro-Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - L Burt Nabors
- Department of Neurology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael Platten
- CCU Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - David A Reardon
- Harvard Medical School, Boston, MA, USA
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Diana D Shi
- Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - David Schiff
- Division of Neuro-Oncology, Department of Neurology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Wolfgang Wick
- Neuro-Oncology at the German Cancer Research Center (DKFZ), Program Chair of Neuro-Oncology at the National Center for Tumor Diseases (NCT), and Neurology and Chairman at the Neurology Clinic in Heidelberg, Heidelberg, Germany
| | - Hai Yan
- Genetron Health Inc, Gaithersburg, Maryland 20879, USA
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, and, Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), and, DKTK, INF 224, 69120 Heidelberg, Germany
| | - Martin van den Bent
- Brain Tumour Centre, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
| | - William G Kaelin
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Harvard Medical School, Boston, MA, USA
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| |
Collapse
|
24
|
Wang Y, Guo S, Wang N, Liu J, Chen F, Zhai Y, Wang Y, Jiao Y, Zhao W, Fan C, Xue Y, Gao G, Ji P, Wang L. The clinical and neurocognitive functional changes with awake brain mapping for gliomas invading eloquent areas: Institutional experience and the utility of The Montreal Cognitive Assessment. Front Oncol 2023; 13:1086118. [PMID: 36910631 PMCID: PMC9992726 DOI: 10.3389/fonc.2023.1086118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
Objective Awake craniotomy with intraoperative brain functional mapping effectively reduces the potential risk of neurological deficits in patients with glioma invading the eloquent areas. However, glioma patients frequently present with impaired neurocognitive function. The present study aimed to investigate the neurocognitive and functional outcomes of glioma patients after awake brain mapping and assess the experience of a tertiary neurosurgical center in China over eight years. Methods This retrospective study included 80 patients who underwent awake brain mapping for gliomas invading the eloquent cortex between January 2013 and December 2021. Clinical and surgical factors, such as the extent of resection (EOR), perioperative Karnofsky Performance Score (KPS), progression-free survival (PFS), and overall survival (OS), were evaluated. We also used the Montreal Cognitive Assessment (MoCA) to assess the neurocognitive status changes. Results The most frequently observed location of glioma was the frontal lobe (33/80, 41.25%), whereas the tumor primarily invaded the language-related cortex (36/80, 45%). Most patients had supratotal resection (11/80, 13.75%) and total resection (45/80, 56.25%). The median PFS was 43.2 months, and the median OS was 48.9 months in our cohort. The transient (less than seven days) neurological deficit rate was 17.5%, whereas the rate of persistent deficit (lasting for three months) was 15%. At three months of follow-up, most patients (72/80, 90%) had KPS scores > 80. Meanwhile, compared to the preoperative baseline tests, the changes in MoCA scores presented significant improvements at discharge and three months follow-up tests. Conclusion Awake brain mapping is a feasible and safe method for treating glioma invading the eloquent cortex, with the benefit of minimizing neurological deficits, increasing EOR, and extending survival time. The results of MoCA test indicated that brain mapping plays a critical role in preserving neurocognitive function during tumor resection.
Collapse
Affiliation(s)
- Yuan Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shaochun Guo
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Na Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jinghui Liu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fan Chen
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yulong Zhai
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yue Wang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yang Jiao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wenjian Zhao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chao Fan
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yanrong Xue
- National Time Service Center, Chinese Academy of Sciences, Xi'an, Shaanxi, China.,School of Optoelectronics, University of Chinese Academy of Sciences, Beijing, China
| | - GuoDong Gao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Peigang Ji
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Liang Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| |
Collapse
|
25
|
Larkin CJ, Yerneni K, Karras CL, Abecassis ZA, Zhou G, Zelano C, Selner AN, Templer JW, Tate MC. Impact of intraoperative direct cortical stimulation dynamics on perioperative seizures and afterdischarge frequency in patients undergoing awake craniotomy. J Neurosurg 2022; 137:1853-1861. [PMID: 35535844 DOI: 10.3171/2022.3.jns226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative stimulation is used as a crucial adjunct in neurosurgical oncology, allowing for greater extent of resection while minimizing morbidity. However, limited data exist regarding the impact of cortical stimulation on the frequency of perioperative seizures in these patients. METHODS A retrospective chart review of patients undergoing awake craniotomy with electrocorticography data by a single surgeon at the authors' institution between 2013 and 2020 was conducted. Eighty-three patients were identified, and electrocorticography, stimulation, and afterdischarge (AD)/seizure data were collected and analyzed. Stimulation characteristics (number, amplitude, density [stimulations per minute], composite score [amplitude × density], total and average stimulation duration, and number of positive stimulation sites) were analyzed for association with intraoperative seizures (ISs), ADs, and postoperative clinical seizures. RESULTS Total stimulation duration (p = 0.005), average stimulation duration (p = 0.010), and number of stimulations (p = 0.020) were found to significantly impact AD incidence. A total stimulation duration of more than 145 seconds (p = 0.04) and more than 60 total stimulations (p = 0.03) resulted in significantly higher rates of ADs. The total number of positive stimulation sites was associated with increased IS (p = 0.048). Lesions located within the insula (p = 0.027) were associated with increased incidence of ADs. Patients undergoing repeat awake craniotomy were more likely to experience IS (p = 0.013). Preoperative antiepileptic drug use, seizure history, and number of prior resections of any type showed no impact on the outcomes considered. The charge transferred to the cortex per second during mapping was significantly higher in the 10 seconds leading to AD than at any other time point examined in patients experiencing ADs, and was significantly higher than any time point in patients not experiencing ADs or ISs. Although the rate of transfer for patients experiencing ISs was highest in the 10 seconds prior to the seizure, it was not significantly different from those who did not experience an AD or IS. CONCLUSIONS The data suggest that intraoperative cortical stimulation is a safe and effective technique in maximizing extent of resection while minimizing neurological morbidity in patients undergoing awake craniotomies, and that surgeons may avoid ADs and ISs by minimizing duration and total number of stimulations and by decreasing the overall charge transferred to the cortex during mapping procedures.
