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Papatzalas C, Papathanasiou I. Exploring tumor-related language disorders: Pretreatment and post-treatment considerations. Asia Pac J Oncol Nurs 2024; 11:100526. [PMID: 39040223 PMCID: PMC11261801 DOI: 10.1016/j.apjon.2024.100526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 07/24/2024] Open
Affiliation(s)
- Christos Papatzalas
- Department of Speech and Language Therapy, University of the Peloponnese, Kalamata, Greece
| | - Ilias Papathanasiou
- Department of Speech and Language Therapy, University of Patras, Patras, Greece
- Medical School, National Kapodistreian University of Athens, Athens, Greece
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Zyryanov A, Stupina E, Gordeyeva E, Buivolova O, Novozhilova E, Akinina Y, Bronov O, Gronskaya N, Gunenko G, Iskra E, Ivanova E, Kalinovskiy A, Kliuev E, Kopachev D, Kremneva E, Kryuchkova O, Medyanik I, Pedyash N, Pozdniakova V, Pronin I, Rainich K, Reutov A, Samoukina A, Shlyakhova A, Sitnikov A, Soloukhina O, Yashin K, Zelenkova V, Zuev A, Ivanova MV, Dragoy O. 'Moderate global aphasia': A generalized decline of language processing caused by glioma surgery but not stroke. BRAIN AND LANGUAGE 2022; 224:105057. [PMID: 34883333 PMCID: PMC8743859 DOI: 10.1016/j.bandl.2021.105057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 10/15/2021] [Accepted: 11/24/2021] [Indexed: 06/13/2023]
Abstract
Unlike stroke, neurosurgical removal of left-hemisphere gliomas acts upon a reorganized language network and involves brain areas rarely damaged by stroke. We addressed whether this causes the profiles of neurosurgery- and stroke-induced language impairments to be distinct. K-means clustering of language assessment data (neurosurgery cohort: N = 88, stroke cohort: N = 95) identified similar profiles in both cohorts. But critically, a cluster of individuals with specific phonological deficits was only evident in the stroke but not in the neurosurgery cohort. Thus, phonological deficits are less clearly distinguished from other language deficits after glioma surgery compared to stroke. Furthermore, the correlations between language production and comprehension scores at different linguistic levels were more extensive in the neurosurgery than in the stroke cohort. Our findings suggest that neurosurgery-induced language impairments do not correspond to those caused by stroke, but rather manifest as a 'moderate global aphasia' - a generalized decline of language processing abilities.
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Affiliation(s)
- Andrey Zyryanov
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia.
| | - Ekaterina Stupina
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Elizaveta Gordeyeva
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Olga Buivolova
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia; Federal Center for Brain and Neurotechnologies, 1 Building 10 Ostrovityanova Ulitsa, Moscow 117997, Russia
| | - Evdokiia Novozhilova
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Yulia Akinina
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Oleg Bronov
- Department of Radiology, National Medical and Surgical Center Named after N.I. Pirogov, 70 Nizhnyaya Pervomayskaya Ulitsa, Moscow 105203, Russia
| | - Natalia Gronskaya
- Center for Language and Brain, HSE University, 25/12 Bolshaya Pecherskaya Ulitsa, Nizhny Novgorod 603155, Russia
| | - Galina Gunenko
- Department of Neurooncology, Federal Center of Neurosurgery Novosibirsk, 132/1 Nemirovicha-Danchenko Ulitsa, Novosibirsk 630048, Russia
| | - Ekaterina Iskra
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia; Center for Speech Pathology and Neurorehabilitation, 20/1 Nikoloyamskaya Ulitsa, Moscow 109240, Russia
| | - Elena Ivanova
- Federal Center for Brain and Neurotechnologies, 1 Building 10 Ostrovityanova Ulitsa, Moscow 117997, Russia; Pirogov Russian National Research Medical University, 1 Ostrovityanova Ulitsa, Moscow 117198, Russia
| | - Anton Kalinovskiy
- Department of Neurooncology, Federal Center of Neurosurgery Novosibirsk, 132/1 Nemirovicha-Danchenko Ulitsa, Novosibirsk 630048, Russia
| | - Evgenii Kliuev
- Department of Radiology, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005, Russia
| | - Dmitry Kopachev
- Research Center of Neurology, 80 Volokolamskoye Shosse, Moscow 125367, Russia
| | - Elena Kremneva
- Research Center of Neurology, 80 Volokolamskoye Shosse, Moscow 125367, Russia
| | - Oksana Kryuchkova
- Department of Radiology, Central Clinical Hospital with Outpatient Health Center of the Business Administration for the President of the Russian Federation, 15 Marshala Timoshenko Ulitsa, Moscow 121359, Russia
| | - Igor Medyanik
- Department of Neurosurgery, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005, Russia
| | - Nikita Pedyash
