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Cao B, Huang Y, Chen L, Jia W, Li D, Jiang Y. Soft bioelectronics for diagnostic and therapeutic applications in neurological diseases. Biosens Bioelectron 2024; 259:116378. [PMID: 38759308 DOI: 10.1016/j.bios.2024.116378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/13/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
Physical and chemical signals in the central nervous system yield crucial information that is clinically relevant under both physiological and pathological conditions. The emerging field of bioelectronics focuses on the monitoring and manipulation of neurophysiological signals with high spatiotemporal resolution and minimal invasiveness. Significant advances have been realized through innovations in materials and structural design, which have markedly enhanced mechanical and electrical properties, biocompatibility, and overall device performance. The diagnostic and therapeutic potential of soft bioelectronics has been corroborated across a diverse array of pre-clinical settings. This review summarizes recent studies that underscore the developments and applications of soft bioelectronics in neurological disorders, including neuromonitoring, neuromodulation, tumor treatment, and biosensing. Limitations and outlooks of soft devices are also discussed in terms of power supply, wireless control, biocompatibility, and the integration of artificial intelligence. This review highlights the potential of soft bioelectronics as a future platform to promote deciphering brain functions and clinical outcomes of neurological diseases.
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Affiliation(s)
- Bowen Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing, China; Department of Materials Science and Engineering, University of Pennsylvania, Philadelphia, United States
| | - Yewei Huang
- Department of Materials Science and Engineering, University of Pennsylvania, Philadelphia, United States
| | - Liangpeng Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing, China
| | - Wang Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
| | - Deling Li
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
| | - Yuanwen Jiang
- Department of Materials Science and Engineering, University of Pennsylvania, Philadelphia, United States.
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Biswas C, Shetty PM, Sahu A, Velayutham P, Singh V, Shah K, Moiyadi AV. Factors affecting the extent of resection and neurological outcomes following transopercular resection of insular gliomas. Acta Neurochir (Wien) 2024; 166:244. [PMID: 38822919 PMCID: PMC11144144 DOI: 10.1007/s00701-024-06124-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Surgical resection of insular gliomas is a challenge. TO resection is considered more versatile and has lower risk of vascular damage. In this study, we aimed to understand the factors that affect resection rates, ischemic changes and neurological outcomes and studied the utility of IONM in patients who underwent TO resection for IGs. METHODS Retrospective analysis of 66 patients with IG who underwent TO resection was performed. RESULTS Radical resection was possible in 39% patients. Involvement of zone II and the absence of contrast enhancement predicted lower resection rate. Persistent deficit rate was 10.9%. Although dominant lobe tumors increased immediate deficit and fronto-orbital operculum involvement reduced prolonged deficit rate, no tumor related factor showed significant association with persistent deficits. 45% of patients developed a postoperative infarct, 53% of whom developed deficits. Most affected vascular territory was lenticulostriate (39%). MEP changes were observed in 9/57 patients. 67% of stable TcMEPs and 74.5% of stable strip MEPs did not develop any postoperative motor deficits. Long-term deficits were seen in 3 and 6% patients with stable TcMEP and strip MEPs respectively. In contrast, 25% and 50% of patients with reversible strip MEP and Tc MEP changes respectively had persistent motor deficits. DWI changes were clinically more relevant when accompanied by MEP changes intraoperatively, with persistent deficit rates three times greater when MEP changes occurred than when MEPs were stable. CONCLUSION Radical resection can be achieved in large, multizone IGs, with reasonable outcomes using TO approach and multimodal intraoperative strategy with IONM.
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Affiliation(s)
- Chandrima Biswas
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prakash M Shetty
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Arpita Sahu
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Parthiban Velayutham
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vikas Singh
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kanchi Shah
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Aliasgar V Moiyadi
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
- Department of Health Sciences, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
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Simon M, Hagemann A, Gajadin S, Signorelli F, Vincent AJ. Surgical treatment for insular gliomas. A systematic review and meta-analysis on behalf of the EANS neuro-oncology section. BRAIN & SPINE 2024; 4:102828. [PMID: 38859917 PMCID: PMC11163152 DOI: 10.1016/j.bas.2024.102828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 06/12/2024]
Abstract
Introduction The appropriate surgical management of insular gliomas is controversial. Management strategies vary considerably between centers. Research question To provide robust resection, functional and epilepsy outcome figures, study growth patterns and tumor classification paradigms, analyze surgical approaches, mapping/monitoring strategies, surgery for insular glioblastoma, as well as molecular findings, and to identify open questions for future research. Material and methods On behalf of the EANS Neuro-oncology Section we performed a systematic review and meta-analysis (using a random-effects model) of the more current (2000-2023) literature in accordance with the PRISMA guidelines. Results The pooled postoperative motor and speech deficit rates were 6.8% and 3.6%. There was a 79.6% chance for postoperative epilepsy control. The postoperative KPI was 80-100 in 83.5% of cases. Functional monitoring/mapping paradigms (which may include awake craniotomies) seem mandatory. (Additional) awake surgery may result in slightly better functional but also worse resection outcomes. Transcortical approaches may carry a lesser rate of (motor) deficits than transsylvian surgeries. Discussion and conclusions This paper provides an inclusive overview and analysis of current surgical management of insular gliomas. Risks and complication rates in experienced centers do not necessarily compare unfavorably with the results of routine neuro-oncological procedures. Limitations of the current literature prominently include a lack of standardized outcome reporting. Questions and issues that warrant more attention include surgery for insular glioblastomas and how to classify the various growth patterns of insular gliomas.
