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van Ierschot FC, Veenstra W, Miozzo A, Santini B, Jeltema HR, Spena G, Miceli G. Written language preservation in glioma patients undergoing awake surgery: The value of tailored intra-operative assessment. J Neuropsychol 2024; 18 Suppl 1:205-229. [PMID: 37840529 DOI: 10.1111/jnp.12349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023]
Abstract
Written language is increasingly important, as contemporary society strongly relies on text-based communication. Nonetheless, in neurosurgical practice, language preservation has classically focused on spoken language. The current study aimed to evaluate the potential role of intra-operative assessments in the preservation of written language skills in glioma patients undergoing awake surgery. It is the first feasibility study to use a standardized and detailed Written language battery in glioma patients undergoing awakening surgery. Reading and spelling were assessed pre- and post-operatively in eleven patients. Intra-operatively, 7 cases underwent written language assessment in addition to spoken object naming. Results show that reading and spelling deficits may arise before and after glioma surgery and that written language may be differently affected than spoken language. In our case series, task-specific preservation of function was obtained in all cases when a specific written language skill was monitored intra-operatively. However, the benefits of intra-operative testing did not always generalize, and non-monitored written language tasks may not be preserved. Hence, when a specific written language skill needs to be preserved, to facilitate return to work and maintain quality of life, results indicate that intra-operative assessment of that skill is advised. An illustrative case report demonstrates how profile analyses can be used pre-operatively to identify cognitive components at risk and intra-operatively to preserve written language abilities in clinical practice.
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Affiliation(s)
- Fleur Céline van Ierschot
- Center for Mind/Brain Sciences (CiMeC), University of Trento, Rovereto, Italy
- International Doctorate for Experimental Approaches to Language and Brain (IDEALAB), Universities of Trento, Groningen, Newcastle, Potsdam and Macquarie University, Trento, Groningen, Newcastle, Potsdam, Sydney, Italy, Netherlands, Australia, Germany, Australia
| | - Wencke Veenstra
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands
| | - Antonio Miozzo
- Centre for Aging Brain and Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Barbara Santini
- Department of Neuroscience, Neurosurgery Clinic, University of Verona, Verona, Italy
| | - Hanne-Rinck Jeltema
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Giannantonio Spena
- Centre for Aging Brain and Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Gabriele Miceli
- Center for Mind/Brain Sciences (CiMeC), University of Trento, Rovereto, Italy
- International Doctorate for Experimental Approaches to Language and Brain (IDEALAB), Universities of Trento, Groningen, Newcastle, Potsdam and Macquarie University, Trento, Groningen, Newcastle, Potsdam, Sydney, Italy, Netherlands, Australia, Germany, Australia
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Li Y, Guo J, Zhang K, Wei H, Fan J, Yu S, Li T, Yang X. Diffusion tensor imaging versus intraoperative subcortical mapping for glioma resection: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:154. [PMID: 37380888 PMCID: PMC10307847 DOI: 10.1007/s10143-023-02058-5] [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: 03/21/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
Maintaining the integrity of crucial fiber tracts allows functional preservation and improved recovery in patients with glioma resection. Diffusion tensor imaging (DTI) and intraoperative subcortical mapping (ISM) are commonly required for pre- and intraoperative assessment of white matter fibers. This study investigated differences of clinical outcomes in glioma resection aided by DTI or ISM. A comprehensive literature retrieval of the PubMed and Embase databases identified several DTI or ISM studies in 2000-2022. Clinical data, including extent of resection (EOR) and postoperative neurological deficits, was collected and statistically analyzed. Heterogeneity was regressed by a random effect model and the Mann-Whitney U test was used to test statistical significance. Publication bias was assessed by Egger test. A total of 14 studies with a pooled cohort of 1837 patients were included. Patients undergoing DTI-navigated glioma surgery showed a higher rate of gross total resection (GTR) than ISM-assisted surgical resection (67.88%, [95% CI 0.55-0.79] vs. 45.73%, [95% CI 0.29-0.63], P = 0.032). The occurrence of early postoperative functional deficit (35.45%, [95% CI 0.13-0.61] vs. 35.60% [95% CI 0.20-0.53], P = 1.000), late postoperative functional deficit (6.00%, [95% CI 0.02-0.11] vs. 4.91% [95% CI 0.03-0.08], P = 1.000) and severe postoperative functional deficit (2.21%, [95% CI 0-0.08] vs. 5.93% [95% CI 0.01-0.16], P = 0.393) were similar between the DTI and ISM group, respectively. While DTI-navigation resulted in a higher rate of GTR, the occurrence of postoperative neurological deficits between DTI and ISM groups was comparable. Together, these data indicate that both techniques could safely facilitate glioma resection.
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Affiliation(s)
- Yiming Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiahe Guo
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Kai Zhang
- Institute for Intelligent Healthcare, Tsinghua University, Beijing, China
- Department of Neurosurgery, Tsinghua University Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Huijie Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jikang Fan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Shengping Yu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Tao Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
| | - Xuejun Yang
- Institute for Intelligent Healthcare, Tsinghua University, Beijing, China.
- Department of Neurosurgery, Tsinghua University Beijing Tsinghua Changgung Hospital, Beijing, China.
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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.
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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
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Nguyen AM, Huynh NT, Nguyen TTP. Intraoperative cortical and subcortical stimulation for lesions related to eloquent motor cortex and corticospinal tract in a developing country. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Kim KM, Kim SM, Kang H, Ji SY, Dho YS, Choi YD, Kwak GH, Kim BE, Oh H, Park HP, Kang KM, Choi SH, Kwon YN, Lee ST, Seo HG, Park CK. Preservation of language function by mapping the arcuate fasciculus using intraoperative corticocortical evoked potential under general anesthesia in glioma surgery. J Neurosurg 2022; 137:1535-1543. [PMID: 35303703 DOI: 10.3171/2022.1.jns212658] [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: 11/19/2021] [Accepted: 01/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative language mapping under general anesthesia is imperative for brain tumor surgery because awake surgery is not always feasible. Monitoring corticocortical evoked potential (CCEP) is known to be a useful method for tracking neuronal connectivity and localizing functional areas. The authors evaluated the clinical benefit of intraoperative CCEP monitoring for language function preservation in patients undergoing glioma surgery. METHODS Between January 2019 and June 2021, the authors performed a total of 29 consecutive glioma surgeries using CCEP monitoring under general anesthesia because of a risk of speech impairment; these were analyzed. Language area mapping was implemented by the anterior language area to posterior language area CCEP method for arcuate fasciculus mapping, and tumor resection was performed while avoiding the localized language areas. Language function before and after surgery was evaluated by the Controlled Oral Word Association Test (COWAT). RESULTS Intraoperative CCEP was successfully monitored in 25 patients (86.2%), and a valid signal was undetectable in the other 4 patients. Language function evaluation was possible before and after surgery in a total of 20 patients. Overall, the preservation rate of language function was 65.0%, and the deterioration rate was 35.0% after tumor resection with CCEP monitoring. Among those 8 patients with preoperative COWAT scores ≥ 18, 5 patients (62.5%) successfully preserved their language function, with COWAT scores > 18 after tumor resection. Among the 12 patients with preoperative deteriorated language function (COWAT score < 18), 8 patients (66.7%) showed improvement or preserved language function after surgery. CONCLUSIONS Intraoperative CCEP monitoring of the arcuate fasciculus is an acceptable technology for the preservation of language function under general anesthesia in glioma surgery in patients in whom awake surgery is not feasible.
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Affiliation(s)
- Kyung Min Kim
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Sung-Min Kim
- 2Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Ho Kang
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - So Young Ji
- 3Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam
| | - Yun-Sik Dho
- 4Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju
| | - Young-Doo Choi
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Gil Ho Kwak
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Bo Eun Kim
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Hyongmin Oh
- 5Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Hee-Pyoung Park
- 5Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Koung Mi Kang
- 6Department of Radiology, Seoul National University College of Medicine, Seoul; and
| | - Seung Hong Choi
- 6Department of Radiology, Seoul National University College of Medicine, Seoul; and
| | - Young Nam Kwon
- 2Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Soon-Tae Lee
- 2Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Han Gil Seo
- 7Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chul-Kee Park
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
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Weiss Lucas C, Faymonville AM, Loução R, Schroeter C, Nettekoven C, Oros-Peusquens AM, Langen KJ, Shah NJ, Stoffels G, Neuschmelting V, Blau T, Neuschmelting H, Hellmich M, Kocher M, Grefkes C, Goldbrunner R. Surgery of Motor Eloquent Glioblastoma Guided by TMS-Informed Tractography: Driving Resection Completeness Towards Prolonged Survival. Front Oncol 2022; 12:874631. [PMID: 35692752 PMCID: PMC9186060 DOI: 10.3389/fonc.2022.874631] [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: 02/12/2022] [Accepted: 03/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background Surgical treatment of patients with glioblastoma affecting motor eloquent brain regions remains critically discussed given the risk–benefit dilemma of prolonging survival at the cost of motor-functional damage. Tractography informed by navigated transcranial magnetic stimulation (nTMS-informed tractography, TIT) provides a rather robust estimate of the individual location of the corticospinal tract (CST), a highly vulnerable structure with poor functional reorganisation potential. We hypothesised that by a more comprehensive, individualised surgical decision-making using TIT, tumours in close relationship to the CST can be resected with at least equal probability of gross total resection (GTR) than less eloquently located tumours without causing significantly more gross motor function harm. Moreover, we explored whether the completeness of TIT-aided resection translates to longer survival. Methods A total of 61 patients (median age 63 years, m = 34) with primary glioblastoma neighbouring or involving the CST were operated on between 2010 and 2015. TIT was performed to inform surgical planning in 35 of the patients (group T; vs. 26 control patients). To achieve largely unconfounded group comparisons for each co-primary outcome (i.e., gross-motor functional worsening, GTR, survival), (i) uni- and multivariate regression analyses were performed to identify features of optimal outcome prediction; (ii), optimal propensity score matching (PSM) was applied to balance those features pairwise across groups, followed by (iii) pairwise group comparison. Results Patients in group T featured a significantly higher lesion-CST overlap compared to controls (8.7 ± 10.7% vs. 3.8 ± 5.7%; p = 0.022). The frequency of gross motor worsening was higher in group T, albeit non-significant (n = 5/35 vs. n = 0/26; p = 0.108). PSM-based paired-sample comparison, controlling for the confounders of preoperative tumour volume and vicinity to the delicate vasculature of the insula, showed higher GTR rates in group T (77% vs. 69%; p = 0.025), particularly in patients with a priori intended GTR (87% vs. 78%; p = 0.003). This translates into a prolonged PFS in the same PSM subgroup (8.9 vs. 5.8 months; p = 0.03), with GTR representing the strongest predictor of PFS (p = 0.001) and OS (p = 0.0003) overall. Conclusion The benefit of TIT-aided GTR appears to overcome the drawbacks of potentially elevated motor functional risk in motor eloquent tumour localisation, leading to prolonged survival of patients with primary glioblastoma close to the CST.