- Department of Neurosurgery, National Medical and Surgical Center named after N.I. Pirogov, 70 Nizhnyaya Pervomayskaya Ulitsa, Moscow 105203, Russia
| | - Viktoria Pozdniakova
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Igor Pronin
- Department of Neuroradiology, National Medical Research Center for Neurosurgery named after N. N. Burdenko, 16 4-ya Tverskaya-Yamskaya Ulitsa, Moscow 125047, Russia
| | - Kristina Rainich
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Andrey Reutov
- Department of Neurosurgery, Central Clinical Hospital with Outpatient Health Center of the Business Administration for the President of the Russian Federation, 15 Marshala Timoshenko Ulitsa, Moscow 121359, Russia
| | - Anastasia Samoukina
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Anastasia Shlyakhova
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Andrey Sitnikov
- Department of Neurosurgery, Federal Centre of Treatment and Rehabilitation of the Ministry of Healthcare of the Russian Federation, 3 Ivan'kovskoye Shosse, Moscow 125367, Russia
| | - Olga Soloukhina
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Konstantin Yashin
- Department of Neurosurgery, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005, Russia
| | - Valeriya Zelenkova
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Andrey Zuev
- Department of Neurosurgery, National Medical and Surgical Center named after N.I. Pirogov, 70 Nizhnyaya Pervomayskaya Ulitsa, Moscow 105203, Russia
| | - Maria V Ivanova
- Aphasia Recovery Lab, Department of Psychology, University of California, Berkley, 210 Barker Hall, CA 94720, USA
| | - Olga Dragoy
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia; Institute of Linguistics, Russian Academy of Sciences, 1 bld. 1 Bolshoy Kislovsky lane, Moscow 125009, Russia
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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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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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Keng A, Stewart DE, Sheehan KA. Examining the Neuropsychiatric Sequelae Postsurgical Resection of Adult Brain Tumors Through a Scoping Review. PSYCHOSOMATICS 2020; 61:209-219. [DOI: 10.1016/j.psym.2019.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
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Abstract
BACKGROUND This is an update of the original review published in the Cochrane Database of Systematic Reviews Issue 1, 2000 and updated in 2003, 2007 and 2010.People with a presumed high-grade glioma (HGG) identified by clinical evaluation and radiological investigation have two initial surgical options: biopsy or resection. In certain situations, such as severe raised intracranial pressure, surgical resection is clinically indicated. Where surgical resection is not feasible, biopsy is the only reasonable option. Most people fall somewhere between these extremes, and in such circumstances it is uncertain which procedure is the best surgical option for the patient. Opinion is divided regarding the relative risks and benefits of each procedure. OBJECTIVES To estimate the clinical effectiveness of surgical resection compared to biopsy in people with a new presumptive diagnosis of HGG. SEARCH METHODS We updated our searches of the following databases to 12 September 2018: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase. We also handsearched the Journal of Neuro-Oncology and Neuro-Oncology from 2010 to 2018 (including all conference abstracts). SELECTION CRITERIA We included randomised controlled trials (RCTs) involving people of all ages with a presumed diagnosis of HGG based upon clinical and radiological investigation. Interventions included any form of biopsy or resection. Surgery was at the time of initial presentation and not for recurrence. DATA COLLECTION AND ANALYSIS Two reviews authors independently assessed the search results for relevance and undertook critical appraisal according to prespecified guidelines. Outcome measures included survival, time to progression/progression-free survival, quality of life, symptom control, adverse events, and mortality. MAIN RESULTS We identified a single RCT of biopsy versus resection in presumed HGG. No other articles met the inclusion criteria. Personal communication revealed that an RCT of biopsy versus resection in elderly people with HGG is underway. Further communication as part of this 2018 update revealed that the results of this study are due to be published in 2019. AUTHORS' CONCLUSIONS There is no high-quality evidence on biopsy versus resection for HGG that can be used to guide management. The single included RCT was of inadequate methodology to reach reliable conclusions. Further large, multicentred RCTs are required to conclusively answer the question of whether biopsy or resection is the best initial surgical management for HGG.