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Affiliation(s)
- Matthias Simon
- Dept. of Neurosurgery, Bethel Clinic, University of Bielefeld Medical Center OWL, Bielefeld, Germany
| | | | - Sanjana Gajadin
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Francesco Signorelli
- Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University "Aldo Moro", Bari, Italy
| | - Arnaud J.P.E. Vincent
- Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University "Aldo Moro", Bari, Italy
| | - for the EANS Neuro-oncology Section
- Dept. of Neurosurgery, Bethel Clinic, University of Bielefeld Medical Center OWL, Bielefeld, Germany
- Society for Epilepsy Research, Bielefeld, Germany
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
- Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University "Aldo Moro", Bari, Italy
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Papadopoulou A, Kumar NS. Prognostic Factors and Resectability Predictors in Insular Gliomas: A Systematic Review. J Neurol Surg A Cent Eur Neurosurg 2024; 85:74-87. [PMID: 37619597 PMCID: PMC10764153 DOI: 10.1055/s-0043-1769128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/03/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Insular gliomas (INGs) remain a surgically intimidating glioma subgroup encased by eloquent cortical parcels and white matter language tracts, and traversed by multiple middle cerebral artery branches. The predictive power of prognostic factors affecting overall survival (OS), progression-free survival (PFS), and resectability of INGs remain disputed. This comprehensive systematic review analyses prognostic factors and resectability predictors of INGs substantiating pragmatic management options. MATERIALS AND METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and the Cochrane Handbook of Systematic Reviews of Interventions guidelines. The PubMed, MEDLINE, and Embase databases were searched in April 2022. All clinical studies with ≥10 patients harboring INGs with any intervention and reporting predictors of OS, PFS, and tumor resectability in INGs were included. Molecular ING prognosticators were also included. Studies combining insular and other gliomas analysis, case studies, experimental and animal studies, conference abstracts, letters to the editor, and articles in other languages were excluded. RESULTS Of the 2,384 articles returned, 27 fulfilled the inclusion criteria totaling 1,985 patients. The review yielded 18 OS and 17 PFS prognosticators. These were classified as preoperative (radiologic; clinical), intraoperative, and postoperative (molecular; histopathologic; clinical) prognosticators. In addition, 21 resectability predictors were categorized as preoperative (radiologic; clinical), intraoperative (surgical approach and assistive technology), and postoperative (histopathologic; clinical). The quality assessment revealed 24/27 studies had low risk of bias. One study with moderate and two studies with high risk of bias were included. CONCLUSION Negative prognosticators reported in ≥2 studies included putaminal or paralimbic involvement and higher tumor grade, while seizures at presentation, isocitrate dehydrogenase (IDH) mutation, increased extent of resection, and higher Karnofsky Performance Status preoperatively and at 3 months postoperation were positive prognosticators. Resectability predictors reported in ≥2 studies included the positive predictors of zone I/zone IV tumor location and intraoperative imaging use and the negative predictor of encased lenticulostriate arteries. Paralimbic INGs are not a single entity with homogeneous prognosis. Integration of identified prognosticators in a prospective trial to devise a grading system for INGs can improve clinical decision-making.
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Affiliation(s)
- Ariadni Papadopoulou
- Division of Medicine, University College London Medical School, London, United Kingdom of Great Britain and Northern Ireland
| | - Niraj S. Kumar
- Division of Medicine, University College London Medical School, London, United Kingdom of Great Britain and Northern Ireland
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Tuleasca C, Leroy HA, Strachowski O, Derre B, Maurage CA, Peciu-Florianu I, Reyns N. Combined use of intraoperative MRI and awake tailored microsurgical resection to respect functional neural networks: preliminary experience. Swiss Med Wkly 2023; 153:40072. [PMID: 37192405 DOI: 10.57187/smw.2023.40072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION The combined use of intraoperative MRI and awake surgery is a tailored microsurgical resection to respect functional neural networks (mainly the language and motor ones). Intraoperative MRI has been classically considered to increase the extent of resection for gliomas, thereby reducing neurological deficits. Herein, we evaluated the combined technique of awake microsurgical resection and intraoperative MRI for primary brain tumours (gliomas, metastasis) and epilepsy (cortical dysplasia, non-lesional, cavernomas). PATIENTS AND METHODS Eighteen patients were treated with the commonly used "asleep awake asleep" (AAA) approach at Lille University Hospital, France, from November 2016 until May 2020. The exact anatomical location was insular with various extensions, frontal, temporal or fronto-temporal in 8 (44.4%), parietal in 3 (16.7%), fronto-opercular in 4 (22.2%), Rolandic in two (11.1%), and the supplementary motor area (SMA) in one (5.6%). RESULTS The patients had a mean age of 38.4 years (median 37.1, range 20.8-66.9). The mean surgical duration was 4.1 hours (median 4.2, range 2.6-6.4) with a mean duration of intraoperative MRI of 28.8 minutes (median 25, range 13-55). Overall, 61% (11/18) of patients underwent further resection, while 39% had no additional resection after intraoperative MRI. The mean preoperative and postoperative tumour volumes of the primary brain tumours were 34.7 cc (median 10.7, range 0.534-130.25) and 3.5 cc (median 0.5, range 0-17.4), respectively. Moreover, the proportion of the initially resected tumour volume at the time of intraoperative MRI (expressed as 100% from preoperative volume) and the final resected tumour volume were statistically significant (p= 0.01, Mann-Whitney test). The tumour remnants were commonly found posterior (5/9) or anterior (2/9) insular and in proximity with the motor strip (1/9) or language areas (e.g. Broca, 1/9). Further resection was not required in seven patients because there were no remnants (3/7), cortical stimulation approaching eloquent areas (3/7) and non-lesional epilepsy (1/7). The mean overall follow-up period was 15.8 months (median 12, range 3-36). CONCLUSION The intraoperative MRI and awake microsurgical resection approach is feasible with extensive planning and multidisciplinary collaboration, as these methods are complementary and synergic rather than competitive to improve patient oncological outcomes and quality of life.