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Affiliation(s)
- Carolin Weiss Lucas
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andrea Maria Faymonville
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Ricardo Loução
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Julich, Juelich, Germany
| | - Catharina Schroeter
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Charlotte Nettekoven
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Karl Josef Langen
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Julich, Juelich, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Julich, Juelich, Germany.,JARA - BRAIN - Translational Medicine, Aachen, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Julich, Juelich, Germany
| | - Volker Neuschmelting
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tobias Blau
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hannah Neuschmelting
- Institute of Pathology and Neuropathology, University Hospital Essen, Essen, Germany
| | - Martin Hellmich
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Kocher
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Julich, Juelich, Germany
| | - Christian Grefkes
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Julich, Juelich, Germany.,Institute for Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roland Goldbrunner
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Le Lann F, Cristante J, De Schlichting E, Quehan R, Réhault E, Lotterie JA, Roux FE. Variability of Intraoperative Electrostimulation Parameters in Conscious Individuals: Language Fasciculi. World Neurosurg 2022; 164:e194-e202. [PMID: 35472645 DOI: 10.1016/j.wneu.2022.04.066] [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: 02/17/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The authors analyzed the current-intensity thresholds for electrostimulation of language fasciculi and the possible consequences of threshold variability on brain mapping. METHODS A prospective protocol of subcortical electrostimulation was used in 50 patients undergoing brain mapping, directly stimulating presumed language fasciculi identified by diffusion tensor imaging. RESULTS The stimulation-intensity thresholds for identification of language fasciculi varied among patients (mean minimum current intensity of 4.4 mA, range = 1.5-10 mA, standard deviation = 1.1 mA), and 23% of fascicular interferences were detected only above 5 mA. Repeated stimulation of the same site with the same intensity led to different types of interferences in 20% of patients, and a higher current intensity led to changes in the type of response in 27%. The mean minimum stimulation intensities did not differ significantly between different fasciculi, between the different types of interference obtained, or with age, sex, or type of tumor. Positive results on cortical mapping were significantly associated with positive results on subcortical mapping (P < 0.001). Subcortical intensity thresholds were slightly lower than cortical ones (mean = 4.43 vs. 5.25 mA, P = 0.034). In 23 of 50 subcortical mappings, fascicular stimulation produced no language interference. CONCLUSIONS Individual variability of minimum stimulation-intensity thresholds for identification of language fasciculi is frequent. Nevertheless, even when a high current intensity was used, many stimulations on language fasciculi remained negative for various hypothetic reasons. Finding the optimal current intensity for identifying language fasciculi is of paramount importance to refine the clinical results and scientific data derived from brain mapping.
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Affiliation(s)
- Florian Le Lann
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; Université de Toulouse, UPS, Toulouse, France.
| | | | - Emmanuel De Schlichting
- Université Grenoble Alpes, Faculté de Médecine, Grenoble, France; Neurochirurgie, Centre Hospitalo-Universitaire de Grenoble, Toulouse, France
| | - Romain Quehan
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; Université de Toulouse, UPS, Toulouse, France
| | - Emilie Réhault
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Jean-Albert Lotterie
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; Université de Toulouse, UPS, Toulouse, France
| | - Franck-Emmanuel Roux
- Pole Neurosciences (Neurochirurgie), Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; Université de Toulouse, UPS, Toulouse, France; Centre de Recherche Cerveau et Cognition (CNRS; CerCo), Toulouse, France
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Herta J, Winter F, Pataraia E, Feucht M, Czech T, Porsche B, Leiss U, Slavc I, Peyrl A, Kasprian G, Rössler K, Dorfer C. Awake brain surgery for language mapping in pediatric patients: a single-center experience. J Neurosurg Pediatr 2022:1-11. [PMID: 35276657 DOI: 10.3171/2022.1.peds21569] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the feasibility, benefit, and safety of awake brain surgery (ABS) and intraoperative language mapping in children and adolescents with structural epilepsies. Whereas ABS is an established method to monitor language function in adults intraoperatively, reports of ABS in children are scarce. METHODS A retrospective chart review of pediatric patients ≤ 18 years of age who underwent ABS and cortical language mapping for supratentorial tumors and nontumoral epileptogenic lesions between 2008 and 2019 was conducted. The authors evaluated the global intellectual and specific language performance by using detailed neuropsychological testing, the patient's intraoperative compliance, results of intraoperative language mapping assisted by electrocorticography (ECoG), and postsurgical language development and seizure outcomes. Descriptive statistics were used for this study, with a statistical significance of p < 0.05. RESULTS Eleven children (7 boys) with a median age of 13 years (range 10-18 years) underwent ABS for a lesion in close vicinity to cortical language areas as defined by structural and functional MRI (left hemisphere in 9 children, right hemisphere in 2). Patients were neurologically intact but experiencing seizures; these were refractory to therapy in 9 patients. Compliance during the awake phase was high in 10 patients and low in 1 patient. Cortical mapping identified eloquent language areas in 6/10 (60%) patients and was concordant in 3/8 (37.5%), discordant in 3/8 (37.5%), and unclear in 2/8 (25%) patients compared to preoperative functional MRI. Stimulation-induced seizures occurred in 2 patients and could be interrupted easily. ECoG revealed that afterdischarge potentials (ADP) were involved in 5/9 (56%) patients with speech disturbances during stimulation. None of these patients harbored postoperative language dysfunction. Gross-total resection was achieved in 10/11 (91%) patients, and all were seizure free after a median follow-up of 4.3 years. Neuropsychological testing using the Wechsler Intelligence Scale for Children and the verbal learning and memory test showed an overall nonsignificant trend toward an immediate postoperative deterioration followed by an improvement to above preoperative levels after 1 year. CONCLUSIONS ABS is a valuable technique in selected pediatric patients with lesions in language areas. An interdisciplinary approach, careful patient selection, extensive preoperative training of patients, and interpretation of intraoperative ADP are pivotal to a successful surgery.
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Greisman JD, Dadario NB, Park J, Silverstein JW, D'Amico RS. Subcortical Stimulation in Brain Tumor Surgery: A closer look beneath the surface. World Neurosurg 2022; 161:55-63. [PMID: 35149248 DOI: 10.1016/j.wneu.2022.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Maximizing a patient's onco-functional balance is the central tenet of brain tumor surgery. As a result, numerous surgical adjuncts have been developed to facilitate identification of the tumor-brain interface and preservation of functional anatomy. Among these, intraoperative neurophysiologic monitoring (IONM) with direct cortical and subcortical stimulation remains the gold standard for real time, functional mapping of motor and language activity. However, stimulation techniques are not standardized and vary significantly across institutions. This is particularly true with subcortical stimulation for mapping of motor function. METHODS We review the state of subcortical IONM and mapping techniques. Historical and predicate literature were reviewed as well as new and emerging techniques. We discuss their evolution, clinical utility, and limitations to direct future research and application. RESULTS We evaluate and discuss the background and current clinical use of direct cortical and subcortical stimulation techniques and protocols and identify current trends and limitations. We focus specifically on methods of subcortical stimulation given the heterogeneity in the published literature. We also suggest directions to optimize the clinical utility of these tools. CONCLUSION Despite significant heterogeneity in published techniques, trends support the use of the Taniguchi method for subcortical stimulation. Novel dynamic stimulation techniques may improve accuracy. Prospective studies to define standardized guidelines are needed.
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Affiliation(s)
- Jacob D Greisman
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Nicholas B Dadario
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Jung Park
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Justin W Silverstein
- Department of Neurology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA; Neuro Protective Solutions, New York, New York, USA
| | - Randy S D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA.
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Liu W, Li C, Wu Y, Xu W, Chen S, Zhang H, Huang H, Zhao S, Wang J. Integrating m6A Regulators-Mediated Methylation Modification Models and Tumor Immune Microenvironment Characterization in Caucasian and Chinese Low-Grade Gliomas. Front Cell Dev Biol 2021; 9:725764. [PMID: 34900988 PMCID: PMC8661096 DOI: 10.3389/fcell.2021.725764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/11/2021] [Indexed: 01/21/2023] Open
Abstract
Background: As an important epigenetic modification, m6A methylation plays an essential role in post-transcriptional regulation and tumor development. It is urgently needed to comprehensively and rigorously explore the prognostic value of m6A regulators and its association with tumor microenvironment (TME) infiltration characterization of low-grade glioma (LGG). Methods: Based on the expression of 20 m6A regulatory factors, we comprehensively evaluated the m6A modification patterns of LGG after unsupervised clustering. Subsequent analysis of the differences between these groups was performed to obtain m6A-related genes, then consistent clustering was conducted to generate m6AgeneclusterA and m6AgeneclusterB. A Random Forest and machining learning algorithms were used to reduce dimensionality, identify TME characteristics and predict responses for LGG patients receiving immunotherapies. Results: Evident differential m6A regulators were found in mutation, CNV and TME characteristics of LGG. Based on TCGA and CGGA databases, we identified that m6A regulators clusterA could significantly predict better prognosis (p = 0.00016) which enriched in mTOR signaling pathway, basal transcription factors, accompanied by elevated immune cells infiltration, and decreased IDH and TP53 mutations. We also investigated the distribution of differential genes in m6A regulators clusters which was closely associated with tumor immune microenvironment through three independent cohort comparisons. Next, we established m6Ascore based on previous m6A model, which accurately predicts outcomes in 1089 LGG patients (p < 0.0001) from discovering cohort and 497 LGG patients from testing cohort. Significant TME characteristics, including genome heterogeneity, abidance of immune cells, and clinicopathologic parameters have been found between m6Ascore groups. Importantly, LGG patients with high m6Ascore are confronted with significantly decreased responses to chemotherapies, but benefit more from immunotherapies. Conclusion: In conclusion, this study first demonstrates that m6A modification is crucial participant in tumorigenesis and TME infiltration characterization of LGG based on large-scale cohorts. The m6Ascore provides useful and accurately predict of prognosis and clinical responses to chemotherapy, immunotherapy and therapeutic strategy development for LGG patients.