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Affiliation(s)
- Michael G Hart
- Addenbrookes HospitalAcademic Division of Neurosurgery, Department of Clinical NeurosciencesBox 167CambridgeUKCB2 0QQ
| | | | - Emma F Solyom
- University of St AndrewsSt AndrewsFifeScotlandUKKY16 9AJ
| | - Robin Grant
- Western General HospitalEdinburgh Centre for Neuro‐Oncology (ECNO)Crewe RoadEdinburghScotlandUKEH4 2XU
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Ng JCH, See AAQ, Ang TY, Tan LYR, Ang BT, King NKK. Effects of surgery on neurocognitive function in patients with glioma: a meta-analysis of immediate post-operative and long-term follow-up neurocognitive outcomes. J Neurooncol 2018; 141:167-182. [PMID: 30446902 DOI: 10.1007/s11060-018-03023-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/01/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE This study aims to identify the neuropsychological tests commonly used for assessment in each neurocognitive domain, and quantify the post-operative changes in neurocognitive function in the immediate post-operation and follow-up. METHODS With the use of the PubMed, a comprehensive search of the English literature was performed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. There were 1021 publications identified for screening. Standardized mean differences (SMD) in neuropsychological task performance were calculated both for immediate post-operation (up to 1 week) and follow-up (up to 6 months). RESULTS Out of 12 studies which met the inclusion criteria, 11 studies were analyzed in this meta-analysis, with a total of 313 patients (age range 18-82, 50% males) with intracranial gliomas (45% high-grade, 55% low-grade). Complex attention, language and executive function were the most frequently tested neurocognitive domains. Surgery had a positive impact in the domains of complex attention, language, learning and memory tasks in the immediate post-operative period and sustained improvement at follow-up. In contrast, surgery was found to negatively impact performance for executive function in the immediate post-operative period with sustained decline in performance in the long term. CONCLUSIONS This meta-analysis suggests that surgery for glioma confers a benefit for the domains of complex attention, language, learning and memory, while negatively affecting executive function, in the periods immediately after surgery and at 6 months follow-up. In addition, awake surgery seemed to confer a beneficial effect on neurocognitive functions. Future research should attempt to standardize a battery of neuropsychological tests for patients undergoing surgical resection for glioma, perhaps with a particular focus on executive function.
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Affiliation(s)
- Justin Choon Hwee Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Angela An Qi See
- Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore.,Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Ting Yao Ang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lysia Yan Rong Tan
- Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore
| | - Beng Ti Ang
- Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore.,Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Nicolas Kon Kam King
- Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore. .,Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
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Changes in Cognition and Decision Making Capacity Following Brain Tumour Resection: Illustrated with Two Cases. Brain Sci 2017; 7:brainsci7100122. [PMID: 28946652 PMCID: PMC5664049 DOI: 10.3390/brainsci7100122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 12/15/2022] Open
Abstract
Changes in cognition, behaviour and emotion frequently occur in patients with primary and secondary brain tumours. This impacts the ability to make considered decisions, especially following surgical resection, which is often overlooked in the management of patients. Moreover, the impact of cognitive deficits on decision making ability affects activities of daily living and functional independence. The assessment process to ascertain decision making capacity remains a matter of debate. One avenue for evaluating a patient’s ability to make informed decisions in the context of brain tumour resection is neuropsychological assessment. This involves the assessment of a wide range of cognitive abilities on standard measurement tools, providing a robust approach to ascertaining capacity. Evidence has shown that a comprehensive and tailored neuropsychological assessment has greater sensitivity than brief cognitive screening tools to detect subtle and/or specific cognitive deficits in brain tumours. It is the precise nature and severity of any cognitive deficits that determines any implications for decision making capacity. This paper focuses on cognitive deficits and decision making capacity following surgical resection of both benign and malignant, and primary and secondary brain tumours in adult patients, and the implications for patients’ ability to consent to future medical treatment and make decisions related to everyday activities.