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Affiliation(s)
- Constantin Tuleasca
- Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Neurosurgery and Neurooncology Service, Lille, France
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Henri-Arthur Leroy
- Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Neurosurgery and Neurooncology Service, Lille, France
| | - Ondine Strachowski
- Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Neurosurgery and Neurooncology Service, Lille, France
| | - Benoit Derre
- Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Neurosurgery and Neurooncology Service, Lille, France
| | - Claude-Alain Maurage
- Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Neurosurgery and Neurooncology Service, Lille, France
| | - Iulia Peciu-Florianu
- Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Neurosurgery and Neurooncology Service, Lille, France
| | - Nicolas Reyns
- Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Neurosurgery and Neurooncology Service, Lille, France
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Review of Intraoperative Adjuncts for Maximal Safe Resection of Gliomas and Its Impact on Outcomes. Cancers (Basel) 2022; 14:cancers14225705. [PMID: 36428797 PMCID: PMC9688206 DOI: 10.3390/cancers14225705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/12/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
Maximal safe resection is the mainstay of treatment in the neurosurgical management of gliomas, and preserving functional integrity is linked to favorable outcomes. How these modalities differ in their effectiveness on the extent of resection (EOR), survival, and complications remains unknown. A systematic literature search was performed with the following inclusion criteria: published between 2005 and 2022, involving brain glioma surgery, and including one or a combination of intraoperative modalities: intraoperative magnetic resonance imaging (iMRI), awake/general anesthesia craniotomy mapping (AC/GA), fluorescence-guided imaging, or combined modalities. Of 525 articles, 464 were excluded and 61 articles were included, involving 5221 glioma patients, 7(11.4%) articles used iMRI, 21(36.8%) used cortical mapping, 15(24.5%) used 5-aminolevulinic acid (5-ALA) or fluorescein sodium, and 18(29.5%) used combined modalities. The heterogeneity in reporting the amount of surgical resection prevented further analysis. Progression-free survival/overall survival (PFS/OS) were reported in 18/61(29.5%) articles, while complications and permanent disability were reported in 38/61(62.2%) articles. The reviewed studies demonstrate that intraoperative adjuncts such as iMRI, AC/GA mapping, fluorescence-guided imaging, and a combination of these modalities improve EOR. However, PFS/OS were underreported. Combining multiple intraoperative modalities seems to have the highest effect compared to each adjunct alone.
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Duffau H. Awake Mapping With Transopercular Approach in Right Insular-Centered Low-Grade Gliomas Improves Neurological Outcomes and Return to Work. Neurosurgery 2022; 91:182-190. [PMID: 35445665 DOI: 10.1227/neu.0000000000001966] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/05/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Asleep vs awake surgery for right insula-centered low-grade glioma (LGG) is still debated. OBJECTIVE To compare neurological outcomes and return to work after resection for right insular/paralimbic LGG performed without vs with awake mapping. METHODS A personal surgical experience of right insula-centered LGG was analyzed, by comparing 2 consecutive periods. In the first period (group 1), patients underwent asleep surgery with motor mapping. In the second period (group 2), patients underwent intraoperative awake mapping of movement and cognitive functions. RESULTS This consecutive series included 143 LGGs: 41 in group 1 (1999-2009) and 102 in group 2 (2009-2020). There were no significant difference concerning preoperative clinicoradiological characteristics and histopathology results between both groups. Intraoperative motor mapping was positive in all cases in group 1. In group 2, beyond motor mapping, somatosensory, visuospatial, language, and/or cognitive functions were identified during cortical-subcortical stimulation. Postoperatively, 3 patients experienced a long-lasting deterioration with 2 hemiparesis due to deep stroke (1.3%) and 1 severe depressive syndrome, all of them in group 1 vs none in group 2 (P = .022). The rate of RTW was 81.5% in group 1 vs 95.5% in group 2 (P = .016). The tumor volume and extent of resection did not significantly differ across both groups. CONCLUSION This is the first study comparing asleep vs awake surgery for right insula-centered LGG. Despite similar extent of resection, functional outcomes were significantly better in awake patients by avoiding permanent neurological impairment and by increasing RTW. These results support the mapping of higher-order functions during awake procedure.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Low-grade gliomas," INSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
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Dmitriev AY, Dashyan VG. [Intraoperative magnetic resonance imaging in surgery of brain gliomas]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:121-127. [PMID: 35170285 DOI: 10.17116/neiro202286011121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Intraoperative magnetic resonance imaging (iMRI) is used in surgery of supratentorial gliomas to assess resection quality, as well as in neoplasm biopsy to control the needle position. Scanners coupled with operating table ensure fast intraoperative imaging, but they require the use of non-magnetic surgical tools. Surgery outside the scanner 5G line allows working with conventional instruments, but patient transportation takes time. Portable iMRI systems do not interfere with surgical workflow but these scanners have poor resolution. Positioning of MRI scanners in adjacent rooms allows imaging simultaneously for several surgeries. Low-field MRI scanners are effective for control of contrast-enhanced glioma resection quality. However, these scanners are less useful in demarcation of residual low-grade tumors. High-field MRI scanners have no similar disadvantage. These scanners ensure fast detection of residual gliomas of all types and functional imaging. Artifacts during iMRI are usually a result of iatrogenic traumatic brain injury and contrast agent leakage. Ways of their prevention are discussed in the review.
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Affiliation(s)
- A Yu Dmitriev
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - V G Dashyan
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Murcia D, D'Souza S, Abozeid M, Thompson JA, Djoyum TD, Ormond DR. Investigation of Asleep versus Awake Motor Mapping in Resective Brain Surgery. World Neurosurg 2021; 157:e129-e136. [PMID: 34619401 DOI: 10.1016/j.wneu.2021.09.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To develop an asleep motor mapping paradigm for accurate detection of the corticospinal tract during glioma surgery and compare outcomes with awake patients undergoing glioma resection. METHODS A consecutive cohort of adult patients undergoing craniotomy for suspected diffuse glioma with tumor in a perirolandic location who had awake or asleep cortical and subcortical motor mapping with positive areas of motor stimulation were assessed for postoperative extent of resection (EOR), permanent neurological deficit, and proximity of stimulation to diffusion tensor imaging-based corticospinal tract depiction on preoperative magnetic resonance imaging. Outcome data were compared between asleep and awake groups. RESULTS In the asleep group, all 16 patients had improved or no change in motor function at last follow-up (minimum 3 months of follow-up). In the awake group, all 23 patients had improved function or no change at last follow-up. EOR was greater in the asleep group (mean [SD] EOR 88.71% [17.56%]) versus the awake group (mean [SD] EOR 80.62% [24.44%]), although this difference was not statistically significant (P = 0.3802). Linear regression comparing distance from stimulation to corticospinal tract in asleep (n = 14) and awake (n = 4) patients was r = -0.3759, R2 = 0.1413, P = 0.1853, and 95% confidence interval = -0.4453 to 0.09611 and r = 0.7326, R2 = 0.5367, P = 0.2674, and 95% confidence interval = -7.042 to 14.75, respectively. CONCLUSION In this small patient series, asleep motor mapping using commonly available motor evoked potential hardware appears to be safe and efficacious in regard to EOR and functional outcomes.