Collapse
Affiliation(s)
- Collin J Larkin
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago
| | - Ketan Yerneni
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago
| | - Constantine L Karras
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago
| | - Zachary A Abecassis
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago
| | - Guangyu Zhou
- 2Department of Neuroscience, Northwestern University, Feinberg School of Medicine, Chicago; and
| | - Christina Zelano
- 2Department of Neuroscience, Northwestern University, Feinberg School of Medicine, Chicago; and
| | - Ashley N Selner
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago
| | - Jessica W Templer
- 3Department of Neurology, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - Matthew C Tate
- 1Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago
- 3Department of Neurology, Northwestern University, Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| |
Collapse
|
26
|
La Corte E, Ordóñez-Rubiano EG, Paiva WS, Johnson JM, Serrao G. Editorial: Current state of the art of human brain white matter: From structural and functional connectivity to neurosurgical applications. Front Neurol 2022; 13:1068212. [DOI: 10.3389/fneur.2022.1068212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022] Open
|
27
|
Monitoring Cortico-cortical Evoked Potentials Using Only Two 6-strand Strip Electrodes for Gliomas Extending to the Dominant Side of Frontal Operculum During One-step Tumor Removal Surgery. World Neurosurg 2022; 165:e732-e742. [PMID: 35798294 DOI: 10.1016/j.wneu.2022.06.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Resection of the dominant side of gliomas extending to the frontal operculum has high risk of severe language dysfunction. Here, we report recording cortico-cortical evoked potentials (CCEP) using only two 6-strand strip electrodes to monitor language-related fibers intraoperatively. We examined whether this simple procedure is useful for removing gliomas extending to the dominant side of frontal operculum. METHODS This study included 7 cases of glioma extending to the left frontal operculum. The frontal language area (FLA) was first identified by functional mapping during awake craniotomy. Next, a 6-strand strip electrode was placed on the FLA, while on the temporal side, an electrode was placed so as to slide parallel to the sylvian fissure toward the posterior language area. Electrical stimulation was performed using the electrode on the frontal side, and CCEPs were measured from the electrode on the temporal side. RESULTS CCEPs were detected in all cases. Immediately after surgery, all patients demonstrated language dysfunction to varying degree. CCEP decreased to 10% in 1 patient, who recovered language function after 24 months. CCEP decreased slightly 80% in 1, and, in the 5 other cases, CCEPs did not change. These 5 patients soon recovered language function within 2 weeks to 1 month. CONCLUSIONS This study confirmed the utility of CCEP monitoring using only two 6-strand strip electrodes during one-step surgery. We believe this simple method helped in monitoring intraoperative language function and predicting its postoperative recovery in patients with gliomas extending to the dominant side of frontal operculum.
Collapse
|
28
|
Axelson HW, Latini F, Jemstedt M, Ryttlefors M, Zetterling M. Continuous subcortical language mapping in awake glioma surgery. Front Oncol 2022; 12:947119. [PMID: 36033478 PMCID: PMC9416475 DOI: 10.3389/fonc.2022.947119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
Abstract
Repetitive monopolar short-train stimulation (STS) delivered from a suction probe enables continuous mapping and distance assessment of corticospinal tracts during asleep glioma resection. In this study, we explored this stimulation technique in awake glioma surgery. Fourteen patients with glioma involving language-related tracts were prospectively included. Continuous (3-Hz) cathodal monopolar STS (five pulses, 250 Hz) was delivered via the tip of a suction probe throughout tumor resection while testing language performance. At 70 subcortical locations, surgery was paused to deliver STS in a steady suction probe position. Monopolar STS influence on language performance at different subcortical locations was separated into three groups. Group 1 represented locations where STS did not produce language disturbance. Groups 2 and 3 represented subcortical locations where STS produced language interference at different threshold intensities (≥7.5 and ≤5 mA, respectively). For validation, bipolar Penfield stimulation (PS; 60 Hz for 3 s) was used as a “gold standard” comparison method to detect close proximity to language-related tracts and classified as positive or negative regarding language interference. There was no language interference from STS in 28 locations (Group 1), and PS was negative for all sites. In Group 2 (STS threshold ≥ 7.5 mA; median, 10 mA), there was language interference at 18 locations, and PS (median, 4 mA) was positive in only one location. In Group 3 (STS threshold ≤ 5 mA; median, 5 mA), there was language interference at 24 locations, and positive PS (median 4 mA) was significantly (p < 0.01) more common (15 out of 24 locations) compared with Groups 1 and 2. Despite the continuous stimulation throughout tumor resection, there were no seizures in any of the patients. In five patients, temporary current spread to the facial nerve was observed. We conclude that continuous subcortical STS is feasibly also in awake glioma surgery and that no language interference from STS or interference at ≥7.5 mA seems to indicate safe distance to language tracts as judged by PS comparisons. STS language interference at STS ≤ 5 mA was not consistently confirmed by PS, which needs to be addressed.
Collapse
Affiliation(s)
- Hans W. Axelson
- Department of Medical Sciences, Section of Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
- *Correspondence: Hans W. Axelson,
| | - Francesco Latini
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Malin Jemstedt
- Department of Medical Sciences, Speech-Language Pathology, Uppsala University, Uppsala, Sweden
| | - Mats Ryttlefors
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Maria Zetterling
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| |
Collapse
|
29
|
Patchana T, Lopez JA, Majeed G, Ho A, Alarcon T, Plantak N, Vu P, Siddiqi J. The Awake Craniotomy: A Patient’s Experience and A Literature Review. Cureus 2022; 14:e26441. [PMID: 35915692 PMCID: PMC9338386 DOI: 10.7759/cureus.26441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2022] Open
Abstract
We present a case report and a literature review of the awake craniotomy procedure for mass resection, with emphasis on the historical aspects, anatomical and surgical considerations, and, uniquely, a patient’s experience undergoing this procedure. This procedure is a safe and effective method for lesion resection when working in and around eloquent brain. We have described our process of guiding a patient through an awake craniotomy procedure and detailed the patient's experience in this study. We also conducted a systematic literature review of studies involving awake craniotomy over three years, 2018-2021. Lastly, we compared the methodology used by our institution and the current mostly used methods within the neurosurgical community. Several studies were identified using PubMed and Google Scholar. Awake craniotomy is a safe and effective method of achieving a high rate of resection of lesions located in and around the eloquent cortex with a low degree of postoperative neurological deficit.
Collapse
|
30
|
Effect of Parecoxib Sodium Preemptive Analgesia on the Recovery Period of General Anesthesia in Patients Undergoing Glioma Resection. JOURNAL OF ONCOLOGY 2022; 2022:4934343. [PMID: 35734224 PMCID: PMC9208977 DOI: 10.1155/2022/4934343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/26/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
Objective To investigate the effect of parecoxib sodium preemptive analgesia on postoperative complications and postoperative recovery of patients undergoing glioma resection. Methods A total of 200 eligible patients with low-grade gliomas in the functional brain area scheduled for an awake craniotomy between January 2017 and December 2020 were reviewed. The subjects were divided into two groups: the study group (n = 100) given dexmedetomidine plus parecoxib sodium for pre-emptive analgesia 30 minutes preoperatively, and the control group (n = 100) receiving dexmedetomidine alone. Venous blood was collected before surgery, at the time of postoperative recovery, and 24 hours after operation, mean artery pressure (MAP) and heart rate (HR) were recorded during surgery. Sedation satisfaction, agitation rate, numerical pain score (NRS), postoperative complications, minimental state examination (MMSE) scores, quality of life (QoL) scores, and incidence of adverse events were also investigated after the surgery. Results There were no significant differences in operation time, awakening time, intraoperative awakening time, and extubation time between the two groups (P > 0.05). Compared with the control group, the ΔMAP (7.26 ± 2.21 versus 5.78 ± 2.36 mmHg) and the ΔHR (11.35 ± 3.66 versus 8.84 ± 2.47 beats/min) were significantly lower in the study group (P < 0.05). Compared with the control group, the satisfaction was higher and agitation rate was lower in the study group (P < 0.05). The incidence of intracranial infection and pulmonary infection decreased after operation (P < 0.05). The NRS of the study group was remarkably lower than the control group at 12 hours postoperatively Preoperative MMSE score and QoL score showed no statistical difference (P > 0.05), while postoperative MMSE and QoL scores showed statistical difference (P < 0.05). Conclusion This study suggests that parecoxib sodium can significantly improve the level of sedation and analgesia in patients undergoing glioma resection, reduce the incidence of intracranial infection and pulmonary infection.