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McCarron A, Chavez A, Babiak M, Berger MS, Chang EF, Wilson SM. Connected speech in transient aphasias after left hemisphere resective surgery. APHASIOLOGY 2017; 31:1266-1281. [PMID: 29056810 PMCID: PMC5646839 DOI: 10.1080/02687038.2017.1278740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Transient aphasias are common in the first few days after resective surgery to the language-dominant hemisphere. The specific speech and language deficits that occur are related to the location of the surgical site, and may include impairments in fluency, lexical access, repetition, and comprehension. The impact of these transient aphasias on connected speech production has not previously been investigated. AIMS The goals of this study were to characterize the nature of connected speech deficits in the immediate post-surgical period, and to determine which deficits resolve completely within 1 month. METHODS & PROCEDURES Forty-three patients undergoing resective surgery in the left (language-dominant) hemisphere participated in the study. Brief connected speech samples were obtained before surgery, and at 2-3 days post-surgery. In a subset of 24 patients (all of whom presented with aphasia in the immediate post-surgical period), follow-up samples were also obtained at 1 month post-surgery. The samples were transcribed and coded in CHAT format. Ten connected speech measures were derived from each speech sample, and were then compared by time point. OUTCOMES & RESULTS At 2-3 days post surgery, deficits were observed in all 10 connected speech measures in comparison to pre-surgical samples: there were decreases in words per minute, words per utterance, and the use of embedded clauses, and increases in phonological errors, lexical access difficulties, morphosyntactic errors, filled pauses, false starts and retraced sequences. The proportion of closed class words could be perturbed in either direction. At 1 month post-surgery, 8 of the 10 connected speech measures had significantly improved, and all measures reflecting structural features (words per utterance, number of embeddings, morphosyntactic errors, proportion of words that were closed class) were equivalent to the pre-surgical time point. Subtle deficits persisted in some other measures; in particular, there were more phonological errors and lexical access difficulties than at the pre-surgical point. CONCLUSIONS Transient aphasias after left hemisphere surgery impacted all aspects of connected speech in the immediate post-surgical period. Most of these deficits were largely or completely resolved by 1 month post surgery, but some subtle impairments persisted.
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Affiliation(s)
- Angelica McCarron
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Ashley Chavez
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Miranda Babiak
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Edward F. Chang
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Corresponding authors and co-senior authors. E. F. Chang: Department of Neurological Surgery, University of California, San Francisco, 675 Nelson Rising Lane, Room 511, San Francisco, CA 94158, USA. . S. M. Wilson: Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Ave S, MCE 8310, Nashville, TN 37232.
| | - Stephen M. Wilson
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Corresponding authors and co-senior authors. E. F. Chang: Department of Neurological Surgery, University of California, San Francisco, 675 Nelson Rising Lane, Room 511, San Francisco, CA 94158, USA. . S. M. Wilson: Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Ave S, MCE 8310, Nashville, TN 37232.