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Affiliation(s)
- Derrick Murcia
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shawn D'Souza
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mohab Abozeid
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Teguo Daniel Djoyum
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - D Ryan Ormond
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
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Pallud J, Zanello M, Moiraghi A, Peeters S, Trancart B, Edjlali M, Oppenheim C, Varlet P, Chrétien F, Dhermain F, Roux A, Dezamis E. Surgery of Insular Diffuse Gliomas-Part 1: Transcortical Awake Resection Is Safe and Independently Improves Overall Survival. Neurosurgery 2021; 89:565-578. [PMID: 34383938 DOI: 10.1093/neuros/nyab254] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Insular diffuse glioma resection is at risk of vascular injury and of postoperative new neurocognitive deficits. OBJECTIVE To assess safety and efficacy of surgical management of insular diffuse gliomas. METHODS Observational, retrospective, single-institution cohort analysis (2005-2019) of 149 adult patients surgically treated for an insular diffuse glioma: transcortical awake resection with intraoperative functional mapping (awake resection subgroup, n = 61), transcortical asleep resection without functional mapping (asleep resection subgroup, n = 50), and stereotactic biopsy (biopsy subgroup, n = 38). All cases were histopathologically assessed according to the 2016 World Health Organization classification and cIMPACT-NOW update 3. RESULTS Following awake resection, 3/61 patients had permanent motor deficit, seizure control rates improved (89% vs 69% preoperatively, P = .034), and neurocognitive performance improved from 5% to 24% in tested domains, despite adjuvant oncological treatments. Resection rates were higher in the awake resection subgroup (median 94%) than in the asleep resection subgroup (median 46%; P < .001). There was more gross total resection (25% vs 12%) and less partial resection (34% vs 80%) in the awake resection subgroup than in the asleep resection subgroup (P < .001). Karnofsky Performance Status score <70 (adjusted hazard ratio [aHR] 2.74, P = .031), awake resection (aHR 0.21, P = .031), isocitrate dehydrogenase (IDH)-mutant grade 2 astrocytoma (aHR 5.17, P = .003), IDH-mutant grade 3 astrocytoma (aHR 6.11, P < .001), IDH-mutant grade 4 astrocytoma (aHR 13.36, P = .008), and IDH-wild-type glioblastoma (aHR 21.84, P < .001) were independent predictors of overall survival. CONCLUSION Awake surgery preserving the brain connectivity is safe, allows larger resections for insular diffuse gliomas than asleep resection, and positively impacts overall survival.
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Affiliation(s)
- Johan Pallud
- Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Alessandro Moiraghi
- Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Sophie Peeters
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Bénédicte Trancart
- Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Myriam Edjlali
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Catherine Oppenheim
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Pascale Varlet
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Department of Neuropathology, GHU Paris-Sainte-Anne Hospital, Paris, France
| | - Fabrice Chrétien
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Department of Neuropathology, GHU Paris-Sainte-Anne Hospital, Paris, France
| | - Frédéric Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - Alexandre Roux
- Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Edouard Dezamis
- Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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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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12
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Rossi M, Gay L, Conti Nibali M, Sciortino T, Ambrogi F, Leonetti A, Puglisi G, Howells H, Zito P, Villa F, Ciroi G, Riva M, Bello L. Challenging Giant Insular Gliomas With Brain Mapping: Evaluation of Neurosurgical, Neurological, Neuropsychological, and Quality of Life Results in a Large Mono-Institutional Series. Front Oncol 2021; 11:629166. [PMID: 33828981 PMCID: PMC8019925 DOI: 10.3389/fonc.2021.629166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/01/2021] [Indexed: 01/23/2023] Open
Abstract
Objective Giant insular tumors are commonly not amenable to complete resection and are associated with a high postoperative morbidity rate. Transcortical approach and brain mapping techniques allow to identify peri-insular functional networks and, with neurophysiological monitoring, to reduce vascular-associated insults. Cognitive functions to be mapped are still under debate, and the analysis of the functional risk of surgery is currently limited to neurological examination. This work aimed to investigate the neurosurgical outcome (extent of resection, EOR) and functional impact of giant insular gliomas resection, focusing on neuropsychological and Quality of Life (QoL) outcomes. Methods In our retrospective analysis, we included all patients admitted in a five-year period with a radiological diagnosis of giant insular glioma. A transcortical approach was adopted in all cases. Resections were pursued up to functional boundaries defined intraoperatively by brain mapping techniques. We examined clinical, radiological, and intra-operative factors possibly affecting EOR and postoperative neurological, neuropsychological, and Quality of Life (QoL) outcomes. Results We finally enrolled 95 patients in the analysis. Mean EOR was 92.3%. A Gross Total Resection (GTR) was obtained in 70 cases (73.7%). Five patients reported permanent morbidity (aphasia in 3, 3.2%, and superior quadrantanopia in 2, 2.1%). Suboptimal EOR associated with poor seizures control postoperatively. Extensive intraoperative mapping (inclusive of cognitive, visual, and haptic functions) decreased long-term neurological, neuropsychological, and QoL morbidity and increased EOR. Tumor infiltration of deep perforators (vessels arising either medial to lenticulostriate arteries through the anterior perforated substance or from the anterior choroidal artery) associated with a higher chance of postoperative ischemia in consonant areas, with the persistence of new-onset motor deficits 1-month post-op, and with minor EOR. Ischemic insults in eloquent sites represented the leading factor for long-term neurological and neuropsychological morbidity. Conclusion In giant insular gliomas, the use of a transcortical approach with extensive brain mapping under awake anesthesia ensures broad insular exposure and extension of the surgical resection preserving patients’ functional integrity. The relation between tumor mass and deep perforators predicts perioperative ischemic insults, the most relevant risk factor for long-term and permanent postoperative morbidity.