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Affiliation(s)
- Wangrui Liu
- Department of Transplantation, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Neurosurgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Guangxi, China
| | - Chuanyu Li
- Department of Neurosurgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Guangxi, China
| | - Yuhao Wu
- School of Medicine, Tongji University, Shanghai, China
| | - Wenhao Xu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shuxian Chen
- Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hailiang Zhang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haineng Huang
- Department of Neurosurgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Guangxi, China
| | - Shuai Zhao
- Department of Transplantation, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Wang
- Department of Transplantation, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Bihemispheric Navigated Transcranial Magnetic Stimulation Mapping for Action Naming Compared to Object Naming in Sentence Context. Brain Sci 2021; 11:brainsci11091190. [PMID: 34573211 PMCID: PMC8469437 DOI: 10.3390/brainsci11091190] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022] Open
Abstract
Preoperative language mapping with navigated transcranial magnetic stimulation (nTMS) is currently based on the disruption of performance during object naming. The resulting cortical language maps, however, lack accuracy when compared to intraoperative mapping. The question arises whether nTMS results can be improved, when another language task is considered, involving verb retrieval in sentence context. Twenty healthy German speakers were tested with object naming and a novel action naming task during nTMS language mapping. Error rates and categories in both hemispheres were compared. Action naming showed a significantly higher error rate than object naming in both hemispheres. Error category comparison revealed that this discrepancy stems from more lexico-semantic errors during action naming, indicating lexico-semantic retrieval of the verb being more affected than noun retrieval. In an area-wise comparison, higher error rates surfaced in multiple right-hemisphere areas, but only trends in the left ventral postcentral gyrus and middle superior temporal gyrus. Hesitation errors contributed significantly to the error count, but did not dull the mapping results. Inclusion of action naming coupled with a detailed error analysis may be favorable for nTMS mapping and ultimately improve accuracy in preoperative planning. Moreover, the results stress the recruitment of both left- and right-hemispheric areas during naming.
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12
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Colle H, Colle D, Noens B, Dhaen B, Alessi G, Muller P, Aerts A, Robert E, van der Linden C. Subcortical Stimulation with Tip of Ultrasound Aspirator. J Neurol Surg A Cent Eur Neurosurg 2021; 82:581-584. [PMID: 34433223 DOI: 10.1055/s-0039-1691824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND During resection of intrinsic brain tumors in eloquent areas, particularly under awake mapping, subcortical stimulation is mandatory to avoid irreversible deficits by damaging white fiber tracts. The current practice is to alternate between subcortical stimulation with an appropriate probe and resection of tumoral tissue with an ultrasound aspiration device. Switching between different devices induces supplementary movement and possible tissue trauma, loss of time, and inaccuracies in the localization of the involved area. OBJECTIVE To use one device for both stimulation as well as a resecting tool. METHODS The tip of different ultrasound aspiration devices is currently used for monopolar current transmission (e.g., for vessel coagulation in liver surgery). We use the same circuitry for monopolar subcortical stimulation when connected with the usual stimulator devices. RESULTS We have applied this method since 2004 in over 500 patients during tumor resection with cortical and subcortical stimulation, mostly with awake language and motor monitoring. CONCLUSION A method is presented using existing stimulation and wiring devices by which simultaneous subcortical stimulation and ultrasonic aspiration are applied with the same tool. The accuracy, safety, and speed of intrinsic intracranial lesion resection can be improved when subcortical stimulation is applied.
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Affiliation(s)
- Henry Colle
- Department of Neurosurgery, St Lucas Hospital, Ghent, Belgium
| | - David Colle
- Department of Neurosurgery, St Lucas Hospital, Ghent, Belgium
| | - Bonny Noens
- Department of Neurosurgery, St Lucas Hospital, Ghent, Belgium
| | - Bob Dhaen
- Department of Neurosurgery, St Lucas Hospital, Ghent, Belgium
| | - Giovanni Alessi
- Department of Neurosurgery, St Lucas Hospital, Ghent, Belgium
| | - Peter Muller
- Department of Neuro-anesthesiology, St Lucas Hospital, Ghent, Belgium
| | - Annelies Aerts
- Department of Neurolinguistics, St Lucas Hospital, Ghent, Belgium
| | - Erik Robert
- Department of Neurolinguistics, St Lucas Hospital, Ghent, Belgium
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13
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Raffa G, Quattropani MC, Marzano G, Curcio A, Rizzo V, Sebestyén G, Tamás V, Büki A, Germanò A. Mapping and Preserving the Visuospatial Network by repetitive nTMS and DTI Tractography in Patients With Right Parietal Lobe Tumors. Front Oncol 2021; 11:677172. [PMID: 34249716 PMCID: PMC8268025 DOI: 10.3389/fonc.2021.677172] [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: 03/07/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The goal of brain tumor surgery is the maximal resection of neoplastic tissue, while preserving the adjacent functional brain tissues. The identification of functional networks involved in complex brain functions, including visuospatial abilities (VSAs), is usually difficult. We report our preliminary experience using a preoperative planning based on the combination of navigated transcranial magnetic stimulation (nTMS) and DTI tractography to provide the preoperative 3D reconstruction of the visuospatial (VS) cortico-subcortical network in patients with right parietal lobe tumors. MATERIAL AND METHODS Patients affected by right parietal lobe tumors underwent mapping of both hemispheres using an nTMS-implemented version of the Hooper Visual Organization Test (HVOT) to identify cortical areas involved in the VS network. DTI tractography was used to compute the subcortical component of the network, consisting of the three branches of the superior longitudinal fasciculus (SLF). The 3D reconstruction of the VS network was used to plan and guide the safest surgical approach to resect the tumor and avoid damage to the network. We retrospectively analyzed the cortical distribution of nTMS-induced errors, and assessed the impact of the planning on surgery by analyzing the extent of tumor resection (EOR) and the occurrence of postoperative VSAs deficits in comparison with a matched historical control group of patients operated without using the nTMS-based preoperative reconstruction of the VS network. RESULTS Twenty patients were enrolled in the study (Group A). The error rate (ER) induced by nTMS was higher in the right vs. the left hemisphere (p=0.02). In the right hemisphere, the ER was higher in the anterior supramarginal gyrus (aSMG) (1.7%), angular gyrus (1.4%) superior parietal lobule (SPL) (1.3%), and dorsal lateral occipital gyrus (dLoG) (1.2%). The reconstruction of the cortico-subcortical VS network was successfully used to plan and guide tumor resection. A gross total resection (GTR) was achieved in 85% of cases. After surgery no new VSAs deficits were observed and a slightly significant improvement of the HVOT score (p=0.02) was documented. The historical control group (Group B) included 20 patients matched for main clinical characteristics with patients in Group A, operated without the support of the nTMS-based planning. A GTR was achieved in 90% of cases, but the postoperative HVOT score resulted to be worsened as compared to the preoperative period (p=0.03). The comparison between groups showed a significantly improved postoperative HVOT score in Group A vs. Group B (p=0.03). CONCLUSIONS The nTMS-implemented HVOT is a feasible approach to map cortical areas involved in VSAs. It can be combined with DTI tractography, thus providing a reconstruction of the VS network that could guide neurosurgeons to preserve the VS network during tumor resection, thus reducing the occurrence of postoperative VSAs deficits as compared to standard asleep surgery.
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Affiliation(s)
- Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | | | - Giuseppina Marzano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonello Curcio
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | - Vincenzo Rizzo
- Division of Neurology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gabriella Sebestyén
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - Viktória Tamás
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - András Büki
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - Antonino Germanò
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
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14
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Asimakidou E, Abut PA, Raabe A, Seidel K. Motor Evoked Potential Warning Criteria in Supratentorial Surgery: A Scoping Review. Cancers (Basel) 2021; 13:2803. [PMID: 34199853 PMCID: PMC8200078 DOI: 10.3390/cancers13112803] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 12/31/2022] Open
Abstract
During intraoperative monitoring of motor evoked potentials (MEP), heterogeneity across studies in terms of study populations, intraoperative settings, applied warning criteria, and outcome reporting exists. A scoping review of MEP warning criteria in supratentorial surgery was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Sixty-eight studies fulfilled the eligibility criteria. The most commonly used alarm criteria were MEP signal loss, which was always a major warning sign, followed by amplitude reduction and threshold elevation. Irreversible MEP alterations were associated with a higher number of transient and persisting motor deficits compared with the reversible changes. In almost all studies, specificity and Negative Predictive Value (NPV) were high, while in most of them, sensitivity and Positive Predictive Value (PPV) were rather low or modest. Thus, the absence of an irreversible alteration may reassure the neurosurgeon that the patient will not suffer a motor deficit in the short-term and long-term follow-up. Further, MEPs perform well as surrogate markers, and reversible MEP deteriorations after successful intervention indicate motor function preservation postoperatively. However, in future studies, a consensus regarding the definitions of MEP alteration, critical duration of alterations, and outcome reporting should be determined.
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Affiliation(s)
- Evridiki Asimakidou
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
| | - Pablo Alvarez Abut
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
- Department of Neurosurgery, Clínica 25 de Mayo, 7600 Mar del Plata, Argentina
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
| | - Kathleen Seidel
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
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15
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Bährend I, Muench MR, Schneider H, Moshourab R, Dreyer FR, Vajkoczy P, Picht T, Faust K. Incidence and linguistic quality of speech errors: a comparison of preoperative transcranial magnetic stimulation and intraoperative direct cortex stimulation. J Neurosurg 2021; 134:1409-1418. [PMID: 32470943 DOI: 10.3171/2020.3.jns193085] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Given the interindividual variance of functional language anatomy, risk prediction based merely on anatomical data is insufficient in language area-related brain tumor surgery, suggesting the need for direct cortical and subcortical mapping during awake surgery. Reliable, noninvasive preoperative methods of language localization hold the potential for reducing the necessity for awake procedures and may improve patient counseling and surgical planning. Repetitive navigated transcranial magnetic stimulation (rnTMS) is an evolving tool for localizing language-eloquent areas. The aim of this study was to investigate the reliability of rnTMS in locating cortical language sites. METHODS Twenty-five patients with brain tumors in speech-related areas were prospectively evaluated with preoperative rnTMS (5 Hz, train of five, average 105% resting motor threshold) and navigated direct cortical stimulation (DCS; bipolar, 50 Hz, 6-8 mA, 200-μsec pulse width) during awake surgeries employing a picture-naming task. Positive and negative stimulation spots within the craniotomy were documented in the same MRI data set. TMS and DCS language-positive areas were compared with regard to their spatial overlap, their allocation in a cortical parcellation system, and their linguistic qualities. RESULTS There were over twofold more positive language spots within the exposed area on rnTMS than on DCS. The comparison of positive rnTMS and DCS (ground truth) overlaps revealed low sensitivity (35%) and low positive predictive value (16%) but high specificity (90%) and high negative predictive value (96%). Within the overlaps, there was no correlation in error quality. On DCS, 73% of language-positive spots were located in the pars opercularis and pars triangularis of the frontal operculum and 24% within the supramarginal gyrus and dorsal portion of the superior temporal gyrus, while on rnTMS language positivity was distributed more evenly over a large number of gyri. CONCLUSIONS The current protocol for rnTMS for language mapping identified language-negative sites with good dependability but was unable to reliably detect language-positive spots. Further refinements of the technique will be needed to establish rnTMS language mapping as a useful clinical tool.