Collapse
|
31
|
Balogun JA. Situating Sub-Saharan Africa Within Intra-Operative Innovations in Neurooncology. Front Surg 2022; 9:889965. [PMID: 35813043 PMCID: PMC9260707 DOI: 10.3389/fsurg.2022.889965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- James A. Balogun
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan and Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
- Correspondence: James A. Balogun
| |
Collapse
|
32
|
Reitz SC, Behrens M, Lortz I, Conradi N, Rauch M, Filipski K, Voss M, Kell C, Czabanka M, Forster MT. Neurocognitive Outcome and Seizure Freedom After Awake Surgery of Gliomas. Front Oncol 2022; 12:815733. [PMID: 35463387 PMCID: PMC9023117 DOI: 10.3389/fonc.2022.815733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Gliomas are often diagnosed due to epileptic seizures as well as neurocognitive deficits. First treatment choice for patients with gliomas in speech-related areas is awake surgery, which aims at maximizing tumor resection while preserving or improving patient’s neurological status. The present study aimed at evaluating neurocognitive functioning and occurrence of epileptic seizures in patients suffering from gliomas located in language-related areas before and after awake surgery as well as during their follow up course of disease. Materials and Methods In this prospective study we included patients who underwent awake surgery for glioma in the inferior frontal gyrus, superior temporal gyrus, or anterior temporal lobe. Preoperatively, as well as in the short-term (median 4.1 months, IQR 2.1-6.0) and long-term (median 18.3 months, IQR 12.3-36.6) postoperative course, neurocognitive functioning, neurologic status, the occurrence of epileptic seizures and number of antiepileptic drugs were recorded. Results Between 09/2012 and 09/2019, a total of 27 glioma patients, aged 36.1 ± 11.8 years, were included. Tumor resection was complete in 15, subtotal in 6 and partial in 6 patients, respectively. While preoperatively impairment in at least one neurocognitive domain was found in 37.0% of patients, postoperatively, in the short-term, 36.4% of patients presented a significant deterioration in word fluency (p=0.009) and 34.8% of patients in executive functions (p=0.049). Over the long-term, scores improved to preoperative baseline levels. The number of patients with mood disturbances significantly declined from 66.7% to 34.8% after surgery (p=0.03). Regarding seizures, these were present in 18 (66.7%) patients prior to surgery. Postoperatively, 22 (81.5%) patients were treated with antiepileptic drugs with all patients presenting seizure-freedom. Conclusions In patients suffering from gliomas in eloquent areas, the combination of awake surgery, regular neurocognitive assessment - considering individual patients´ functional outcome and rehabilitation needs – and the individual adjustment of antiepileptic therapy results in excellent patient outcome in the long-term course.
Collapse
Affiliation(s)
- Sarah Christina Reitz
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Marion Behrens
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Irina Lortz
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Nadine Conradi
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Maximilian Rauch
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Katharina Filipski
- Edinger Institute, Institute of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung), Partner Site Frankfurt/Mainz, Heidelberg, Germany.,German Cancer Research Center (Deutsches Krebsforschungszentrum), Heidelberg, Germany
| | - Martin Voss
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Christian Kell
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Marie-Therese Forster
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| |
Collapse
|
33
|
Jensdottir M, Beniaminov S, Jakola AS, Persson O, Norrelgen F, Hylin S, Fletcher-Sandersjöö A, Bartek J. Standardized reporting of adverse events and functional status from the first 5 years of awake surgery for gliomas: a population-based single-institution consecutive series. Acta Neurochir (Wien) 2022; 164:1995-2008. [PMID: 35420374 DOI: 10.1007/s00701-022-05191-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report our experience and investigate frequencies of adverse events and functional status from the first 5 years of performing awake surgery for gliomas in a single-center population-based setting. METHODS We conducted a review of all patients with a glioma treated with awake surgery during the first 5 years following introduction of awake surgery at our center (February 2015 to February 2020). We assessed functional and radiological outcome, with adverse events classified according to the Landriel-Ibanez classification for neurosurgical complications, while neurological deficits were further subdivided into transient vs permanent. We sought to analyze our initial results and learning curve, as well as compare our results with literature. RESULTS Forty-two patients were included. The median age was 38 years (range 18-66) and 13 (31%) were female. The indication for awake surgery was a presumed glioma in or near an eloquent area. The overall 30-day complication rate was 25 (59%), with 19 (45%) grade I complications, 3 (7%) grade II complications, and 3 (7%) grade III complications. Fifteen patients (36%) experienced transient neurological deficits, and 11 (26%) permanent neurological deficits. At 3-month follow-up, the Karnofsky Performance Score was 80 or higher for the entire cohort. The median extent of resection was 87%, with GTR achieved in 11 (26%). In search of potential learning curve difficulties, patients were divided into the 21 patients treated first (Early Group) versus the remaining 21 patients treated later (Late Group); no statistically significant difference in operating time, amount of tumor removed, or incidence of long-term postoperative neurological deficit was identified between groups. No awake surgery was aborted due to seizures. Comparison to the literature was limited by the diverse and unsystematic way in which previous studies have reported adverse events after awake craniotomy for gliomas. CONCLUSION We provide a standardized report of adverse events and functional status following awake surgery for glioma during a single-center 5-year learning period, with similar rates of severe adverse events and functional outcome compared to literature without concerns of substantial learning curve difficulties. However, this comparison was flawed by non-standardized reporting of complications, highlighting a demand for more standardized reporting of adverse events after awake craniotomies.
Collapse
Affiliation(s)
- Margret Jensdottir
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Stanislav Beniaminov
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Asgeir S Jakola
- Sahlgrenska Academy and Department of Neurosurgery, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Oscar Persson
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Fritjof Norrelgen
- Department of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Sofia Hylin
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Fletcher-Sandersjöö
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jiri Bartek
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
34
|
Current Status of Neuromodulation-Induced Cortical Prehabilitation and Considerations for Treatment Pathways in Lower-Grade Glioma Surgery. LIFE (BASEL, SWITZERLAND) 2022; 12:life12040466. [PMID: 35454957 PMCID: PMC9024440 DOI: 10.3390/life12040466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/19/2022] [Accepted: 03/19/2022] [Indexed: 12/15/2022]
Abstract
The infiltrative character of supratentorial lower grade glioma makes it possible for eloquent neural pathways to remain within tumoural tissue, which renders complete surgical resection challenging. Neuromodulation-Induced Cortical Prehabilitation (NICP) is intended to reduce the likelihood of premeditated neurologic sequelae that otherwise would have resulted in extensive rehabilitation or permanent injury following surgery. This review aims to conceptualise current approaches involving Repetitive Transcranial Magnetic Stimulation (rTMS-NICP) and extraoperative Direct Cortical Stimulation (eDCS-NICP) for the purposes of inducing cortical reorganisation prior to surgery, with considerations derived from psychiatric, rehabilitative and electrophysiologic findings related to previous reports of prehabilitation. Despite the promise of reduced risk and incidence of neurologic injury in glioma surgery, the current data indicates a broad but compelling possibility of effective cortical prehabilitation relating to perisylvian cortex, though it remains an under-explored investigational tool. Preliminary findings may prove sufficient for the continued investigation of prehabilitation in small-volume lower-grade tumour or epilepsy patients. However, considering the very low number of peer-reviewed case reports, optimal stimulation parameters and duration of therapy necessary to catalyse functional reorganisation remain equivocal. The non-invasive nature and low risk profile of rTMS-NICP may permit larger sample sizes and control groups until such time that eDCS-NICP protocols can be further elucidated.