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Affiliation(s)
- Marco Rossi
- Neurosurgical Oncological Unit, Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milano, Italy
| | - Lorenzo Gay
- Neurosurgical Oncological Unit, Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milano, Italy
| | - Marco Conti Nibali
- Neurosurgical Oncological Unit, Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milano, Italy
| | - Tommaso Sciortino
- Neurosurgical Oncological Unit, Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milano, Italy
| | - Federico Ambrogi
- Laboratory of Medical Statistics, Biometry, and Epidemiology "G.A. Maccararo," Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Antonella Leonetti
- Neurosurgical Oncological Unit, Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milano, Italy.,Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Laboratorio Interdisciplinare di Tecnologie Avanzate (LITA), Milano, Italy
| | - Guglielmo Puglisi
- Neurosurgical Oncological Unit, Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milano, Italy.,Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Laboratorio Interdisciplinare di Tecnologie Avanzate (LITA), Milano, Italy
| | - Henrietta Howells
- Laboratory of Motor Control, Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Laboratorio Interdisciplinare di Tecnologie Avanzate (LITA), Milano, Italy
| | - Paola Zito
- Department of Anesthesia and Intensive Care, Humanitas Research Hospital, IRCCS, Milano, Italy
| | - Federico Villa
- Department of Anesthesia and Intensive Care, Humanitas Research Hospital, IRCCS, Milano, Italy
| | - Gjulio Ciroi
- Neurosurgical Oncological Unit, Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milano, Italy
| | - Marco Riva
- Neurosurgical Oncological Unit, Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milano, Italy
| | - Lorenzo Bello
- Neurosurgical Oncological Unit, Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milano, Italy
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13
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Impact of combined use of intraoperative MRI and awake microsurgical resection on patients with gliomas: a systematic review and meta-analysis. Neurosurg Rev 2021; 44:2977-2990. [PMID: 33537890 PMCID: PMC8592967 DOI: 10.1007/s10143-021-01488-3] [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: 10/05/2020] [Revised: 12/29/2020] [Accepted: 01/25/2021] [Indexed: 10/29/2022]
Abstract
Microsurgical resection of primary brain tumors located within or near eloquent areas is challenging. Primary aim is to preserve neurological function, while maximizing the extent of resection (EOR), to optimize long-term neurooncological outcomes and quality of life. Here, we review the combined integration of awake craniotomy and intraoperative MRI (IoMRI) for primary brain tumors, due to their multiple challenges. A systematic review of the literature was performed, in accordance with the Prisma guidelines. Were included 13 series and a total number of 527 patients, who underwent 541 surgeries. We paid particular attention to operative time, rate of intraoperative seizures, rate of initial complete resection at the time of first IoMRI, the final complete gross total resection (GTR, complete radiological resection rates), and the immediate and definitive postoperative neurological complications. The mean duration of surgery was 6.3 h (median 7.05, range 3.8-7.9). The intraoperative seizure rate was 3.7% (range 1.4-6; I^2 = 0%, P heterogeneity = 0.569, standard error = 0.012, p = 0.002). The intraoperative complete resection rate at the time of first IoMRI was 35.2% (range 25.7-44.7; I^2 = 66.73%, P heterogeneity = 0.004, standard error = 0.048, p < 0.001). The rate of patients who underwent supplementary resection after one or several IoMRI was 46% (range 39.8-52.2; I^2 = 8.49%, P heterogeneity = 0.364, standard error = 0.032, p < 0.001). The GTR rate at discharge was 56.3% (range 47.5-65.1; I^2 = 60.19%, P heterogeneity = 0.01, standard error = 0.045, p < 0.001). The rate of immediate postoperative complications was 27.4% (range 15.2-39.6; I^2 = 92.62%, P heterogeneity < 0.001, standard error = 0.062, p < 0.001). The rate of permanent postoperative complications was 4.1% (range 1.3-6.9; I^2 = 38.52%, P heterogeneity = 0.123, standard error = 0.014, p = 0.004). Combined use of awake craniotomy and IoMRI can help in maximizing brain tumor resection in selected patients. The technical obstacles to doing so are not severe and can be managed by experienced neurosurgery and anesthesiology teams. The benefits of bringing these technologies to bear on patients with brain tumors in or near language areas are obvious. The lack of equipoise on this topic by experienced practitioners will make it difficult to do a prospective, randomized, clinical trial. In the opinion of the authors, such a trial would be unnecessary and would deprive some patients of the benefits of the best available methods for their tumor resections.