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Affiliation(s)
| | | | | | | | - Felix R Dreyer
- 3Brain Language Laboratory, Freie Universität Berlin, Germany
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16
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Saito T, Muragaki Y, Tamura M, Maruyama T, Nitta M, Tsuzuki S, Fukui A, Kawamata T. Correlation between localization of supratentorial glioma to the precentral gyrus and difficulty in identification of the motor area during awake craniotomy. J Neurosurg 2021; 134:1490-1499. [PMID: 32357342 DOI: 10.3171/2020.2.jns193471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Identification of the motor area during awake craniotomy is crucial for preservation of motor function when resecting gliomas located within or close to the motor area or the pyramidal tract. Nevertheless, sometimes the surgeon cannot identify the motor area during awake craniotomy. However, the factors that influence failure to identify the motor area have not been elucidated. The aim of this study was to assess whether tumor localization was correlated with a negative cortical response in motor mapping during awake craniotomy in patients with gliomas located within or close to the motor area or pyramidal tract. METHODS Between April 2000 and May 2019 at Tokyo Women's Medical University, awake craniotomy was performed to preserve motor function in 137 patients with supratentorial glioma. Ninety-one of these patients underwent intraoperative cortical motor mapping for a primary glioma located within or close to the motor area or pyramidal tract and were enrolled in the study. MRI was used to evaluate whether or not the tumors were localized to or involved the precentral gyrus. The authors performed motor functional mapping with electrical stimulation during awake craniotomy and evaluated the correlation between identification of the motor area and various clinical characteristics, including localization to the precentral gyrus. RESULTS Thirty-four of the 91 patients had tumors that were localized to the precentral gyrus. The mean extent of resection was 89.4%. Univariate analyses revealed that identification of the motor area correlated significantly with age and localization to the precentral gyrus. Multivariate analyses showed that older age (≥ 45 years), larger tumor volume (> 35.5 cm3), and localization to the precentral gyrus were significantly correlated with failure to identify the motor area (p = 0.0021, 0.0484, and 0.0015, respectively). Localization to the precentral gyrus showed the highest odds ratio (14.135) of all regressors. CONCLUSIONS Identification of the motor area can be difficult when a supratentorial glioma is localized to the precentral gyrus. The authors' findings are important when performing awake craniotomy for glioma located within or close to the motor area or the pyramidal tract. A combination of transcortical motor evoked potential monitoring and awake craniotomy including subcortical motor mapping may be needed for removal of gliomas showing negative responses in the motor area to preserve the motor-related subcortical fibers.
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Affiliation(s)
| | - Yoshihiro Muragaki
- 1Department of Neurosurgery and
- 2Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Manabu Tamura
- 2Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Maruyama
- 1Department of Neurosurgery and
- 2Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
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17
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How I do it? Anatomical multifocal high-grade glioma resection. Acta Neurochir (Wien) 2021; 163:953-957. [PMID: 33180195 DOI: 10.1007/s00701-020-04637-7] [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: 05/31/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND If an awake surgery is somehow not available for gliomas at the language area, understanding the anatomy and well-designed surgical strategy are important. METHOD We present a case with left hemispheric multifocal high-grade gliomas located deeply at the left temporal pole, the Wernicke's area, and mesial temporal region. Because the patient could not endure the awake surgery and obtain practicable functional magnetic resonance imaging (MRI) for eloquent cortex evaluation, we removed the lesions following the anatomical resection strategy guided by diffusion tensor imaging (DTI). CONCLUSION This case demonstrates the value of DTI and the importance of anatomical resection strategies in glioma surgeries.
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18
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Papatzalas C, Fountas K, Kapsalaki E, Papathanasiou I. The Use of Standardized Intraoperative Language Tests in Awake Craniotomies: A Scoping Review. Neuropsychol Rev 2021; 32:20-50. [PMID: 33786797 DOI: 10.1007/s11065-021-09492-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/22/2021] [Indexed: 12/12/2022]
Abstract
Assessment of speech and language functions is an essential part of awake craniotomies. Although standardized and validated tests have several advantages compared to homemade (or mixed) batteries, in the literature it is unclear how such tests are used or whether they are used at all. In this study, we performed a scoping review in order to locate standardized and validated intraoperative language tests. Our inquiry included two databases (PubMED and MEDLINE), gray literature, and snowball referencing. We discovered 87 studies reporting use of mixed batteries, which consist of homemade tasks and tests borrowed from other settings. The tests we found to meet the validation and standardization criteria we set were ultimately three (n = 3) and each one has its own advantages and disadvantages. We argue that tests with high sensitivity and specificity not only can lead to better outcomes postoperatively, but they can also help us to gain a better understanding of the neuroanatomy of language.
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Affiliation(s)
- Christos Papatzalas
- Department of Medicine, University of Thessaly, Larisa, Greece.
- Department of Neurosurgery, University Hospital of Larisa, Larisa, Greece.
| | - Kostas Fountas
- Department of Medicine, University of Thessaly, Larisa, Greece
- Department of Neurosurgery, University Hospital of Larisa, Larisa, Greece
| | - Eftychia Kapsalaki
- Department of Medicine, University of Thessaly, Larisa, Greece
- Department of Radiology, University Hospital of Larisa, Larisa, Greece
| | - Ilias Papathanasiou
- Department of Speech & Language Therapy, University of Patras, Patras, Greece
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Vanacôr CN, Isolan GR, Yu YH, Telles JPM, Oberman DZ, Rabelo NN, Figueiredo EG. Microsurgical anatomy of language. Clin Anat 2020; 34:154-168. [PMID: 32918507 DOI: 10.1002/ca.23681] [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: 04/15/2020] [Revised: 08/21/2020] [Accepted: 09/05/2020] [Indexed: 11/09/2022]
Abstract
The localizationist model, which focused on classical cortical areas such as Broca's and Wernicke's, can no longer explain how language processing works. Over recent years, several studies have revealed new language-related cortical and subcortical areas, resulting in a transition from localizationist concepts to a hodotopical model. These studies have described language processing as an extensive and complex network of multiple interconnected cortical areas and subcortical pathways, differing from the classical circuit described by the localizationist perspective. The hodotopical model was made possible by a paradigm shift in the treatment of cerebral tumors, especially low-grade gliomas: total or subtotal tumor resections with cortical and subcortical mapping on awake patients have become the gold standard treatment for lesions located in the dominant hemisphere. In this article, we review current understating of the microsurgical anatomy of language.
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Affiliation(s)
- Clarissa Nunes Vanacôr
- Postgraduate Program in Medicine - Surgical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,CEANNE (Centro Avançado de Neurologia e Neurocirurgia), Porto Alegre, Brazil.,Moinhos De Vento Hospital, Porto Alegre, Brazil
| | - Gustavo Rassier Isolan
- Postgraduate Program in Medicine - Surgical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,CEANNE (Centro Avançado de Neurologia e Neurocirurgia), Porto Alegre, Brazil
| | - Yang Han Yu
- Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - João Paulo Mota Telles
- Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Nícollas Nunes Rabelo
- Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Eberval Gadelha Figueiredo
- Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Broggi M, Zattra CM, Tringali G, Acerbi F. Commentary: Novel Use of Stimulating Fence-Post Technique for Functional Mapping of Subcortical White Matter During Tumor Resection: A Technical Case Series. Oper Neurosurg (Hagerstown) 2020; 19:E222-E223. [PMID: 32348480 DOI: 10.1093/ons/opaa111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Costanza M Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Giovanni Tringali
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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21
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Piai V, De Witte E, Sierpowska J, Zheng X, Hinkley LB, Mizuiri D, Knight RT, Berger MS, Nagarajan SS. Language Neuroplasticity in Brain Tumor Patients Revealed by Magnetoencephalography. J Cogn Neurosci 2020; 32:1497-1507. [PMID: 32286133 PMCID: PMC8330634 DOI: 10.1162/jocn_a_01561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Little is known about language impairment in brain tumor patients, especially in the presurgical phase. Impairment in this population may be missed because standardized tests fail to capture mild deficits. Additionally, neuroplasticity may also contribute to minimizing language impairments. We examined 14 presurgical patients with brain tumors in the language-dominant hemisphere using magnetoencephalography (MEG) while they performed a demanding picture-word interference task, that is, participants name pictures while ignoring distractor words. Brain tumor patients had behavioral picture-naming effects typically observed in healthy controls. The MEG responses also showed the expected pattern in its timing and amplitude modulation typical of controls, but with an altered spatial distribution of right hemisphere sources, in contrast to the classic left hemisphere source found in healthy individuals. This finding supports tumor-induced neural reorganization of language before surgery. Crucially, the use of electrophysiology allowed us to show the "same" neuronal response in terms of its timing and amplitude modulation in the right hemisphere, supporting the hypothesis that the processes performed by the right hemisphere following reorganization are similar in nature to those (previously) performed by the left hemisphere. We also identified one participant with a fast-growing tumor affecting large parts of critical language areas and underlying ventral and dorsal white matter tracts who showed a deviant pattern in behavior and in the MEG event-related responses. In conclusion, our results attest to the validity of using a demanding picture-naming task in presurgical patients and provide evidence for neuroplasticity, with the right hemisphere performing similar computations as the left hemisphere typically performs.
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Affiliation(s)
- Vitória Piai
- Radboud University, Nijmegen, the Netherlands
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elke De Witte
- Free University of Brussels
- University of California, San Francisco
| | - Joanna Sierpowska
- Radboud University, Nijmegen, the Netherlands
- Radboud University Medical Center, Nijmegen, the Netherlands
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Leroy HA, Lacoste M, Maurage CA, Derré B, Baroncini M, Reyns N, Delmaire C. Anatomo-radiological correlation between diffusion tensor imaging and histologic analyses of glial tumors: a preliminary study. Acta Neurochir (Wien) 2020; 162:1663-1672. [PMID: 32291589 DOI: 10.1007/s00701-020-04323-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/02/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE The challenge of the neurosurgical management of gliomas lies in achieving a maximal resection without persistent functional deficit. Diffusion tensor imaging (DTI) allows non-invasive identification of white matter tracts and their interactions with the tumor. Previous DTI validation studies were compared with intraoperative cortical stimulation, but none was performed based on the tumor anatomopathological analysis. This preliminary study evaluates the correlation between the preoperative subcortical DTI tractography and histology in terms of fiber direction as well as potential tumor-related fiber disruption. METHODS Eleven patients harboring glial tumors underwent preoperative DTI images. Correlations were performed between the visual color-coded anisotropy (FA) map analysis and the tumor histology after "en bloc" resection. Thirty-one tumor areas were classified according to the degree of tumor infiltration, the destruction of myelin fibers and neurofilaments, the presence of organized white matter fibers, and their orientation in space. RESULTS After histologic comparison, the DTI sensitivity and specificity to predict disrupted fiber tracts were respectively of 89% and 90%. The positive and negative predicted values of DTI were 80% and 95%. The DTI data were in line with the histologic myelin fiber orientation in 90% of patients. In our series, the prevalence of destructed fiber was 31%. Glioblastoma WHO grade IV harbored a higher proportion of destructed white matter tracts. Lower WHO grades were associated with higher preservation of subcortical fiber tracts. CONCLUSION This DTI/histology study of "en bloc"-resected gliomas reported a high and reproducible concordance of the visual color-coded FA map with the histologic examination to predict subcortical fiber tract disruption. Our series brought consistency to the DTI data that could be performed routinely for glioma surgery to predict the tumor grade and the postoperative clinical outcomes.