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Zhang J, Wu JS, Lu JF, Yao CJ, Song YY, Mao Y, Zhou LF. Awake language mapping for cerebral glioma surgery. Hippokratia 2016. [DOI: 10.1002/14651858.cd009791.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jie Zhang
- Huashan Hospital, Shanghai Medical College, Fudan University; Neurological Surgery Department; 12 Wulumuqi Zhong Road Shanghai Shanghai China 200040
| | - Jin-Song Wu
- Huashan Hospital, Shanghai Medical College, Fudan University; Neurological Surgery Department; 12 Wulumuqi Zhong Road Shanghai Shanghai China 200040
| | - Jun-Feng Lu
- Huashan Hospital, Shanghai Medical College, Fudan University; Neurological Surgery Department; 12 Wulumuqi Zhong Road Shanghai Shanghai China 200040
| | - Cheng-Jun Yao
- Huashan Hospital, Shanghai Medical College, Fudan University; Neurological Surgery Department; 12 Wulumuqi Zhong Road Shanghai Shanghai China 200040
| | - Yan-Yan Song
- School of Medicine; Department of Biostatistics; Shanghai Jiaotong University Shanghai China 200025
| | - Ying Mao
- Huashan Hospital, Shanghai Medical College, Fudan University; Neurological Surgery Department; 12 Wulumuqi Zhong Road Shanghai Shanghai China 200040
| | - Liang-Fu Zhou
- Huashan Hospital, Shanghai Medical College, Fudan University; Neurological Surgery Department; 12 Wulumuqi Zhong Road Shanghai Shanghai China 200040
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Satoer D, Visch-Brink E, Dirven C, Vincent A. Glioma surgery in eloquent areas: can we preserve cognition? Acta Neurochir (Wien) 2016; 158:35-50. [PMID: 26566782 PMCID: PMC4684586 DOI: 10.1007/s00701-015-2601-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive preservation is crucial in glioma surgery, as it is an important aspect of daily life functioning. Several studies claimed that surgery in eloquent areas is possible without causing severe cognitive damage. However, this conclusion was relatively ungrounded due to the lack of extensive neuropsychological testing in homogenous patient groups. In this study, we aimed to elucidate the short-term and long-term effects of glioma surgery on cognition by identifying all studies who conducted neuropsychological tests preoperatively and postoperatively in glioma patients. METHODS We systematically searched the electronical databases Embase, Medline OvidSP, Web of Science, PsychINFO OvidSP, PubMed, Cochrane, Google Scholar, Scirius and Proquest aimed at cognitive performance in glioma patients preoperatively and postoperatively. RESULTS We included 17 studies with tests assessing the cognitive domains: language, memory, attention, executive functions and/or visuospatial abilities. Language was the domain most frequently examined. Immediately postoperatively, all studies except one, found deterioration in one or more cognitive domains. In the longer term (3-6/6-12 months postoperatively), the following tests showed both recovery and deterioration compared with the preoperative level: naming and verbal fluency (language), verbal word learning (memory) and Trailmaking B (executive functions). CONCLUSIONS Cognitive recovery to the preoperative level after surgery is possible to a certain extent; however, the results are too arbitrary to draw definite conclusions and not all studies investigated all cognitive domains. More studies with longer postoperative follow-up with tests for cognitive change are necessary for a better understanding of the conclusive effects of glioma surgery on cognition.
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Affiliation(s)
- Djaina Satoer
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Wytemaweg 80, Room EE220, 3015 GE, Rotterdam, The Netherlands.
- Centre for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, The Netherlands.
| | - Evy Visch-Brink
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Wytemaweg 80, Room EE220, 3015 GE, Rotterdam, The Netherlands
| | - Clemens Dirven
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Wytemaweg 80, Room EE220, 3015 GE, Rotterdam, The Netherlands
| | - Arnaud Vincent
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Wytemaweg 80, Room EE220, 3015 GE, Rotterdam, The Netherlands
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Wilson SM, Lam D, Babiak MC, Perry DW, Shih T, Hess CP, Berger MS, Chang EF. Transient aphasias after left hemisphere resective surgery. J Neurosurg 2015; 123:581-93. [PMID: 26115463 DOI: 10.3171/2015.4.jns141962] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Transient aphasias are often observed in the first few days after a patient has undergone resection in the language-dominant hemisphere. The aims of this prospective study were to characterize the incidence and nature of these aphasias and to determine whether there are relationships between location of the surgical site and deficits in specific language domains. METHODS One hundred ten patients undergoing resection to the language-dominant hemisphere participated in the study. Language was evaluated prior to surgery and 2-3 days and 1 month postsurgery using the Western Aphasia Battery and the Boston Naming Test. Voxel-based lesion-symptom mapping was used to identify relationships between the surgical site location assessed on MRI and deficits in fluency, information content, comprehension, repetition, and naming. RESULTS Seventy-one percent of patients were classified as aphasic based on the Western Aphasia Battery 2-3 days postsurgery, with deficits observed in each of the language domains examined. Fluency deficits were associated with resection of the precentral gyrus and adjacent inferior frontal cortex. Reduced information content of spoken output was associated with resection of the ventral precentral gyrus and posterior inferior frontal gyrus (pars opercularis). Repetition deficits were associated with resection of the posterior superior temporal gyrus. Naming deficits were associated with resection of the ventral temporal cortex, with midtemporal and posterior temporal damage more predictive of naming deficits than anterior temporal damage. By 1 month postsurgery, nearly all language deficits were resolved, and no language measure except for naming differed significantly from its presurgical level. CONCLUSIONS These findings show that transient aphasias are very common after left hemisphere resective surgery and that the precise nature of the aphasia depends on the specific location of the surgical site. The patient cohort in this study provides a unique window into the neural basis of language because resections are discrete, their locations are not limited by vascular distribution or patterns of neurodegeneration, and language can be studied prior to substantial reorganization.