Collapse
|
35
|
A systematic review of the use of subcortical intraoperative electrical stimulation mapping for monitoring of executive deficits and neglect: what is the evidence so far? Acta Neurochir (Wien) 2022; 164:177-191. [PMID: 34674026 PMCID: PMC8761150 DOI: 10.1007/s00701-021-05012-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/21/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Over the past decade, the functional importance of white matter pathways has been increasingly acknowledged in neurosurgical planning. A method to directly study anatomo-functional correlations is direct electrical stimulation (DES). DES has been widely accepted by neurosurgeons as a reliable tool to minimize the occurrence of permanent postoperative motor, vision, and language deficits. In recent years, DES has also been used for stimulation mapping of other cognitive functions, such as executive functions and visuospatial awareness. METHODS The aim of this review is to summarize the evidence so far from DES studies on subcortical pathways that are involved in visuospatial awareness and in the following three executive functions: (1) inhibitory control, (2) working memory, and (3) cognitive flexibility. RESULTS Eleven articles reported on intraoperative electrical stimulation of white matter pathways to map the cognitive functions and explicitly clarified which subcortical tract was stimulated. The results indicate that the right SLF-II is involved in visuospatial awareness, the left SLF-III and possibly the right SLF-I are involved in working memory, and the cingulum is involved in cognitive flexibility. CONCLUSIONS We were unable to draw any more specific conclusions, nor unequivocally establish the critical involvement of pathways in executive functions or visuospatial awareness due to the heterogeneity of the study types and methods, and the limited number of studies that assessed these relationships. Possible approaches for future research to obtain converging and more definite evidence for the involvement of pathways in specific cognitive functions are discussed.
Collapse
|
36
|
Aabedi AA, Young JS, Zhang Y, Ammanuel S, Morshed RA, Dalle Ore C, Brown D, Phillips JJ, Oberheim Bush NA, Taylor JW, Butowski N, Clarke J, Chang SM, Aghi M, Molinaro AM, Berger MS, Hervey-Jumper SL. Association of Neurological Impairment on the Relative Benefit of Maximal Extent of Resection in Chemoradiation-Treated Newly Diagnosed Isocitrate Dehydrogenase Wild-Type Glioblastoma. Neurosurgery 2022; 90:124-130. [PMID: 34982879 PMCID: PMC9514750 DOI: 10.1227/neu.0000000000001753] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increases in the extent of resection of both contrast-enhanced (CE) and non-contrast-enhanced (NCE) tissue are associated with substantial survival benefits in patients with isocitrate dehydrogenase wild-type glioblastoma. The fact, however, remains that these lesions exist within the framework of complex neural circuitry subserving cognition, movement, and behavior, all of which affect the ultimate survival outcome. The prognostic significance of the interplay between CE and NCE cytoreduction and neurological morbidity is poorly understood. OBJECTIVE To identify a clinically homogenous population of 228 patients with newly diagnosed isocitrate dehydrogenase wild-type glioblastoma, all of whom underwent maximal safe resection of CE and NCE tissue and adjuvant chemoradiation. We then set out to delineate the competing interactions between resection of CE and NCE tissue and postoperative neurological impairment with respect to overall survival. METHODS Nonparametric multivariate models of survival were generated via recursive partitioning to provide a clinically intuitive framework for the prognostication and surgical management of such patients. RESULTS We demonstrated that the presence of a new postoperative neurological impairment was the key factor in predicting survival outcomes across the entire cohort. Patients older than 60 yr who suffered from at least one new impairment had the worst survival outcome regardless of extent of resection (median of 11.6 mo), whereas those who did not develop a new impairment had the best outcome (median of 28.4 mo) so long as all CE tissue was resected. CONCLUSION Our data provide novel evidence for management strategies that prioritize safe and complete resection of CE tissue.
Collapse
Affiliation(s)
- Alexander A Aabedi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jacob S Young
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Yalan Zhang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Simon Ammanuel
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Ramin A Morshed
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Cecilia Dalle Ore
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Desmond Brown
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joanna J Phillips
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Nancy Ann Oberheim Bush
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Jennie W Taylor
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Nicholas Butowski
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jennifer Clarke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Susan M Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Manish Aghi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Annette M Molinaro
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
37
|
Abstract
As the epidemiological and clinical burden of brain metastases continues to grow, advances in neurosurgical care are imperative. From standard magnetic resonance imaging (MRI) sequences to functional neuroimaging, preoperative workups for metastatic disease allow high-resolution detection of lesions and at-risk structures, facilitating safe and effective surgical planning. Minimally invasive neurosurgical approaches, including keyhole craniotomies and tubular retractors, optimize the preservation of normal parenchyma without compromising extent of resection. Supramarginal surgery has pushed the boundaries of achieving complete removal of metastases without recurrence, especially in eloquent regions when paired with intraoperative neuromonitoring. Brachytherapy has highlighted the potential of locally delivering therapeutic agents to the resection cavity with high rates of local control. Neuronavigation has become a cornerstone of operative workflow, while intraoperative ultrasound (iUS) and intraoperative brain mapping generate real-time renderings of the brain unaffected by brain shift. Endoscopes, exoscopes, and fluorescent-guided surgery enable increasingly high-definition visualizations of metastatic lesions that were previously difficult to achieve. Pushed forward by these multidisciplinary innovations, neurosurgery has never been a safer, more effective treatment for patients with brain metastases.
Collapse
Affiliation(s)
- Patrick R Ng
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bryan D Choi
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Manish K Aghi
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
38
|
Louppe E, Moritz-Gasser S, Duffau H. Language recovery through a two-stage awake surgery in an aphasic patient with a voluminous left fronto-temporo-insular glioma: case report. Acta Neurochir (Wien) 2021; 163:3115-3119. [PMID: 34275021 DOI: 10.1007/s00701-021-04932-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/26/2021] [Indexed: 12/18/2022]
Abstract
Awake surgery is difficult in glioma patients with preoperative aphasia. A 29-year-old right-handed bilingual (Spanish/English) patient experienced intractable seizures with severe language disorders due to a voluminous left fronto-temporo-insular tumor. We performed awake procedure with initial laborious language mapping, but with real-time improvement throughout the debulking, allowing preservation of the connectivity. A substantial residue was left. Postoperative cognitive rehabilitation resulted in a dramatic functional improvement, in both languages, permitting a complementary awake surgery, this time with a perfect collaboration of the patient. This multistep strategy enabled 92% of resection while enhancing quality of life with language recovery and epilepsy control.
Collapse
Affiliation(s)
- Elisa Louppe
- Department of Neurosurgery, Montpellier University Medical Center, 34295, Montpellier, France
- Institute of Functional Genomics, INSERM U-1191, University of Montpellier, 34298, Montpellier, France
| | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Montpellier University Medical Center, 34295, Montpellier, France
- Institute of Functional Genomics, INSERM U-1191, University of Montpellier, 34298, Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Montpellier University Medical Center, 34295, Montpellier, France.
- Institute of Functional Genomics, INSERM U-1191, University of Montpellier, 34298, Montpellier, France.