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Affiliation(s)
- Henri-Arthur Leroy
- Department of Neurosurgery, CHU Lille, Univ. Lille, F-59000, Lille, France.
- Inserm, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, Univ. Lille, F-59000, Lille, France.
| | - M Lacoste
- Department of Neuroradiology, CHU Lille, Univ. Lille, F-59000, Lille, France
| | - C-A Maurage
- Department of Anatomopathology, CHU Lille, Univ. Lille, F-59000, Lille, France
| | - B Derré
- Department of Neurosurgery, CHU Lille, Univ. Lille, F-59000, Lille, France
| | - M Baroncini
- Department of Neurosurgery, CHU Lille, Univ. Lille, F-59000, Lille, France
| | - N Reyns
- Department of Neurosurgery, CHU Lille, Univ. Lille, F-59000, Lille, France
- Inserm, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, Univ. Lille, F-59000, Lille, France
| | - C Delmaire
- Department of Neuroradiology, CHU Lille, Univ. Lille, F-59000, Lille, France
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Martín-Monzón I, Rivero Ballagas Y, Arias-Sánchez S. Language mapping: A systematic review of protocols that evaluate linguistic functions in awake surgery. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:845-854. [PMID: 32543924 DOI: 10.1080/23279095.2020.1776287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Nowadays, numerous neuropsychological tests are available for multidisciplinary teams to perform awake brain surgery but none-or very few-of them constitutes a mandatory prerequisite. No consensus has been reached about the choice of intraoperative tests, which can be relatively simple for certain primary functions, but can be much more difficult for high-level cognitive functions. This review aims to give an overview about the assessment of language during awake brain surgery in adults and focus on the analysis of the different language protocols that have been published, to compile the most used standardized tests that evaluate different linguistic cognitive processes. We performed a systematic review about awake brain surgery studies that mentioned a specific test or protocol for assessing language in adults from the last 15 years. The search yielded 3,504 articles. 120 studies reported a linguistic protocol or test. This review allowed to obtain a defined neuropsychological picture of the essential tasks that a linguistic protocol in awake surgery should compile. This review will help clinicians in selecting tasks for monitoring cognition during awake brain surgery as well as contributes to enlighten the efficacy of linguistics protocols in order to minimize language deficits in awake surgery.
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Affiliation(s)
- Isabel Martín-Monzón
- Laboratory of Psychobiology, Faculty of Psychology, Campus Santiago Ramón y Cajal, University of Sevilla, Sevilla, Spain
| | - Yudania Rivero Ballagas
- Department of Experimental Psychology, Faculty of Psychology, Campus, Santiago Ramón y Cajal, University of Sevilla, Sevilla, Spain
| | - Samuel Arias-Sánchez
- Department of Experimental Psychology, Faculty of Psychology, Campus, Santiago Ramón y Cajal, University of Sevilla, Sevilla, Spain
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Verst SM, Melo MND, Caivano AS, Fonseca US, Mathias LR, Alves TV. Awake surgery versus VEP in tumors of visual pathway: Case report. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hinkley LBN, De Witte E, Cahill-Thompson M, Mizuiri D, Garrett C, Honma S, Findlay A, Gorno-Tempini ML, Tarapore P, Kirsch HE, Mariën P, Houde JF, Berger M, Nagarajan SS. Optimizing Magnetoencephalographic Imaging Estimation of Language Lateralization for Simpler Language Tasks. Front Hum Neurosci 2020; 14:105. [PMID: 32499685 PMCID: PMC7242765 DOI: 10.3389/fnhum.2020.00105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/09/2020] [Indexed: 12/13/2022] Open
Abstract
Magnetoencephalographic imaging (MEGI) offers a non-invasive alternative for defining preoperative language lateralization in neurosurgery patients. MEGI indeed can be used for accurate estimation of language lateralization with a complex language task - auditory verb generation. However, since language function may vary considerably in patients with focal lesions, it is important to optimize MEGI for estimation of language function with other simpler language tasks. The goal of this study was to optimize MEGI laterality analyses for two such simpler language tasks that can have compliance from those with impaired language function: a non-word repetition (NWR) task and a picture naming (PN) task. Language lateralization results for these two tasks were compared to the verb-generation (VG) task. MEGI reconstruction parameters (regions and time windows) for NWR and PN were first defined in a presurgical training cohort by benchmarking these against laterality indices for VG. Optimized time windows and regions of interest (ROIs) for NWR and PN were determined by examining oscillations in the beta band (12-30 Hz) a marker of neural activity known to be concordant with the VG laterality index (LI). For NWR, additional ROIs include areas MTG/ITG and for both NWR and PN, the postcentral gyrus was included in analyses. Optimal time windows for NWR were defined as 650-850 ms (stimulus-locked) and -350 to -150 ms (response-locked) and for PN -450 to -250 ms (response-locked). To verify the optimal parameters defined in our training cohort for NWR and PN, we examined an independent validation cohort (n = 30 for NWR, n = 28 for PN) and found high concordance between VG laterality and PN laterality (82%) and between VG laterality and NWR laterality (87%). Finally, in a test cohort (n = 8) that underwent both the intracarotid amobarbital procedure (IAP) test and MEG for VG, NWR, and PN, we identified excellent concordance (100%) with IAP for VG + NWR + PN composite LI, high concordance for PN alone (87.5%), and moderate concordance for NWR alone (66.7%). These findings provide task options for non-invasive language mapping with MEGI that can be calibrated for language abilities of individual patients. Results also demonstrate that more accurate estimates can be obtained by combining laterality estimates obtained from multiple tasks. MEGI.
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Affiliation(s)
- Leighton B. N. Hinkley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Elke De Witte
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Megan Cahill-Thompson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Danielle Mizuiri
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Coleman Garrett
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Susanne Honma
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Anne Findlay
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Phiroz Tarapore
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Heidi E. Kirsch
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Peter Mariën
- Department of Neurology, Ziekenhuis Netwerk Antwerpen, Antwerp, Belguim
| | - John F. Houde
- Department of Otolaryngology; University of California, San Francisco, San Francisco, CA, United States
| | - Mitchel Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Srikantan S. Nagarajan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
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Pesce A, Palmieri M, Cofano F, Iasanzaniro M, Angelini A, D'Andrea G, Monticelli M, Zeppa P, Santonio FV, Zenga F, Salvati M, Santoro A, Garbossa D, Frati A. Standard awake surgery versus hypnosis aided awake surgery for the management of high grade gliomas: A non-randomized cohort comparison controlled trial. J Clin Neurosci 2020; 77:41-48. [PMID: 32409219 DOI: 10.1016/j.jocn.2020.05.047] [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: 11/17/2019] [Revised: 04/18/2020] [Accepted: 05/03/2020] [Indexed: 01/22/2023]
Abstract
Hypnosis could extend the time of Intraoperative Neuropsychological Testing and Brain Mapping in Awake Surgery. A clinical validation for the Hypnosis aided AS (HAs) is still ongoing and further evidences are required. The objective of the present study is to compare two homogeneous cohorts of patients undergoing AS, the first with the aid of the hypnosis and the second according to a standard AS (SAs) protocols. The clinical, radiological and surgical data of two comparable procedures cohorts were retrospectively examined for the present study. All surgeries in Group A were performed with a HAs protocol. Procedures belonging to Group B were performed with a SAs protocol. Endpoints: to compare 1. Incidence of complications in the immediate postoperative period, 2. Clinical and neurological status in the immediate postoperative period and 30 days after surgery, 3. Duration of surgical interventions, 4. Extent of Resection (EOR). The final cohort is composed of 15 procedures; 6 belonging to Group A and 9 to Group B. The different methods outline statistically comparable results from the clinical (Neurological outcomes) both in the postoperative period and one month after surgery and from the surgical point of view (comparable EOR). The incidence of complications is comparable either. The duration of the procedures was significantly longer in HAs group. Hypnosis is a promising approach to increasing the duration of intraoperative "testability" of patients at the price of a longer operative time. A specific professional is needed to induce hypnosis in the difficult intraoperative setting.
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Affiliation(s)
| | - Mauro Palmieri
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Rome, Italy; A.O.U "Policlinico Umberto I", Neurosurgery Unit, Rome, Italy.
| | - Fabio Cofano
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Manuela Iasanzaniro
- A.O.U. "Sant'Andrea", Anesthesia and Intensive Care Unit, "Sapienza" University, Italy
| | - Albina Angelini
- A.O.U. "Sant'Andrea", Anesthesia and Intensive Care Unit, "Sapienza" University, Italy
| | - Giancarlo D'Andrea
- Department of Neurosurgery, Fabrizio Spaziani Hospital, Frosinone, Italy
| | - Matteo Monticelli
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Pietro Zeppa
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Filippo Veneziani Santonio
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Francesco Zenga
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Maurizio Salvati
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Rome, Italy; A.O.U "Policlinico Umberto I", Neurosurgery Unit, Rome, Italy
| | - Antonio Santoro
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Rome, Italy; A.O.U "Policlinico Umberto I", Neurosurgery Unit, Rome, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
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Roth J, Constantini S. Aborting a neurosurgical procedure: analyzing the decision factors, with endoscopic third ventriculostomy as a model. Childs Nerv Syst 2020; 36:919-924. [PMID: 32144490 DOI: 10.1007/s00381-020-04562-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
Aborting a neurosurgical procedure is a situation in which the surgeon modifies the original surgical plan and decides to stop a procedure without achieving the pre-operative goal. While adhering to predefined goals is important, intra-operative judgment, especially in terms of adjusting the risk/benefit ratio in response to real-time data, may change the balance and lead, in selective scenarios, to aborting of a procedure. The literature regarding aborting a surgical procedure is sparse, with no objective guidelines on when, and how, to make such a decision. Defining "when to abort" is difficult and is influenced by many factors, including unexpected intraoperative findings, the surgeon's surgical experience and perspective, and the patient and family perspective. Aborting a procedure is a decision that must be ultimately determined by the surgical findings and the individual treatment alternatives. The aim of this paper is to discuss the condition of aborting a neurosurgical procedure, using the relatively common endoscopic third ventriculostomy (ETV) as a model procedure prototype.
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Affiliation(s)
- Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel.