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Affiliation(s)
- Stephen M Wilson
- Departments of 1 Speech, Language, and Hearing Sciences and.,Neurology, University of Arizona, Tucson, Arizona; and
| | | | | | | | - Tina Shih
- Neurology, and.,UCSF Epilepsy Center, University of California, San Francisco, California
| | | | | | - Edward F Chang
- Departments of 3 Neurological Surgery.,UCSF Epilepsy Center, University of California, San Francisco, California
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Kerrigan S, Dengu F, Erridge S, Grant R, Whittle I. Recognition of mental incapacity when consenting patients with intracranial tumours for surgery: how well are we doing? Br J Neurosurg 2011; 26:28-31. [DOI: 10.3109/02688697.2011.594187] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Scotland JL, Al-Shahi Salman R, Deary IJ, Whittle IR. Recruitment difficulties in brain tumour patients cause participation bias: findings from a neuropsychological study of adult inpatients with supratentorial intracranial tumours. Acta Neurochir (Wien) 2009; 151:1191-5. [PMID: 19440655 DOI: 10.1007/s00701-009-0371-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 04/10/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Patients who participate in questionnaire surveys, clinical studies and clinical trials can be different from patients who do not participate. The occurrence and direction of this response, participation or ascertainment bias is unpredictable, and can harm the external validity of medical research. METHODS We compared the characteristics of patients with intracranial tumours who participated in a psychological study of inspection time with the characteristics of patients who did not participate for a number of reasons. RESULTS Of 178 newly diagnosed adults with intracranial tumours, 136 (76%) were eligible, of whom 76 (56%) participated and 34 (25%) declined. There were no significant differences in terms of age and sex of the patients who participated and those who declined. When the participation group was combined with those who were ineligible and those who declined, the majority of patients in the combined cohort (n = 152) had a WHO grade III or IV glioma (high-grade glioma) (48.0%), and only 13.2% had a WHO grade I or II glioma (low-grade glioma). However, only 38.2% of those who participated had a WHO grade III or IV glioma, and 23.7% had a WHO grade I or II glioma. Comparisons of the participation vs. ineligible and declined groups revealed there was a significant difference (p = 0.002) between the ratio of high-grade to low-grade gliomas in the total and recruited cohorts. Comparisons of only the participation vs. declined groups approached significance (p = 0.051). WHO grade III and IV glioma patients were under-represented, and WHO grade I or II glioma patients were over-represented in the study group. CONCLUSIONS Noninterventional, non-therapeutic applied neuropsychological studies in neuro-oncology are susceptible to bias since the spectrum of neuropathologies in recruited patients can be significantly different from that of the total cohort. These data could help anticipate recruitment rates for applied neuropsychological studies in clinical neuro-oncology and may help anticipate likely selection biases amongst those who participate.