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14
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Policicchio D, Ticca S, Dipellegrini G, Doda A, Muggianu G, Boccaletti R. Multimodal Surgical Management of Cerebral Lesions in Motor-Eloquent Areas Combining Intraoperative 3D Ultrasound with Neurophysiological Mapping. J Neurol Surg A Cent Eur Neurosurg 2020; 82:344-356. [PMID: 33352612 DOI: 10.1055/s-0040-1717111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Resection of tumors adjacent to motor pathways carries risks of both postoperative motor deficit and incomplete resection. Our aim was to assess usefulness and limitations of a multimodal strategy that combines intraoperative ultrasound (iUS) guided resection with intraoperative neurophysiology. METHODOLOGY This is a prospective study of 25 patients with brain lesions adjacent to motor areas who underwent intracranial surgery with assistance of the iUS guidance system and intraoperative neurophysiological monitoring and mapping. Pathologies treated included 19 gliomas, 3 metastases, 1 anaplastic meningioma, 1 arteriovenous malformation (AVM), and 1 ependymoma. The iUS-guided lesion removal accuracy and the extent of resection were estimated and compared with a 30-day postoperative brain MRI. The results were assessed considering the extent of resection related to 6-month motor function outcome. RESULTS iUS was accurate in checking the extent of resection in 17 patients, whereas in 8 cases the decline of the iUS images quality did not allow a valuable assessment. Positive mapping was obtained in 16 patients. Gross total resection was achieved in 16 patients. In five of nine cases with subtotal resection, surgery was stopped because a functional area was reached. In four patients, tumor removal was limited due to the difficulty of identifying neoplastic tissue. Motor function worsening was transient in six patients and permanent in two. CONCLUSIONS The integrated use of intraoperative neuromonitoring to identify motor areas and iUS to identify tumor-tissue interface could help increase the rate of radical resection respecting the eloquent areas.
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Affiliation(s)
- Domenico Policicchio
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Stefano Ticca
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Giosuè Dipellegrini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Artan Doda
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Giampiero Muggianu
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Riccardo Boccaletti
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
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15
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Bu LH, Zhang J, Lu JF, Wu JS. Glioma surgery with awake language mapping versus generalized anesthesia: a systematic review. Neurosurg Rev 2020; 44:1997-2011. [PMID: 33089447 DOI: 10.1007/s10143-020-01418-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 12/24/2022]
Abstract
Awake craniotomy with language mapping is being increasingly applied to avoid postoperative language dysfunctions worldwide. However, the effectiveness and reliability of this technique remain unclear due to the paucity of studies comparing the awake craniotomy with general anesthesia. To determine the benefit of awake craniotomy for language, motor, and neurological functions, as well as other clinical outcomes, we searched Medline, Embase, the Cochrane Library, and the Chinese Biomedical Literature Database up to December 2019. Gray literatures were also searched. We included randomized and non-randomized controlled studies comparing awake craniotomy versus general anesthetic resection and reporting the language and neurological outcomes. Ten studies with 833 patients were included in the meta-analysis. The pooled risk ratio (RR) suggested no significant differences in language and neurological outcomes between general anesthesia group and awake craniotomy group without electrical stimulation. Awake craniotomy with electrical stimulation, however, was associated with improved late language and neurological outcomes (≥ 3 months) versus general anesthesia with pooled RR of 0.44 (95% CI = 0.20-0.96) and 0.49 (95% CI = 0.30-0.79), respectively. Awake craniotomy with electrical stimulation was also associated with better extent of resection with the pooled RR of 0.81 (95%CI = 0.71-0.92) and shorter hospital stay duration with the pooled weighted mean difference (WMD) of - 1.14 (95%CI = - 1.80 to - 0.48). This meta-analysis suggested that the application of awake craniotomy with electrical stimulation during glioma resection is associated with lower risks of long-term neurological and language deficits and higher extent of tumor resection, as well as shorter hospital stay duration.
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Affiliation(s)
- Ling-Hao Bu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, China.,Institute of Neurosurgery, Fudan University, Shanghai, 200040, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
| | - Jie Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, China. .,Institute of Neurosurgery, Fudan University, Shanghai, 200040, China. .,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China.
| | - Jun-Feng Lu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, China.,Institute of Neurosurgery, Fudan University, Shanghai, 200040, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
| | - Jin-Song Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, China.,Institute of Neurosurgery, Fudan University, Shanghai, 200040, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
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16
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Hervey-Jumper SL, Berger MS. Insular glioma surgery: an evolution of thought and practice. J Neurosurg 2020; 130:9-16. [PMID: 30611160 DOI: 10.3171/2018.10.jns181519] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVEThe goal of this article is to review the history of surgery for low- and high-grade gliomas located within the insula with particular focus on microsurgical technique, anatomical considerations, survival, and postoperative morbidity.METHODSThe authors reviewed the literature for published reports focused on insular region anatomy, neurophysiology, surgical approaches, and outcomes for adults with World Health Organization grade II-IV gliomas.RESULTSWhile originally considered to pose too great a risk, insular glioma surgery can be performed safely due to the collective efforts of many individuals. Similar to resection of gliomas located within other cortical regions, maximal resection of gliomas within the insula offers patients greater survival time and superior seizure control for both newly diagnosed and recurrent tumors in this region. The identification and the preservation of M2 perforating and lateral lenticulostriate arteries are critical steps to preventing internal capsule stroke and hemiparesis. The transcortical approach and intraoperative mapping are useful tools to maximize safety.CONCLUSIONSThe insula's proximity to middle cerebral and lenticulostriate arteries, primary motor areas, and perisylvian language areas makes accessing and resecting gliomas in this region challenging. Maximal safe resection of insular gliomas not only is possible but also is associated with excellent outcomes and should be considered for all patients with low- and high-grade gliomas in this area.