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
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Ge S, Wang L, Shi Y, Ji P, Liu J, Wang Y, Guo S, Zhai Y, Chao M, Gao G, Qu Y. Strategy of awake surgical resection for glioma based on intraoperative functional mapping and monitoring: A case report. GLIOMA 2020. [DOI: 10.4103/glioma.glioma_15_20] [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
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29
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Metwali H, Samii A. Seed-Based Connectivity Analysis of Resting-State fMRI in Patients with Brain Tumors: A Feasibility Study. World Neurosurg 2019; 128:e165-e176. [DOI: 10.1016/j.wneu.2019.04.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 11/24/2022]
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Costabile JD, Alaswad E, D'Souza S, Thompson JA, Ormond DR. Current Applications of Diffusion Tensor Imaging and Tractography in Intracranial Tumor Resection. Front Oncol 2019; 9:426. [PMID: 31192130 PMCID: PMC6549594 DOI: 10.3389/fonc.2019.00426] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 05/07/2019] [Indexed: 01/01/2023] Open
Abstract
In the treatment of brain tumors, surgical intervention remains a common and effective therapeutic option. Recent advances in neuroimaging have provided neurosurgeons with new tools to overcome the challenge of differentiating healthy tissue from tumor-infiltrated tissue, with the aim of increasing the likelihood of maximizing the extent of resection volume while minimizing injury to functionally important regions. Novel applications of diffusion tensor imaging (DTI), and DTI-derived tractography (DDT) have demonstrated that preoperative, non-invasive mapping of eloquent cortical regions and functionally relevant white matter tracts (WMT) is critical during surgical planning to reduce postoperative deficits, which can decrease quality of life and overall survival. In this review, we summarize the latest developments of applying DTI and tractography in the context of resective surgery and highlight its utility within each stage of the neurosurgical workflow: preoperative planning and intraoperative management to improve postoperative outcomes.
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Affiliation(s)
- Jamie D Costabile
- Department of Neurosurgery, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Elsa Alaswad
- Department of Neurosurgery, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Shawn D'Souza
- Department of Neurosurgery, School of Medicine, University of Colorado, Aurora, CO, United States
| | - John A Thompson
- Department of Neurosurgery, School of Medicine, University of Colorado, Aurora, CO, United States
| | - D Ryan Ormond
- Department of Neurosurgery, School of Medicine, University of Colorado, Aurora, CO, United States
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31
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Sakreida K, Blume-Schnitzler J, Heim S, Willmes K, Clusmann H, Neuloh G. Phonological picture–word interference in language mapping with transcranial magnetic stimulation: an objective approach for functional parcellation of Broca’s region. Brain Struct Funct 2019; 224:2027-2044. [DOI: 10.1007/s00429-019-01891-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
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The Role and Real Effect of an Iterative Surgical Approach for the Management of Recurrent High-Grade Glioma: An Observational Analytic Cohort Study. World Neurosurg 2019; 124:e480-e488. [PMID: 30610982 DOI: 10.1016/j.wneu.2018.12.118] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The benefits of multiple interventions on the recurrence of high-grade gliomas are renowned. However, the real effect of repeated operations on the survival parameters does not seem to have been assessed. The aim of the present study was to determine whether reoperation for selected patients is safe and feasible. METHODS A total of 78 patients with high-grade glioma had undergone surgery from 2004 to 2014. All the patients had met the following inclusion criteria: American Society of Anesthesiologists score 1-3, Karnofsky performance scale score >60, and reintervention ≥4 months after the first surgery. The following parameters were evaluated: overall survival (OS) after diagnosis and reintervention, progression-free survival (PFS) after reintervention, number of surgical procedures, and OS of patients who had undergone surgery >2 times. The results were compared with those of 78 patients with high-grade glioma who had undergone adjuvant chemotherapy. RESULTS OS at 1 year was 100%. At 2 years, OS was 39.4% for those with glioblastoma and 58.3% for those with anaplastic astrocytoma. PFS after 6 months was 53.03% for glioblastoma and 75.0% for anaplastic astrocytoma. Of the 78 patients, 55 had undergone reoperation, with 15 requiring a third intervention and 8 requiring 4. Major complications developed in only 2 patients. Statistical analysis revealed no significant differences in complications or worsening neurological status. CONCLUSIONS These data showed excellent outcomes in terms of OS and PFS and clinical conditions after multiple surgical procedures. Therefore, reintervention appears to be a feasible and safe solution for selected patients.
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De Witte E, Piai V, Kurteff G, Cai R, Mariën P, Dronkers N, Chang E, Berger M. A valid alternative for in-person language assessments in brain tumor patients: feasibility and validity measures of the new TeleLanguage test. Neurooncol Pract 2019; 6:93-102. [PMID: 31386040 PMCID: PMC6656337 DOI: 10.1093/nop/npy020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although language deficits after awake brain surgery are usually milder than post-stroke, postoperative language assessments are needed to identify these. Follow-up of brain tumor patients in certain geographical regions can be difficult when most patients are not local and come from afar. We developed a short telephone-based test for pre- and postoperative language assessments. METHODS The development of the TeleLanguage Test was based on the Dutch Linguistic Intraoperative Protocol and existing standardized English batteries. Two parallel versions were composed and tested in healthy native English speakers. Subsequently, the TeleLanguage Test was administered in a group of 14 tumor patients before surgery and at 1 week, 1 month, and 3 months after surgery. The test includes auditory comprehension, repetition, semantic selection, sentence or story completion, verbal naming, and fluency tests. It takes less than 20 minutes to administer. RESULTS Healthy participants had no difficulty performing any of the language tests via the phone, attesting to the feasibility of a phone assessment. In the patient group, all TeleLanguage test scores significantly declined shortly after surgery with a recovery to preoperative levels at 3 months postsurgery for naming and fluency tasks and a recovery to normal levels for the other language tasks. Analysis of the in-person language assessments (until 1 month) revealed a similar profile. CONCLUSION The use of the TeleLanguage battery to conduct language assessments from afar can provide convenience, might optimize patient care, and enables longitudinal clinical research. The TeleLanguage is a valid tool for various clinical and scientific purposes.
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Affiliation(s)
- Elke De Witte
- University of California San Francisco Medical Center, Department of Neurological Surgery, San Francisco, California, USA
- Vrije Universiteit Brussel, Department of Clinical and Experimental Neurolinguistics, Center of Linguistics and Literary Studies, Brussels, Belgium
| | - Vitória Piai
- Radboud University Medical Center, Department of Medical Psychology, Nijmegen, the Netherlands
- Radboud University, Donders Centre for Cognition, Nijmegen, the Netherlands
| | - Garret Kurteff
- University of California San Francisco Medical Center, Department of Neurological Surgery, San Francisco, California, USA
| | - Ruofan Cai
- University of California San Francisco Medical Center, Department of Neurological Surgery, San Francisco, California, USA
| | - Peter Mariën
- Vrije Universiteit Brussel, Department of Clinical and Experimental Neurolinguistics, Center of Linguistics and Literary Studies, Brussels, Belgium
- ZNA Middelheim, Department of Neurology & Memory Clinic, Antwerp, Belgium
| | - Nina Dronkers
- VA Northern California Health Care System, Center for Aphasia and Related Disorders, Martinez, California, USA
| | - Edward Chang
- University of California San Francisco Medical Center, Department of Neurological Surgery, San Francisco, California, USA
| | - Mitchel Berger
- University of California San Francisco Medical Center, Department of Neurological Surgery, San Francisco, California, USA
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Pichierri A, Bradley M, Iyer V. Intraoperative Magnetic Resonance Imaging-Guided Glioma Resections in Awake or Asleep Settings and Feasibility in the Context of a Public Health System. World Neurosurg X 2019; 3:100022. [PMID: 31225516 PMCID: PMC6584609 DOI: 10.1016/j.wnsx.2019.100022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 02/07/2019] [Indexed: 12/01/2022] Open
Abstract
Background Despite the most recent surgical aids and tools, surgical removal of infiltrating brain tumors remains a challenge. Unclear margins, edematous areas, and infiltrative behavior are the main causes for failing gross total removals. Also, excessive resection of peri-tumoral tissue often carries risks of damaging the nearby functioning cortical and subcortical structures with an unacceptable decrease in patient's quality of life and postoperative functional status, and the risk of making patients not eligible to adjuvant treatments. Awake surgery and intraoperative magnetic resonance imaging (ioMRI) are among the most effective aids in preventing damage to functional brain while maximizing the extent of resection. Methods We present our series of 46 patients operated on at Southmead Hospital (North Bristol NHS Trust) in between July 2014 and February 2017 using ioMRI plus or minus awake surgery. Setting, patient features, indications, type and size of tumors, surgical times, extent of resection, morbidity, and survival are analyzed and discussed. Results Overall, ioMRI check led to a +43% resections in Group 1 and +58% in Group 2. In grade 2 tumors, GTR was 46% in Group 1 and 55% in Group 2 (41% in control group). In grade 3 tumors, GTR was 57% in Group 1 and 66% in Group 2 (30% in control group). In Grade 4 tumors, GTR was 63% in Group 1, 66% in Group 2 (36% in control group). In terms of theatre occupation, the use of ioMRI added 1/2 operative session; the addition of awake surgery implied the use of another 1/2 operative session. Morbidity did not differ among the groups, with low incidence of permanent post-operative deficits (<5%). Group 2 OS was statistically longer when compared to the control group. Conclusions Using ioMRI together with awake surgery is demanding for the anesthetic team, staff nurses, and for the patient. Nevertheless, low morbidity, greater total resections rates, and longer survival suggest its use is effective in making more approachable gliomas of all grades that we would consider “complex” due to their intrinsic features or locations.