- Department of Neurosurgery, Gui de Chauliac Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
| |
Collapse
|
39
|
Murcia D, D'Souza S, Abozeid M, Thompson JA, Djoyum TD, Ormond DR. Investigation of Asleep versus Awake Motor Mapping in Resective Brain Surgery. World Neurosurg 2021; 157:e129-e136. [PMID: 34619401 DOI: 10.1016/j.wneu.2021.09.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To develop an asleep motor mapping paradigm for accurate detection of the corticospinal tract during glioma surgery and compare outcomes with awake patients undergoing glioma resection. METHODS A consecutive cohort of adult patients undergoing craniotomy for suspected diffuse glioma with tumor in a perirolandic location who had awake or asleep cortical and subcortical motor mapping with positive areas of motor stimulation were assessed for postoperative extent of resection (EOR), permanent neurological deficit, and proximity of stimulation to diffusion tensor imaging-based corticospinal tract depiction on preoperative magnetic resonance imaging. Outcome data were compared between asleep and awake groups. RESULTS In the asleep group, all 16 patients had improved or no change in motor function at last follow-up (minimum 3 months of follow-up). In the awake group, all 23 patients had improved function or no change at last follow-up. EOR was greater in the asleep group (mean [SD] EOR 88.71% [17.56%]) versus the awake group (mean [SD] EOR 80.62% [24.44%]), although this difference was not statistically significant (P = 0.3802). Linear regression comparing distance from stimulation to corticospinal tract in asleep (n = 14) and awake (n = 4) patients was r = -0.3759, R2 = 0.1413, P = 0.1853, and 95% confidence interval = -0.4453 to 0.09611 and r = 0.7326, R2 = 0.5367, P = 0.2674, and 95% confidence interval = -7.042 to 14.75, respectively. CONCLUSION In this small patient series, asleep motor mapping using commonly available motor evoked potential hardware appears to be safe and efficacious in regard to EOR and functional outcomes.
Collapse
Affiliation(s)
- Derrick Murcia
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shawn D'Souza
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mohab Abozeid
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Teguo Daniel Djoyum
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - D Ryan Ormond
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
| |
Collapse
|
40
|
Hartung SL, Mandonnet E, de Witt Hamer P, Klein M, Wager M, Rech F, Pallud J, Pessanha Viegas C, Ille S, Krieg SM, Robe PA, van Zandvoort MJE. Impaired Set-Shifting from Dorsal Stream Disconnection: Insights from a European Series of Right Parietal Lower-Grade Glioma Resection. Cancers (Basel) 2021; 13:cancers13133337. [PMID: 34283043 PMCID: PMC8267741 DOI: 10.3390/cancers13133337] [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] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Awake surgery with cognitive monitoring has increasingly been implemented to preserve brain networks and functionality. More recently, not only surgery in the left but also in the right hemisphere, i.c., the parietal lobe, was associated with potential risk for deficits in cognitive functions, such as cognitive flexibility. We describe an explorative pilot study in an international consortium within clinical care as usual. Careful interpretation of our findings indicates that disconnection of the lateral part of the dorsal stream correlated with impaired set-shifting. More importantly, it illustrates the need for international collaboration on neuropsychological tests and methodologies to improve our understanding of white matter networks at risk during awake surgery. Abstract Awake surgery with cognitive monitoring has increasingly been implemented to preserve brain networks and functionality. More recently, not only surgery in the left but also in the right hemisphere, i.c., the parietal lobe, was associated with potential risk for deficits in cognitive functions, such as cognitive flexibility. In this explorative pilot study, we compare cognitive performance more than three months after surgery with baseline measurements and explore the association between cognitive decline and subcortical tracts that may have been severed during surgery in the right hemisphere. Twenty-two patients who underwent surgery for a right parietal low-grade glioma were assessed pre- and postoperatively using the Trail Making Test and the Stroop task to administer set-shifting abilities and inhibition. Volume measurements and lesion–symptom mapping analyses were performed on postoperative MRI scans. Careful interpretation of the results shows a change in TMT performance and not on the Stroop Task when the lateral part of the arcuate fasciculus is damaged, indicating that disconnection of the lateral part of the dorsal stream might be correlated specifically with impaired set-shifting and not with inhibition. More importantly, this study underlines the need for international concertation to allow larger studies to increase power and perform more detailed analyses.
Collapse
Affiliation(s)
- Suzanne L. Hartung
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (P.A.R.); (M.J.E.v.Z.)
- Correspondence:
| | | | - Philip de Witt Hamer
- Department of Neurosurgery, Location VUmc, Cancer Center Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands;
| | - Martin Klein
- Department of Medical Psychology and Brain Tumor Center Amsterdam at Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Michel Wager
- Department of Neurological Surgery, Poitiers University Hospital, 86021 Poitiers, France;
| | - Fabien Rech
- CHRU-Nancy, Service de Neurochirurgie, Université de Lorraine, F-54000 Nancy, France;
- CNRS, CRAN, Université de Lorraine, F-54000 Nancy, France
| | - Johan Pallud
- Department of Neursurgery, Saint-Anne Hospital, 75014 Paris, France;
| | | | - Sebastian Ille
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany; (S.I.); (S.M.K.)
| | - Sandro M. Krieg
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany; (S.I.); (S.M.K.)
| | - Pierre A. Robe
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (P.A.R.); (M.J.E.v.Z.)
| | - Martine J. E. van Zandvoort
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (P.A.R.); (M.J.E.v.Z.)
- Department of Experimental Psychology, Utrecht University, 3584 CS Utrecht, The Netherlands
| |
Collapse
|
41
|
Aabedi AA, Kakaizada S, Young JS, Ahn E, Weissman DH, Berger MS, Brang D, Hervey-Jumper SL. Balancing task sensitivity with reliability for multimodal language assessments. J Neurosurg 2021; 135:1817-1824. [PMID: 34049284 PMCID: PMC10404475 DOI: 10.3171/2020.10.jns202947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative tasks for awake language mapping are typically selected based on the language tracts that will likely be encountered during tumor resection. However, diminished attention and arousal secondary to perioperative sedatives may reduce a task's usefulness for identifying eloquent cortex. For instance, accuracy in performing select language tasks may be high preoperatively but decline in the operating room. In the present study, the authors sought to identify language tasks that can be performed with high accuracy in both situational contexts so the neurosurgical team can be confident that speech errors committed during awake language mapping result from direct cortical stimulation to eloquent cortex, rather than from poor performance in general. METHODS We administered five language tasks to 44 patients: picture naming (PN), text reading (TR), auditory object naming (AN), repetition of 4-syllable words (4SYL), and production of syntactically intact sentences (SYNTAX). Performance was assessed using the 4-point scale of the quick aphasia battery 24 hours preoperatively and intraoperatively. We next determined whether or not accuracy on each task was higher preoperatively than intraoperatively. We also determined whether 1) intraoperative accuracy on a given task predicted intraoperative performance on the other tasks and 2) low preoperative accuracy on a task predicted a decrease in accuracy intraoperatively. RESULTS Relative to preoperative accuracy, intraoperative accuracy declined on PN (3.90 vs 3.82, p = 0.0001), 4SYL (3.96 vs 3.91, p = 0.0006), and SYNTAX (3.85 vs 3.67, p = 0.0001) but not on TR (3.96 vs 3.94, p = 0.13) or AN (3.70 vs 3.58, p = 0.058). Intraoperative accuracy on PN and AN independently predicted intraoperative accuracy on the remaining language tasks (p < 0.001 and p < 0.01, respectively). Finally, low preoperative accuracy on SYNTAX predicted a decrease in accuracy on this task intraoperatively (R2 = 0.36, p = 0.00002). CONCLUSIONS While TR lacks sensitivity in identifying language deficits at baseline, accuracy on TR is stable across testing settings. Baseline accuracy on the other four of our five language tasks was not predictive of intraoperative performance, signifying the need to repeat language tests prior to stimulation mapping to confirm reliability.