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17
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Caras A, Mugge L, Miller WK, Mansour TR, Schroeder J, Medhkour A. Usefulness and Impact of Intraoperative Imaging for Glioma Resection on Patient Outcome and Extent of Resection: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 134:98-110. [DOI: 10.1016/j.wneu.2019.10.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
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18
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Lateral or Medial Surgical Approaches for Thalamic Gliomas Resection? World Neurosurg 2019; 136:e90-e107. [PMID: 31785434 DOI: 10.1016/j.wneu.2019.11.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aimed to investigate the selection, safety, and prognosis of medial (transcorpus callosal) and lateral (translateral brain gyrus) approaches for adult thalamic glioma resection. METHODS The medical records of adult patients with thalamic glioma between March 2006 and March 2016 in Huashan Hospital were reviewed. The probabilistic map of the gliomas was shown in Montreal Neurological Institute (MNI) space, and a paralleling midline was delineated to decide the approach. The extent of resection, complications, adjuvant treatment, and survival data were analyzed. A literature review was also conducted. RESULTS Fifty-three patients with thalamic glioma were enrolled. Eighteen patients received tumor resection by a medial approach and 35 by a lateral approach. The probabilistic map based on 20 patients showed that 9 gliomas with ≥45% located in the medial side were treated medially and the other 11 gliomas were treated laterally. Both approaches achieved adequate extent of resection with similar morbidity. Kaplan-Meier analysis showed no significant difference of overall survival by a transcorpus callosal or translateral brain gyrus approach. Total resection (TR) or subtotal resection (STR) (P = 0.0003), radiochemotherapy (P < 0.0001), and low-grade glioma (P = 0.031) were correlated with better OS. Multivariate Cox regression analysis showed that TR/STR (P = 0.007; 95% confidence interval, 1.345-6.287) and radiochemotherapy (P < 0.0001; 95% confidence interval, 4.740-71.569) were independent prognostic factors for adult thalamic gliomas. CONCLUSIONS Both medial and lateral approaches are feasible and adequate for resection of thalamic gliomas. The paramidline paralleling midline crossing the genu of the internal capsule could help make the choice. TR/STR, radiochemotherapy, and low-grade glioma could benefit the prognosis.
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19
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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: 35] [Impact Index Per Article: 7.0] [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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20
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Post-operative morbidity ensuing surgery for insular gliomas: a systematic review and meta-analysis. Neurosurg Rev 2019; 43:987-997. [DOI: 10.1007/s10143-019-01113-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/31/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
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21
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Dasenbrock HH, See AP, Smalley RJ, Bi WL, Dolati P, Frerichs KU, Golby AJ, Chiocca EA, Aziz-Sultan MA. Frameless Stereotactic Navigation during Insular Glioma Resection using Fusion of Three-Dimensional Rotational Angiography and Magnetic Resonance Imaging. World Neurosurg 2019; 126:322-330. [PMID: 30898738 DOI: 10.1016/j.wneu.2019.03.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Perioperative cerebral infarction is a potential complication of glioma resection, of which insular tumors are at higher risk because of the proximity of middle cerebral artery branches, including the lateral lenticulostriates and long insular arteries. In this study, 3 patients received three-dimensional rotational angiography, which was fused with magnetic resonance imaging (MRI) for frameless stereotactic navigation during dominant-hemisphere insular glioma resection. METHODS All patients obtained a preoperative catheter angiogram with a three-dimensional rotational acquisition of the ipsilateral internal carotid artery. The pixel-based axial three-dimensional angiography data, thin-cut structural MRI, tractography from diffusion tensor imaging, and expressive language activation from functional MRI were uploaded into the iPlan software (Brainlab, Heimstetten, Germany) and fused. The target tumor, regional blood vessels, adjacent functional areas, and their associated fiber tracts were segmented and overlaid on the appropriate MRI sequence. This image fusion was used preoperatively to visualize the relationship of the mass with the adjacent vasculature and intraoperatively for frameless stereotactic navigation to optimize preservation of arterial structures. RESULTS Three patients aged 27-60 years with excellent baseline functional status presented with seizures and were found to have a large dominant-hemisphere T2 hyperintense nonenhancing insular mass. Surgical resection was performed using multimodality neuronavigation. None sustained a postoperative arterial infarction or a perioperative neurologic deficit. CONCLUSIONS Neuronavigation using a fusion of three-dimensional rotational angiography with MRI is a technique that can be used for preoperative planning and during resection of insular gliomas to optimize preservation of adjacent arteries.
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Affiliation(s)
- Hormuzdiyar H Dasenbrock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Alfred P See
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J Smalley
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Parviz Dolati
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kai U Frerichs
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Ali Aziz-Sultan
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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22
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Lu VM, Goyal A, Quinones-Hinojosa A, Chaichana KL. Updated incidence of neurological deficits following insular glioma resection: A systematic review and meta-analysis. Clin Neurol Neurosurg 2019; 177:20-26. [DOI: 10.1016/j.clineuro.2018.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/14/2018] [Accepted: 12/16/2018] [Indexed: 12/16/2022]
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23
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Chowdhury T, Singh GP, Zeiler FA, Hailu A, Loewen H, Schaller B, Cappellani RB, West M. Anesthesia for Awake Craniotomy for Brain Tumors in an Intraoperative MRI Suite: Challenges and Evidence. Front Oncol 2018; 8:519. [PMID: 30488018 PMCID: PMC6246734 DOI: 10.3389/fonc.2018.00519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/23/2018] [Indexed: 01/11/2023] Open
Affiliation(s)
- Tumul Chowdhury
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Gyaninder P Singh
- Department of Neuroanaesthesiology & Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Frederick A Zeiler
- Section-Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.,Clincian Investigator Program, University of Manitoba, Winnipeg, MB, Canada.,Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Abseret Hailu
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Hal Loewen
- College of Rehabilitation Sciences, Neil John Maclean Health Science Library, University of Manitoba, Winnipeg, MB, Canada
| | - Bernhard Schaller
- Department of Primary Care, University of Zurich, Zurich, Switzerland
| | - Ronald B Cappellani
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Michael West
- Department of Neuroanaesthesiology & Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Chowdhury T, Zeiler FA, Singh GP, Hailu A, Loewen H, Schaller B, Cappellani RB, West M. The Role of Intraoperative MRI in Awake Neurosurgical Procedures: A Systematic Review. Front Oncol 2018; 8:434. [PMID: 30364103 PMCID: PMC6191486 DOI: 10.3389/fonc.2018.00434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/17/2018] [Indexed: 11/15/2022] Open
Abstract
Background: Awake craniotomy for brain tumors remains an important tool in the arsenal of the treating neurosurgeon working in eloquent areas of the brain. Furthermore, with the implementation of intraoperative magnetic resonance imaging (I-MRI), one can afford the luxury of imaging to assess surgical resection of the underlying gross imaging defined neuropathology and the surrounding eloquent areas. Ideally, the combination of I-MRI and awake craniotomy could provide the maximal lesion resection with the least morbidity and mortality. However, more resection with the aid of real time imaging and awake craniotomy techniques might give opposite outcome results. The goal of this systematic review.is to identify the available literature on combined I-MRI and awake craniotomy techniques, to better understand the potential morbidity and mortality associated. Methods: MEDLINE, EMBASE, and CENTRAL were searched from inception up to December 2016. A total of 10 articles met inclusion in to the review, with a total of 324 adult patients. Results: All studies showed transient neurological deficits between 2.9 to 76.4%. In regards to persistent morbidity, the mean was ~10% (ranges from zero to 35.3%) with a follow up period between 5 days and 6 months. Conclusion: The preliminary results of this review also suggest this combined technique may impose acceptable post-operative complication profiles and morbidity. However, this is based on low quality evidence, and is therefore questionable. Further, well-designed future trials with the long-term follow-up are needed to provide various aspects of feasibility and outcome data for this approach.