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Key Words
- 5-ALA, 5-Aminolevulinic acid
- Awake surgery
- EOR, Extent of resection
- FLAIR, Fluid-attenuated inversion recovery
- GBM, Glioblastoma multiforme
- GTR, Gross total resection
- Glioma
- HGG, High-grade glioma
- LGG, Low-grade glioma
- MAC, Monitored anesthesia care
- Neuro-oncology
- OS, Overall survival
- PFS, Progression-free survival
- PR, Partial resection
- PS, Performance Status
- Survival
- Volumetric analysis
- WHO, World Health Organization
- ioMRI
- ioMRI, Intraoperative magnetic resonance imaging
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Affiliation(s)
- Angelo Pichierri
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Marcus Bradley
- Department of Neuroradiology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Venkat Iyer
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
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Jung J, Lavrador JP, Patel S, Giamouriadis A, Lam J, Bhangoo R, Ashkan K, Vergani F. First United Kingdom Experience of Navigated Transcranial Magnetic Stimulation in Preoperative Mapping of Brain Tumors. World Neurosurg 2019; 122:e1578-e1587. [DOI: 10.1016/j.wneu.2018.11.114] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
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Frati A, Pesce A, Palmieri M, Iasanzaniro M, Familiari P, Angelini A, Salvati M, Rocco M, Raco A. Hypnosis-Aided Awake Surgery for the Management of Intrinsic Brain Tumors versus Standard Awake-Asleep-Awake Protocol: A Preliminary, Promising Experience. World Neurosurg 2019; 121:e882-e891. [DOI: 10.1016/j.wneu.2018.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 12/17/2022]
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van Ierschot F, Bastiaanse R, Miceli G. Evaluating Spelling in Glioma Patients Undergoing Awake Surgery: a Systematic Review. Neuropsychol Rev 2018; 28:470-495. [DOI: 10.1007/s11065-018-9391-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/07/2018] [Indexed: 01/20/2023]
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38
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Saito T, Muragaki Y, Tamura M, Maruyama T, Nitta M, Tsuzuki S, Kawamata T. Impact of connectivity between the pars triangularis and orbitalis on identifying the frontal language area in patients with dominant frontal gliomas. Neurosurg Rev 2018; 43:537-545. [PMID: 30415305 DOI: 10.1007/s10143-018-1052-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/04/2018] [Accepted: 11/01/2018] [Indexed: 11/30/2022]
Abstract
We have previously revealed that identification of the frontal language area (FLA) can be difficult in patients with dominant frontal glioma involving the pars triangularis (PT). The present study added new cases and performed additional analyses. We noticed a new finding that the presence of extension to the pars orbitalis (POr) was associated with negative response to the FLA. The aim of the present study was to evaluate the impact of PT involvement with extension to the POr on the failure to identify the FLA. From 2000 to 2017, awake craniotomy was performed on 470 patients. Of these patients, the present study included 148 consecutive patients with frontal glioma on the dominant side. We evaluated whether tumors involved the PT or extended to the POr. Thirty one of 148 patients showed involvement of the PT, and we examined the detailed characteristics of these 31 patients. The rate of negative response for the FLA was 61% in patients with involvement of the PT. In 31 patients with frontal glioma involving the PT, univariate analyses showed significant correlation between extension to the POr and failure to identify the FLA (P = 0.0070). Similarly, multivariate analysis showed only extension to the POr correlated significantly with failure to identify the FLA (P = 0.0129). We found new evidence that extension to the POr which impacts connectivity between the PT and POr correlated significantly with negative response to the FLA of patients with dominant frontal glioma.
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Affiliation(s)
- Taiichi Saito
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Yoshihiro Muragaki
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Manabu Tamura
- Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Maruyama
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayuki Nitta
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shunsuke Tsuzuki
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Semenza C, Benavides-Varela S. Reassessing lateralization in calculation. Philos Trans R Soc Lond B Biol Sci 2018; 373:rstb.2017.0044. [PMID: 29292349 DOI: 10.1098/rstb.2017.0044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/12/2022] Open
Abstract
The role of the left hemisphere in calculation has been unequivocally demonstrated in numerous studies in the last decades. The right hemisphere, on the other hand, had been traditionally considered subsidiary to the left hemisphere functions, although its role was less clearly defined. Recent clinical studies as well as investigations conducted with other methodologies (e.g. neuroimaging, transcranial magnetic stimulation and direct cortical electro-stimulation) leave several unanswered questions about the contribution of the right hemisphere in calculation. In particular, novel clinical studies show that right hemisphere acalculia encompasses a wide variety of symptoms, affecting even simple calculation, which cannot be easily attributed to spatial disorders or to a generic difficulty effect as previously believed. The studies reported here also show how the right hemisphere has its own specific role and that only a bilateral orchestration between the respective functions of each hemisphere guarantees, in fact, precise calculation. Vis-à-vis these data, the traditional wisdom that attributes to the right hemisphere a role mostly confined to spatial aspects of calculation needs to be significantly reshaped. The question for the future is whether it is possible to precisely define the specific contribution of the right hemisphere in several aspects of calculation while highlighting the nature of the cross-talk between the two hemispheres.This article is part of a discussion meeting issue 'The origins of numerical abilities'.
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Affiliation(s)
- Carlo Semenza
- Department of Neuroscience, University of Padova, via Giustiniani 5, 35128 Padova, Italy .,IRCCS Ospedale S. Camillo, Lido di Venezia, Italy
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Javadi SA, Nabavi A, Giordano M, Faghihzadeh E, Samii A. Evaluation of Diffusion Tensor Imaging-Based Tractography of the Corticospinal Tract: A Correlative Study With Intraoperative Magnetic Resonance Imaging and Direct Electrical Subcortical Stimulation. Neurosurgery 2018; 80:287-299. [PMID: 28175893 DOI: 10.1227/neu.0000000000001347] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 05/07/2016] [Indexed: 11/19/2022] Open
Abstract
Background The accuracy of intraoperative diffusion tensor imaging (DTI)–based tractography of the corticospinal tract (CST) is crucial for its use in neurosurgical planning and its implementation in image-guided surgery. To the best of our knowledge, this is the largest prospective correlative study of the intraoperative DTI tractography of the CST and intraoperative direct electrical subcortical stimulation (DESS) of the CST, with application of intraoperative magnetic resonance imaging (iMR). Objective To evaluate intraoperatively acquired DTI-based tractography of the CST in correlation with DESS. Methods Twenty patients with gliomas (grades II-IV) adjacent to the CST were included in this prospective study. Bilateral DTI tractography of the CST was performed pre- and intraoperatively with application of 1.5-T iMRI and the results correlated and compared with the prevailing gold standard of DESS. Sensitivity, specificity, positive predictive value, and negative predictive value were considered to quantify the correlation of DTI tractography with DESS. The intensity of DESS was correlated with the distance from the CST. Moreover, the tissue quality of stimulation points at the wall of the resection cavity was evaluated with 5-aminolevulinic acid. The clinical and volumetric outcomes at postoperative and follow-up periods were also analyzed. Results The mean ± SD age of the patients was 54.9 ± 12 years. A total of 40 CSTs were reconstructed and 36 stimulations were included at 20 pathological CSTs, resulting in 18 true-positive, 5 false-positive, and 13 true-negative responses. The sensitivity, specificity, positive predictive value, and negative predictive value of DTI tractography to localize the CST were 100%, 72%, 78%, and 100%, respectively. DTI-based tractography correlated well at 86% of DESSs, and a linear correlation was detected between the intensity of DESS and the distance. All of the patients improved clinically, and the mean extent of resection was 97.2%. 5-Aminolevulinic acid was valuable in visualizing tumor infiltration in the false-positive cases, suggesting an infiltration of the CST at stimulation points. Conclusion CST visualization in the iMRI setting appears to have a high sensitivity in accurately localizing the area of the CST adjacent to the resection cavity in glioma surgery. More prospective studies with a large sample size are needed to further support the results.
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Affiliation(s)
- Seyed A Javadi
- Department of Neurosurgery, Interna-tional Neuroscience Institute, Hannover, Germany
| | - Arya Nabavi
- Brain and Spinal Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mario Giordano
- Brain and Spinal Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Faghihzadeh
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Samii
- Brain and Spinal Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Münnich T, Klein J, Hattingen E, Noack A, Herrmann E, Seifert V, Senft C, Forster MT. Tractography Verified by Intraoperative Magnetic Resonance Imaging and Subcortical Stimulation During Tumor Resection Near the Corticospinal Tract. Oper Neurosurg (Hagerstown) 2018; 16:197-210. [DOI: 10.1093/ons/opy062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 03/08/2018] [Indexed: 02/07/2023] Open
Abstract
Abstract
BACKGROUND
Tractography is a popular tool for visualizing the corticospinal tract (CST). However, results may be influenced by numerous variables, eg, the selection of seeding regions of interests (ROIs) or the chosen tracking algorithm.
OBJECTIVE
To compare different variable sets by correlating tractography results with intraoperative subcortical stimulation of the CST, correcting intraoperative brain shift by the use of intraoperative MRI.
METHODS
Seeding ROIs were created by means of motor cortex segmentation, functional MRI (fMRI), and navigated transcranial magnetic stimulation (nTMS). Based on these ROIs, tractography was run for each patient using a deterministic and a probabilistic algorithm. Tractographies were processed on pre- and postoperatively acquired data.
RESULTS
Using a linear mixed effects statistical model, best correlation between subcortical stimulation intensity and the distance between tractography and stimulation sites was achieved by using the segmented motor cortex as seeding ROI and applying the probabilistic algorithm on preoperatively acquired imaging sequences. Tractographies based on fMRI or nTMS results differed very little, but with enlargement of positive nTMS sites the stimulation-distance correlation of nTMS-based tractography improved.
CONCLUSION
Our results underline that the use of tractography demands for careful interpretation of its virtual results by considering all influencing variables.
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Affiliation(s)
- Timo Münnich
- Department of Neurosurgery, Goet-he University Hospital, Frankfurt am Main, Germany
| | - Jan Klein
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe University Hospital, Frankfurt am Main, Germa-ny
| | - Anika Noack
- Department of Neurosurgery, Goet-he University Hospital, Frankfurt am Main, Germany
| | - Eva Herrmann
- Institute for Biostatistics and Math-ematical Modelling, Goethe-University Hospital, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goet-he University Hospital, Frankfurt am Main, Germany
| | - Christian Senft
- Department of Neurosurgery, Goet-he University Hospital, Frankfurt am Main, Germany
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Intraoperative linguistic performance during awake brain surgery predicts postoperative linguistic deficits. J Neurooncol 2018; 139:215-223. [PMID: 29637508 PMCID: PMC6061224 DOI: 10.1007/s11060-018-2863-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/04/2018] [Indexed: 11/20/2022]
Abstract
Introduction Awake craniotomy pursues a balance between extensive tumor resection and preservation of postoperative language function. A dilemma exists in patients whose tumor resection is restricted due to signs of language impairment observed during awake craniotomy. In order to determine the degree to which recovery of language function caused by tumor resection can be achieved by spontaneous neuroplasticity, the change in postoperative language function was compared to quantified intraoperative linguistic performance. Methods The modified, short-form Boston Diagnostic Aphasia Examination (sfBDAE) was used to assess pre- and postoperative language functions; visual object naming (DO 80) and semantic-association (Pyramid and Palm Tree Test, PPTT) tests assessed intraoperative linguistic performance. DO 80 and PPTT were performed alternatively during subcortical functional monitoring while performing tumor resection and sfBDAE was assessed 1-week postoperatively. Results Most patients with observed language impairment during awake surgery showed improved language function postoperatively. Both intraoperative DO 80 and PPTT showed significant correlation to postoperative sfBDAE domain scores (p < 0.05), with a higher correlation observed with PPTT. A linear regression model showed that only PPTT predicted the postoperative sfBDAE domain scores with the adjusted R2 ranging from 0.51 to 0.89 (all p < 0.01). Receiver operating characteristic analysis showed a cutoff value of PPTT that yielded a sensitivity of 80% and specificity of 100%. Conclusion PPTT may be a feasible tool for intraoperative linguistic evaluation that can predict postoperative language outcomes. Further studies are needed to determine the extent of tumor resection that optimizes the postoperative language following neuroplasticity.