Collapse
Affiliation(s)
- Alexander A. Aabedi
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Sofia Kakaizada
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Jacob S. Young
- Department of Neurological Surgery, University of California, San Francisco, California
| | - EunSeon Ahn
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | | | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, California
| | - David Brang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | | |
Collapse
|
42
|
Krambek MC, Vitorino-Araújo JL, Lovato RM, Veiga JCE. Awake craniotomy in brain tumors - Technique systematization and the state of the art. Rev Col Bras Cir 2021; 48:e20202722. [PMID: 33978121 PMCID: PMC10683424 DOI: 10.1590/0100-6991e-20202722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 02/03/2021] [Indexed: 02/07/2023] Open
Abstract
The anesthesia for awake craniotomy (AC) is a consecrated anesthetic technique that has been perfected over the years. Initially used to map epileptic foci, it later became the standard technique for the removal of glial neoplasms in eloquent brain areas. We present an AC anesthesia technique consisting of three primordial times, called awake-asleep-awake, and their respective particularities, as well as delve into the anesthetic medications used. Its use in patients with low and high-grade gliomas was favorable for the resection of tumors within the functional boundaries of patients, with shorter hospital stay and lower direct costs. The present study aims to systematize the technique based on the experience of the largest philanthropic hospital in Latin America and discusses the most relevant aspects that have consolidated this technique as the most appropriate in the surgery of gliomas in eloquent areas.
Collapse
Affiliation(s)
- Márcio Cardoso Krambek
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Anestesiologia - ISCMSP, SP, Brasil
- - Hospital Sírio Libanês - São Paulo, SP, Brasil
- - Hospital HCOR - São Paulo, SP, Brasil
| | - João Luiz Vitorino-Araújo
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Neurocirurgia - ISCMSP, SP, Brasil
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brasil
- - Hospital Sírio Libanês - São Paulo, SP, Brasil
- - Hospital HCOR - São Paulo, SP, Brasil
| | - Renan Maximilian Lovato
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Neurocirurgia - ISCMSP, SP, Brasil
- - Hospital Sírio Libanês - São Paulo, SP, Brasil
- - Hospital HCOR - São Paulo, SP, Brasil
| | - José Carlos Esteves Veiga
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Neurocirurgia - ISCMSP, SP, Brasil
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brasil
| |
Collapse
|
43
|
Latini F, Axelson H, Fahlström M, Jemstedt M, Alberius Munkhammar Å, Zetterling M, Ryttlefors M. Role of Preoperative Assessment in Predicting Tumor-Induced Plasticity in Patients with Diffuse Gliomas. J Clin Med 2021; 10:jcm10051108. [PMID: 33799925 PMCID: PMC7961995 DOI: 10.3390/jcm10051108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 01/03/2023] Open
Abstract
When diffuse gliomas (DG) affect the brain’s potential to reorganize functional networks, patients can exhibit seizures and/or language/cognitive impairment. The tumor–brain interaction and the individual connectomic organization cannot be predicted preoperatively. We aimed to, first, investigate the relationship between preoperative assessment and intraoperative findings of eloquent tumors in 36 DG operated with awake surgery. Second, we also studied possible mechanisms of tumor-induced brain reorganization in these patients. FLAIR-MRI sequences were used for tumor volume segmentation and the Brain-Grid system (BG) was used as an overlay for infiltration analysis. Neuropsychological (NPS) and/or language assessments were performed in all patients. The distance between eloquent spots and tumor margins was measured. All variables were used for correlation and logistic regression analyses. Eloquent tumors were detected in 75% of the patients with no single variable able to predict this finding. Impaired NPS functions correlated with invasive tumors, crucial location (A4C2S2/A3C2S2-voxels, left opercular-insular/sub-insular region) and higher risk of eloquent tumors. Epilepsy was correlated with larger tumor volumes and infiltrated A4C2S2/A3C2S2 voxels. Language impairment was correlated with infiltrated A3C2S2 voxel. Peritumoral cortical eloquent spots reflected an early compensative mechanism with age as possible influencing factor. Preoperative NPS impairment is linked with high risk of eloquent tumors. A systematic integration of extensive cognitive assessment and advanced neuroimaging can improve our comprehension of the connectomic brain organization at the individual scale and lead to a better oncological/functional balance.
Collapse
Affiliation(s)
- Francesco Latini
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, 75185 Uppsala, Sweden; (M.Z.); (M.R.)
- Correspondence: ; Tel.: +46-764-244-653
| | - Hans Axelson
- Section of Clinical Neurophysiology, Department of Neuroscience, Uppsala University, 75185 Uppsala, Sweden;
| | - Markus Fahlström
- Section of Radiology, Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden;
| | - Malin Jemstedt
- Department of Neuroscience, Speech-Language Pathology, Uppsala University, 75185 Uppsala, Sweden;
| | | | - Maria Zetterling
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, 75185 Uppsala, Sweden; (M.Z.); (M.R.)
| | - Mats Ryttlefors
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, 75185 Uppsala, Sweden; (M.Z.); (M.R.)
| |
Collapse
|
44
|
Senova S, Lefaucheur JP, Brugières P, Ayache SS, Tazi S, Bapst B, Abhay K, Langeron O, Edakawa K, Palfi S, Bardel B. Case Report: Multimodal Functional and Structural Evaluation Combining Pre-operative nTMS Mapping and Neuroimaging With Intraoperative CT-Scan and Brain Shift Correction for Brain Tumor Surgical Resection. Front Hum Neurosci 2021; 15:646268. [PMID: 33716700 PMCID: PMC7947337 DOI: 10.3389/fnhum.2021.646268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/08/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Maximum safe resection of infiltrative brain tumors in eloquent area is the primary objective in surgical neuro-oncology. This goal can be achieved with direct electrical stimulation (DES) to perform a functional mapping of the brain in patients awake intraoperatively. When awake surgery is not possible, we propose a pipeline procedure that combines advanced techniques aiming at performing a dissection that respects the anatomo-functional connectivity of the peritumoral region. This procedure can benefit from intraoperative monitoring with computerized tomography scan (iCT-scan) and brain shift correction. Associated with this intraoperative monitoring, the additional value of preoperative investigation combining brain mapping by navigated transcranial magnetic stimulation (nTMS) with various neuroimaging modalities (tractography and resting state functional MRI) has not yet been reported. Case Report: A 42-year-old left-handed man had increased intracranial pressure (IICP), left hand muscle deficit, and dysarthria, related to an infiltrative tumor of the right frontal lobe with large mass effect and circumscribed contrast enhancement in motor and premotor cortical areas. Spectroscopy profile and intratumoral calcifications on CT-scan suggested an WHO grade III glioma, later confirmed by histology. The aforementioned surgical procedure was considered, since standard awake surgery was not appropriate for this patient. In preoperative time, nTMS mapping of motor function (deltoid, first interosseous, and tibialis anterior muscles) was performed, combined with magnetic resonance imaging (MRI)-based tractography reconstruction of 6 neural tracts (arcuate, corticospinal, inferior fronto-occipital, uncinate and superior and inferior longitudinal fasciculi) and resting-state functional MRI connectivity (rs-fMRI) of sensorimotor and language networks. In intraoperative time, DES mapping was performed with motor evoked response recording and tumor resection was optimized using non-rigid image transformation of the preoperative data (nTMS, tractography, and rs-fMRI) to iCT data. Image guidance was updated with correction for brain shift and tissue deformation using biomechanical modeling taking into account brain elastic properties. This correction was done at crucial surgical steps, i.e., when tumor bulged through the craniotomy after dura mater opening and when approaching the presumed eloquent brain regions. This procedure allowed a total resection of the tumor region with contrast enhancement as well as a complete regression of IICP and dysarthria. Hand paresis remained stable with no additional deficit. Postoperative nTMS mapping confirmed the good functional outcome. Conclusion: This case report and technical note highlights the value of preoperative functional evaluation by nTMS updated intraoperatively with correction of brain deformation by iCT. This multimodal approach may become the optimized technique of reference for patients with brain tumors in eloquent areas that are unsuitable for awake brain surgery.