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Affiliation(s)
- Tumul Chowdhury
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Frederick A Zeiler
- Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.,Clincian Investigator Program, University of Manitoba, Winnipeg, MB, Canada.,Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Gyaninder P Singh
- Department of Neuroanaesthesiology & Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Abseret Hailu
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Hal Loewen
- College of Rehabilitation Sciences Librarian, Neil John Maclean Health Science Library, University of Manitoba, Winnipeg, MB, Canada
| | - Bernhard Schaller
- Department of Primary Care, University of Zurich, Zurich, Switzerland
| | - Ronald B Cappellani
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Michael West
- Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
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Zhang N, Yu Z, Hameed NUF, Xu G, Song Y, Wu B, Zhang J, Qiu T, Zhuang D, Lu J, Wu J. Long-Term Functional and Oncologic Outcomes of Glioma Surgery with and without Intraoperative Neurophysiologic Monitoring: A Retrospective Cohort Study in a Single Center. World Neurosurg 2018; 119:e94-e105. [PMID: 30026163 DOI: 10.1016/j.wneu.2018.07.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate long-term functional and survival outcomes of patients with glioma after intraoperative neurophysiologic monitoring (IONM) application. METHODS A total of 856 patients with glioma, who underwent tumor resection between October 2010 and March 2016, were included in this retrospective cohort study. All patients were stratified into IONM (439 patients) and non-IONM groups (417 patients). The primary outcome measured was overall survival (OS), and the secondary outcome measured was rate of late neurologic deficits. Analyses were performed using univariate tests and multivariate logistic regression and Cox proportional hazard model. RESULTS The 2 cohorts were well balanced with respect to baseline characteristics. Univariate survival analysis showed longer OS in the IONM group than that in the non-IONM group (P = 0.036), especially in patients with high-grade astrocytic tumor (P = 0.034). The IONM group showed a lower rate of neurologic deficits than did the non-IONM group. Multivariate analysis showed that IONM was a favorable factor of OS (odds ratio, 0.776; P = 0.046) and late neurologic function (odds ratio, 0.583; P = 0.039). Dominant hemispheric and eloquent location of glioma had no association with OS. CONCLUSIONS Application of IONM is beneficial to long-term functional and oncologic outcomes of patients with glioma.
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Affiliation(s)
- Nan Zhang
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Zhengda Yu
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - N U Farrukh Hameed
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Geng Xu
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Yanyan Song
- Department of Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bin Wu
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Zhang
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Tianming Qiu
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Dongxiao Zhuang
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Junfeng Lu
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China.
| | - Jinsong Wu
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
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Uzun H, Kaynak EG, Ibanoglu E, Ibanoglu S. Chemical and structural variations in hazelnut and soybean oils after ozone treatments. GRASAS Y ACEITES 2018. [DOI: 10.3989/gya.1098171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the present work, the effect of ozone treatments on the structural properties of soybean oil (SBO) and hazelnut oil (HO) were investigated. The study presents the findings and results about the oxidation of HO and SBO with ozone, which has not been fully studied previously. The HO and SBO were treated with ozone gas for 1, 5, 15, 30, 60, 180 and 360 min. The ozone reactivity with the SBO and HO during the ozone treatment was analyzed by 1H, 13C NMR, FTIR and GC. The iodine value, viscosity and color variables (L*, a* and b*) of untreated and ozone treated oils were determined. Reaction products were identified according to the Criegee mechanism. New signals at 5.15 and 104.35 ppm were assigned to the ring protons of 1,2,4- trioxolane (secondary ozonide) in the ozonated oils in 1H and 13C NMR, respectively. Ozonated oils exhibited peaks at 9.75 and 2.43 ppm in 1H and NMR, which corresponded to the aldehydic proton and α-methylene group and to the carbonyl carbon, respectively. The peak at 43.9 ppm in 13C NMR was related to the α-methylene group and to the carbonyl carbon. The new signals formed in the ozonation process gradually increased with respect to ozone treatment time. After 360 min of ozone treatment, the carbon-carbon double bond signal, which belongs to the unsaturated fatty acids, disappeared completely in the spectrum. An increase in viscosity, a decrease in iodine value and a dramatic reduction in b* of the oil samples on (+) axis were observed with increased ozone treatment time.
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Abstract
Maximal safe resection is the cornerstone of treatment for low-grade and high-grade gliomas. In addition to high-resolution anatomic MRI studies that highlight tumor architecture, it is important to determine the relationship of the tumor to the eloquent cortical and subcortical areas to avoid introducing or exacerbating a neurologic deficit. The goal of this review was to highlight imaging modalities that provide functional information and can be integrated with intraoperative MRI navigation to maximize the extent of resection while preserving a patient's neurologic function.
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Alimohamadi M, Shirani M, Shariat Moharari R, Pour-Rashidi A, Ketabchi M, Khajavi M, Arami M, Amirjamshidi A. Application of Awake Craniotomy and Intraoperative Brain Mapping for Surgical Resection of Insular Gliomas of the Dominant Hemisphere. World Neurosurg 2016; 92:151-158. [DOI: 10.1016/j.wneu.2016.04.079] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 04/23/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
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