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Opciones de monitorización neurofisiológica en la resección de tumoraciones cerebrales. Documento de consenso entre el Grupo de Trabajo de Neurooncología de la Sociedad Española de Neurocirugía (SENEC) y la Sociedad Española de Neurofisiología Clínica (SENFC). Neurocirugia (Astur) 2018; 29:25-38. [DOI: 10.1016/j.neucir.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 11/23/2022]
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Sakreida K, Lange I, Willmes K, Heim S, Binkofski F, Clusmann H, Neuloh G. High-resolution language mapping of Broca's region with transcranial magnetic stimulation. Brain Struct Funct 2017; 223:1297-1312. [PMID: 29116426 DOI: 10.1007/s00429-017-1550-8] [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: 06/09/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
Broca's region, corresponding roughly to cytoarchitectonic areas 44 and 45 in the inferior frontal cortex, holds a multifunctional role in language processing, as shown, e.g., by functional imaging data. Neuro-navigated transcranial magnetic stimulation (TMS) enables complementary non-invasive mapping of cortical functions with high spatial resolution. Here, we report on detailed TMS language mapping of Broca's region in 12 healthy participants. The test protocol with an object naming task was adapted for high-resolution and semi-quantitative mapping of TMS-induced effects on speech and language performance. Hierarchical cluster analysis of normalized ratings of error frequency and severity revealed a clear focus of TMS impact at dorso-posterior target sites, close to the inferior frontal junction. Adjacent clusters of moderate and slightly affected stimulation sites yielded a posterosuperior-to-anteroinferior gradient of TMS susceptibility. Our findings indicate that the part of Broca's region most susceptible to TMS-induced language inhibition in object naming is located in the dorsal area 44.
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Affiliation(s)
- Katrin Sakreida
- Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Inga Lange
- Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.,Section Clinical Cognitive Sciences, Department of Neurology, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Klaus Willmes
- Department of Neurology, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Stefan Heim
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany.,Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1), 52425, Jülich, Germany.,JARA - Translational Brain Medicine, Aachen, Germany
| | - Ferdinand Binkofski
- Section Clinical Cognitive Sciences, Department of Neurology, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany.,Research Centre Jülich, Institute of Neuroscience and Medicine (INM-4), 52425, Jülich, Germany.,JARA - Translational Brain Medicine, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Georg Neuloh
- Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
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45
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Rosenstock T, Giampiccolo D, Schneider H, Runge SJ, Bährend I, Vajkoczy P, Picht T. Specific DTI seeding and diffusivity-analysis improve the quality and prognostic value of TMS-based deterministic DTI of the pyramidal tract. NEUROIMAGE-CLINICAL 2017; 16:276-285. [PMID: 28840099 PMCID: PMC5560117 DOI: 10.1016/j.nicl.2017.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/22/2017] [Accepted: 08/11/2017] [Indexed: 12/17/2022]
Abstract
Object Navigated transcranial magnetic stimulation (nTMS) combined with diffusion tensor imaging (DTI) is used preoperatively in patients with eloquent-located brain lesions and allows analyzing non-invasively the spatial relationship between the tumor and functional areas (e.g. the motor cortex and the corticospinal tract [CST]). In this study, we examined the diffusion parameters FA (fractional anisotropy) and ADC (apparent diffusion coefficient) within the CST in different locations and analyzed their interrater reliability and usefulness for predicting the patients' motor outcome with a precise approach of specific region of interest (ROI) seeding based on the color-coded FA-map. Methods Prospectively collected data of 30 patients undergoing bihemispheric nTMS mapping followed by nTMS-based DTI fiber tracking prior to surgery of motor eloquent high-grade gliomas were analyzed by 2 experienced and 1 unexperienced examiner. The following data were scrutinized for both hemispheres after tractography based on nTMS-motor positive cortical seeds and a 2nd region of interest in one layer of the caudal pons defined by the color-coded FA-map: the pre- and postoperative motor status (day of discharge und 3 months), the closest distance between the tracts and the tumor (TTD), the fractional anisotropy (FA) and the apparent diffusion coefficient (ADC). The latter as an average within the CST as well as specific values in different locations (peritumoral, mesencephal, pontine). Results Lower average FA-values within the affected CST as well as higher average ADC-values are significantly associated with deteriorated postoperative motor function (p = 0.006 and p = 0.026 respectively). Segmental analysis within the CST revealed that the diffusion parameters are especially disturbed on a peritumoral level and that the degree of their impairment correlates with motor deficits (FA p = 0.065, ADC p = 0.007). No significant segmental variation was seen in the healthy hemisphere. The interrater reliability showed perfect agreement for almost all analyzed parameters. Conclusions Adding diffusion weighted imaging derived information on the structural integrity of the nTMS-based tractography results improves the predictive power for postoperative motor outcome. Utilizing a second subcortical ROI which is specifically seeded based on the color-coded FA map increases the tracking quality of the CST independently of the examiner's experience. Further prospective studies are needed to validate the nTMS-based prediction of the patient's outcome. ROI seeding based on nTMS-data and FA-maps improves DTI tractography of the CST. Perfect interrater reliability for DTI tractography of the CST was observed. The pattern of diffusivity disturbance predicts the postoperative motor outcome.
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Affiliation(s)
- Tizian Rosenstock
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Davide Giampiccolo
- Institute of Neurosurgery, University Hospital, Piazzale Stefani 1, 37100 Verona, Italy
| | - Heike Schneider
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Sophia Jutta Runge
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Ina Bährend
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
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Boissonneau S, Duffau H. Identifying clinical risk in low grade gliomas and appropriate treatment strategies, with special emphasis on the role of surgery. Expert Rev Anticancer Ther 2017; 17:703-716. [PMID: 28608763 DOI: 10.1080/14737140.2017.1342537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Diffuse low-grade glioma (DLGG) is a chronic tumoral disease that ineluctably grows, migrates along white matter pathways, and progresses to a higher grade of malignancy. Areas covered: To determine the best individualized treatment attitude for each DLGG patient, and to redefine it over the years, i.e. to optimize the 'onco-functional balance' of serial and multimodal therapies, the understanding of the natural history of this chronic disease is crucial but not sufficient. A paradigmatic shift is to tailor the individual management according to the dynamic relationships between DLGG course and neural remodeling. In this spirit, a better knowledge of brain plasticity in a connectomal account of cerebral processing has enabled a dramatic improvement of both oncological and functional outcomes in DLGG patients, by increasing overall survival while preserving (or even improving) the quality of life. Expert commentary: Here, we propose an individualized and recursive therapeutic strategy in DLGG, leading to the concept of a 'personalized functional neuro-oncology', by emphasizing the role of early and maximal safe surgical resection(s) reliably achieved using intraoperative mapping of cortico-subcortical networks in awake patients.
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Affiliation(s)
| | - Hugues Duffau
- b Department of Neurosurgery , Gui de Chauliac Hospital, Montpellier University Medical Center , Montpellier , France.,c Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," INSERM U1051, Institute for Neurosciences of Montpellier , Montpellier University Medical Center , Montpellier , France
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Pallud J, Rigaux-Viode O, Corns R, Muto J, Lopez Lopez C, Mellerio C, Sauvageon X, Dezamis E. Direct electrical bipolar electrostimulation for functional cortical and subcortical cerebral mapping in awake craniotomy. Practical considerations. Neurochirurgie 2017; 63:164-174. [DOI: 10.1016/j.neuchi.2016.08.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/22/2016] [Accepted: 08/27/2016] [Indexed: 10/20/2022]
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48
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Huberfeld G, Trébuchon A, Capelle L, Badier JM, Chen S, Lefaucheur JP, Gavaret M. Preoperative and intraoperative neurophysiological investigations for surgical resections in functional areas. Neurochirurgie 2017; 63:142-149. [DOI: 10.1016/j.neuchi.2016.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 10/17/2016] [Accepted: 10/31/2016] [Indexed: 01/23/2023]
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49
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Pallud J, Mandonnet E, Corns R, Dezamis E, Parraga E, Zanello M, Spena G. Technical principles of direct bipolar electrostimulation for cortical and subcortical mapping in awake craniotomy. Neurochirurgie 2017; 63:158-163. [DOI: 10.1016/j.neuchi.2016.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 11/24/2016] [Accepted: 12/04/2016] [Indexed: 12/01/2022]
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50
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TAMURA M, MURAGAKI Y, SAITO T, MARUYAMA T, NITTA M, TSUZUKI S, ISEKI H, OKADA Y. Strategy of Surgical Resection for Glioma Based on Intraoperative Functional Mapping and Monitoring. Neurol Med Chir (Tokyo) 2017; 55:383-98. [PMID: 26185825 PMCID: PMC4628166 DOI: 10.2176/nmc.ra.2014-0415] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A growing number of papers have pointed out the relationship between aggressive resection of gliomas and survival prognosis. For maximum resection, the current concept of surgical decision-making is in “information-guided surgery” using multimodal intraoperative information. With this, anatomical information from intraoperative magnetic resonance imaging (MRI) and navigation, functional information from brain mapping and monitoring, and histopathological information must all be taken into account in the new perspective for innovative minimally invasive surgical treatment of glioma. Intraoperative neurofunctional information such as neurophysiological functional monitoring takes the most important part in the process to acquire objective visual data during tumor removal and to integrate these findings as digitized data for intraoperative surgical decision-making. Moreover, the analysis of qualitative data and threshold-setting for quantitative data raise difficult issues in the interpretation and processing of each data type, such as determination of motor evoked potential (MEP) decline, underestimation in tractography, and judgments of patient response for neurofunctional mapping and monitoring during awake craniotomy. Neurofunctional diagnosis of false-positives in these situations may affect the extent of resection, while false-negatives influence intra- and postoperative complication rates. Additionally, even though the various intraoperative visualized data from multiple sources contribute significantly to the reliability of surgical decisions when the information is integrated and provided, it is not uncommon for individual pieces of information to convey opposing suggestions. Such conflicting pieces of information facilitate higher-order decision-making that is dependent on the policies of the facility and the priorities of the patient, as well as the availability of the histopathological characteristics from resected tissue.
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Affiliation(s)
- Manabu TAMURA
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo
- Department of Neurosurgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo
| | - Yoshihiro MURAGAKI
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo
- Department of Neurosurgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo
- Address reprint requests to: Yoshihiro Muragaki, MD, PhD, Department of Neurosurgery, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. e-mail:
| | - Taiichi SAITO
- Department of Neurosurgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo
| | - Takashi MARUYAMA
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo
- Department of Neurosurgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo
| | - Masayuki NITTA
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo
- Department of Neurosurgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo
| | - Shunsuke TSUZUKI
- Department of Neurosurgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo
| | - Hiroshi ISEKI
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo
| | - Yoshikazu OKADA
- Department of Neurosurgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo
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