Collapse
Affiliation(s)
- Suhan Senova
- Department of Neurosurgery, DMU CARe, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Translational Psychiatry (Equipe 15), IMRB - INSERM U955, Univ Paris-Est Creteil, Creteil, France
| | - Jean-Pascal Lefaucheur
- Department of Clinical Neurophysiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Excitabilite Nerveuse et Therapeutique, EA 4391, Univ Paris-Est Creteil, Creteil, France
| | - Pierre Brugières
- Department of Neuroradiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France
| | - Samar S Ayache
- Department of Clinical Neurophysiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Excitabilite Nerveuse et Therapeutique, EA 4391, Univ Paris-Est Creteil, Creteil, France
| | - Sanaa Tazi
- Department of Neurosurgery, DMU CARe, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Translational Psychiatry (Equipe 15), IMRB - INSERM U955, Univ Paris-Est Creteil, Creteil, France
| | - Blanche Bapst
- Department of Neuroradiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France
| | - Kou Abhay
- Department of Anesthesiology and Critical Care, DMU CARe, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France
| | - Olivier Langeron
- Department of Anesthesiology and Critical Care, DMU CARe, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Experimental Neuropathology Unit, Institut Pasteur, Paris, France
| | - Kohtaroh Edakawa
- Department of Neurosurgery, DMU CARe, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Translational Psychiatry (Equipe 15), IMRB - INSERM U955, Univ Paris-Est Creteil, Creteil, France.,Department of Neurosurgery, Graduate School of Medicine Osaka University, Suita, Japan
| | - Stéphane Palfi
- Department of Neurosurgery, DMU CARe, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Translational Psychiatry (Equipe 15), IMRB - INSERM U955, Univ Paris-Est Creteil, Creteil, France
| | - Benjamin Bardel
- Department of Clinical Neurophysiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Creteil, France.,Excitabilite Nerveuse et Therapeutique, EA 4391, Univ Paris-Est Creteil, Creteil, France
| |
Collapse
|
45
|
Verst SM, de Castro I, Scappini-Junior W, de Melo MN, de Oliveira JR, de Almeida SS, Alvarez NRC, Sucena ACB, Barros MR, Marrone CD, Maldaun MVC. Methodology for creating and validating object naming and semantic tests used by Verst-Maldaun Language Assessment during awake craniotomies. Clin Neurol Neurosurg 2021; 202:106485. [PMID: 33476885 DOI: 10.1016/j.clineuro.2021.106485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/29/2020] [Accepted: 01/07/2021] [Indexed: 11/17/2022]
Abstract
Verst-Maldaun Language Assessment (VMLA) is a new intraoperative neuropsychological test (NT) within our local culture, e.g., native Portuguese speaking Brazilians. It aims to fill the specific need of an objective and dynamic approach for assessing the language network during awake craniotomies. The test includes object naming (ON) and semantic functions. This paper describes the process of validation, allowing for other centers to create their own language assessment. The validation process included 248 volunteers and the results were associated with age, gender and educational level (EL). The factor with the greatest impact was EL, followed by age. Intraoperative image learning by repetition is unlikely, since it is composed of 388 items and 70 combinations. The test will be available for free use under http://www.vemotests.com/ (beginning in February 2021).
Collapse
Affiliation(s)
- Silvia Mazzali Verst
- Brain Spine Neurophysiologia, Intraoperative Neurophysiology at Hospital Sirio Libanês, São Paulo, Brazil; Rua Barão de Teffé, 1000 sala 55, Jundiai, SP 13208-761, Brazil.
| | - Isac de Castro
- Neuromuscular Diseases Sector, Department of Neurology, Universidade Federal de São Paulo, SP, Brazil.
| | - Wilson Scappini-Junior
- Brain Spine Neurofisiologia, Rua Barão de Teffé, 1000 sala 55, Jundiai, SP 13208-761, Brazil.
| | - Mônica Nascimento de Melo
- Brain Spine Neurofisiologia, Rua dos Salgueiros, QD 09 lote 03, Jardins Valência Goiânia, GO 74885-860, Brazil.
| | - Jean Ramos de Oliveira
- Brain Spine Neurofisiologia, Rua Elzira Sammarco Palma, 405/242, Ribeirão Preto, SP 14021-684, Brazil.
| | - Soraya Soares de Almeida
- Brain Spine Neurofisiologia, Rua Antônio Muniz, 182, Pontalzinho, Itabuna, BA 45603-023, Brazil.
| | | | | | - Maria Rufina Barros
- Vitória Apart Hospital, Rodovia Mário Covas, 591 Sala 113-B, Bairro Boa Vista 1, Vitória, ES, 29161-001, Brazil.
| | - Carlo Domenico Marrone
- Clinica Marrone, Av. Túlio de Rose, 400 apto 501 Torre E Porto, Alegre, RS 91340-110, Brazil.
| | - Marcos Vinicius Calfat Maldaun
- Neuro-Oncology postgraduate course at Sirio Libanês Hospital, São Paulo, Rua Barata Ribeiro, 414, cj 63, São Paulo, SP, 01308-000, Brazil.
| |
Collapse
|
46
|
Berger M. Progress on glioma surgery and multimodal treatments. GLIOMA 2021. [DOI: 10.4103/glioma.glioma_9_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
47
|
Awake surgery for right frontal lobe glioma can preserve visuospatial cognition and spatial working memory. J Neurooncol 2020; 151:221-230. [PMID: 33136234 DOI: 10.1007/s11060-020-03656-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/27/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Awake surgery is the standard treatment to preserve motor and language functions. This longitudinal study aimed to evaluate the resection rate and preservation of neurocognitive functions in patients with right frontal lobe glioma who underwent awake surgery. METHODS Thirty-three patients (mean age, 48.0 years) with right frontal lobe glioma who underwent awake surgery at our hospital between 2013 and 2019 were included. Fourteen, thirteen, and six cases had WHO classification grades of II, III, and IV, respectively. We evaluated visuospatial cognition (VSC) and spatial working memory (SWM) before and three months after surgery. Relevant brain areas for VSC and SWM were intraoperatively mapped, whenever the task was successfully accomplished. Therefore, patients were divided into an intraoperative evaluation group and a non-evaluation group for each function, and the resection rate and functional outcomes were compared. RESULTS The removal rate in the evaluation group for VSC and SWM were similar to that in the non-evaluation group. Chronic impairment rate of VSC was significantly lower in the evaluation than in the non-evaluation group (5.6% vs. 33.3%, p = 0.034). No patient showed postoperative SWM impairment in the evaluation group as opposed to the non-evaluation group (16.7%, p = 0.049). The probability of resection of the deeper posterior part of the middle frontal gyrus, the relevant area of VSC, was higher in the non-evaluation group than in the evaluation group. CONCLUSIONS We statistically verified that awake surgery for right frontal lobe glioma results in successful preservation of VSC and SWM with satisfying resection rates.
Collapse
|
48
|
Gogos AJ, Young JS, Pereira MP, Morshed RA, Potts MB, Hervey-Jumper SL, Berger MS. Surgical management of incidentally discovered low-grade gliomas. J Neurosurg 2020; 135:480-487. [PMID: 33007758 DOI: 10.3171/2020.6.jns201296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although most patients with low-grade glioma (LGG) present after a seizure, a small proportion is diagnosed after neuroimaging is performed for a sign or symptom unrelated to the tumor. While these tumors invariably grow, some surgeons argue for a watchful waiting approach. Here, the authors report on their experience in the surgical treatment of patients with incidental LGG (iLGG) and describe the neurological outcomes, survival, and complications. METHODS Relevant cases were identified from a prospective registry of patients undergoing glioma resection at the University of California, San Francisco, between 1997 and 2019. Cases were considered iLGG when the lesion was noted on imaging performed for a reason unrelated to the tumor. Demographic, clinical, pathological, and imaging data were extracted from the electronic medical record. Tumor volumes, growth, and extent of resection were calculated from pre- and postoperative volumetric FLAIR sequences. RESULTS One hundred thirteen of 657 (17.2%) first-time resections for LGG were for incidental lesions. The most common reasons for the discovery of an iLGG were headaches (without mass effect, 34.5%) or trauma (16.8%). Incidental tumors were no different from symptomatic lesions in terms of laterality or location, but they were significantly smaller (22.5 vs 57.5 cm3, p < 0.0001). There was no difference in diagnosis between patients with iLGG and those with symptomatic LGG (sLGG), incorporating both molecular and pathological data. The median preoperative observation time for iLGG was 3.1 months (range 1 month-12 years), and there was a median growth rate of 3.9 cm3/year. Complete resection of the FLAIR abnormality was achieved in 57% of patients with incidental lesions but only 23.8% of symptomatic lesions (p < 0.001), and the residual volumes were smaller for iLGGs (2.9 vs 13.5 cm3, p < 0.0001). Overall survival was significantly longer for patients with incidental tumors (median survival not reached for patients with iLGG vs 14.6 years for those with sLGG, p < 0.0001). There was a 4.4% rate of neurological deficits at 6 months. CONCLUSIONS The authors present the largest cohort of iLGGs. Patient age, tumor location, and molecular genetics were not different between iLGGs and sLGGs. Incidental tumors were smaller, a greater extent of resection could be achieved, and overall survival was improved compared to those for patients with sLGG. Operative morbidity and rates of neurological deficit were acceptably low; thus, the authors advocate upfront surgical intervention aimed at maximal safe resection for these incidentally discovered lesions.
Collapse
Affiliation(s)
- Andrew J Gogos
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Jacob S Young
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Matheus P Pereira
- 2School of Medicine, University of California, San Francisco, California; and
| | - Ramin A Morshed
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Matthew B Potts
- 3Department of Neurological Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Mitchel S Berger
- 1Department of Neurological Surgery, University of California, San Francisco
| |
Collapse
|
49
|
Núñez-Velasco S, Mercado-Pimentel R, Rodríguez-Arias R. Letter to the Editor: Awake Craniotomy for Intracranial Gliomas During Coronavirus Disease 2019 Pandemic. World Neurosurg 2020; 140:470-472. [PMID: 32485243 PMCID: PMC7260566 DOI: 10.1016/j.wneu.2020.05.219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Santiago Núñez-Velasco
- Department of Neurosurgery, Neurosurgical Oncology Clinic, Fray Antonio Alcalde Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico.
| | - Rodrigo Mercado-Pimentel
- Department of Neurosurgery, Neurosurgical Oncology Clinic, Fray Antonio Alcalde Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Regina Rodríguez-Arias
- Department of Anesthesiology, Neuroanesthesiology Clinic, Fray Antonio Alcalde Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
| |
Collapse
|
50
|
Incekara F, Smits M, van der Voort SR, Dubbink HJ, Atmodimedjo PN, Kros JM, Vincent AJPE, van den Bent M. The Association Between the Extent of Glioblastoma Resection and Survival in Light of MGMT Promoter Methylation in 326 Patients With Newly Diagnosed IDH-Wildtype Glioblastoma. Front Oncol 2020; 10:1087. [PMID: 32766140 PMCID: PMC7381265 DOI: 10.3389/fonc.2020.01087] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/01/2020] [Indexed: 12/14/2022] Open
Abstract
Background: The association between contrast enhanced (CE) and non-contrast enhanced (NCE) tumor resection and survival in patients with glioblastoma in relation to molecular subtypes is poorly understood. The aim of this study was to assess the association between CE and NCE tumor resection and survival in light of MGMT promoter methylation in newly diagnosed IDH-wildtype glioblastoma. Materials and methods: Patients with newly diagnosed IDH-wildtype glioblastoma who underwent surgery were eligible. CE and NCE tumor volumes were assessed on pre- and post-operative MRI scans and extent of resection was calculated. The association between CE and NCE tumor resection and survival was evaluated using multivariable Cox proportional hazards models and Kaplan Meier estimates. Results: Three hundred and twenty-six patients were included: 177 (54.3%) with and 149 (45.7%) without MGMT methylation. Multivariable Cox proportional hazards models stratified for MGMT methylation identified age ≤ 65y (HR 0.63; 95% CI, 0.49–0.81; p < 0.0001), chemoradiation (HR 0.13; 95% CI, 0.09–0.19; p < 0.0001), maximal CE tumor resection (HR 0.58; 95% CI, 0.39–0.87; p = 0.009), ≥ 30% NCE tumor resection (HR 0.71; 95% CI, 0.53–0.93; p = 0.014), and minimal residual CE tumor volume (HR 0.64; 95% CI, 0.46–0.88 p = 0.007) as being associated with longer overall survival. Kaplan Meier estimates showed that extensive surgery was more beneficial for patients with MGMT methylated glioblastoma. Conclusions: This study shows an association between maximal CE tumor resection, ≥30% NCE tumor resection, minimal residual CE tumor volume, and longer overall survival in patients with newly diagnosed IDH wildtype glioblastoma. Intraoperative imaging and stimulation mapping may be used to pursue safe and maximal resection. In future research, the safety aspect of maximizing tumor resection needs to be addressed.
Collapse
Affiliation(s)
- Fatih Incekara
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sebastian R van der Voort
- Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Hendrik Jan Dubbink
- Department of Pathology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Peggy N Atmodimedjo
- Department of Pathology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Johan M Kros
- Department of Pathology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Martin van den Bent
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| |
Collapse
|