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Maeda T, Hamasaki T, Morioka M, Hirano T, Yano S, Nakamura H, Makino K, Kuratsu JI. Deficits in Japanese word spelling as an initial language symptom of malignant glioma in the left hemisphere. ACTA ACUST UNITED AC 2008; 71:451-6; discussion 456-7. [PMID: 18514272 DOI: 10.1016/j.surneu.2008.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Accepted: 02/04/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND A good performance status at diagnosis is a prognostic factor in patients with malignant glioma whose median survival is 24 months. As early diagnosis may improve their poor prognosis, we looked for currently unknown initial symptoms among patients in good performance status. METHODS We chose 17 consecutive patients with malignant glioma in the left frontal and/or temporal lobe whose Karnofsky Performance Status was more than 80. At preoperative evaluation, we administered the Japanese version of the Western Aphasia Battery. RESULTS The chief complaint was difficulty in speech (n = 6), headache/nausea (n = 4), seizures (n = 5), and uncinate fits (n = 1); one patient was symptom-free. Of the 17 patients, 14 exhibited no motor deficits. In 15 patients, the aphasia quotient exceeded 80, indicating that the overall language deficits were mild. However, in the reading section, their scores on the "spelled kanji (Japanese ideogram) recognition" test (full score = 10) were selectively low (5.3 +/- 1.6 for right-handed individuals with frontal lesions, 6.1 +/- 1.0 for right-handed patients with temporal lesions, 7.2 +/- 2.0 for left-handed/bimanual individuals with frontal/temporal lesions). Their scores on the "spelling kanji" test were 3.0 +/- 1.6, 4.8 +/- 1.2, and 9.4 +/- 0.6, respectively. CONCLUSIONS Our findings point to the importance of recognizing spelling deficits as an initial symptom of left hemisphere glioma in efforts to identify patients in good performance status whose prognosis may be improved. It would be important to determine if the spelling of alphabetic words is also impaired early in the clinical course of left hemisphere glioma.
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Affiliation(s)
- Tatsumi Maeda
- Department of Neurosurgery, Kumamoto University Medical School, Kumamoto 860-8556, Japan
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Pang BC, Wan WH, Lee CK, Khu KJ, Ng WH. The Role of Surgery in High-grade Glioma – Is Surgical Resection Justified? A Review of the Current Knowledge. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2007. [DOI: 10.47102/annals-acadmedsg.v36n5p358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Introduction: The aims of this article were to review the role of surgical resection in the management of high-grade gliomas and to determine whether there is any survival benefit from surgical resection.
Methods: A literature review of the influence of surgical resection on outcome was carried out. Relevant original and review papers were obtained through a PubMed search using the following keywords: glioma, resection, prognosis and outcome.
Results: Presently, there is a lack of evidence to support a survival benefit with aggressive glioma resection, but this should not detract patients from undergoing surgery as there are many other clinical benefits of glioma excision. In addition, limiting surgical morbidity through the use of adjuvant techniques such as intraoperative magnetic resonance imaging (MRI), functional MRI and awake craniotomy is becoming increasingly important.
Conclusions: Ideally, a randomised controlled trial would be the best way to resolve the issue of whether (and to what extent) surgical resection leads to improvements in patient outcome and survival, but this would not be ethical. The second best option would be well-controlled retrospective studies with a multivariate analysis of all potential confounding factors.
Key words: Astrocytoma, Brain tumour, Glioma, Outcome, Resection, Surgery, Survival
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Affiliation(s)
| | | | | | | | - Wai-Hoe Ng
- National Neuroscience Institute, Singapore
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Sakurada K, Sato S, Sonoda Y, Kokubo Y, Saito S, Kayama T. Surgical resection of tumors located in subcortex of language area. Acta Neurochir (Wien) 2007; 149:123-9; discussion 129-30. [PMID: 16990990 DOI: 10.1007/s00701-006-0857-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 07/26/2006] [Indexed: 10/24/2022]
Abstract
OBJECT Although functional mapping facilitates the planning of surgery in and around eloquent areas, the resection of tumors adjacent to language areas remains challenging. In this report, we took notice that the language areas (Broca's and Wernicke's) present at the perisylvian fissure. We posit that if there is non-essential language area on the inner surface of the Sylvian fissure, safe tumor resection may be possible even if the tumor is located under the language cortex. METHODS The study population consisted of 5 patients with intrinsic brain tumors (frontal glioma, n = 3; temporal cavernous angioma, n = 1; primary malignant central nervous system lymphoma, n = 1) located in the perisylvian subcortex, in the language-dominant hemisphere. All patients underwent awake surgery and we performed intra-operative bipolar cortical functional language mapping. When the tumor was located under the language area, the Sylvian fissure was opened and the inner surface of the opercular cortex was exposed with the patient asleep, and additional functional mapping of that cortex was performed. This enabled us to remove the tumor from the non-functioning cortex. In our series, 4 of 5 patients had not language function on the inner surface of the operculum. Only one patient, a 52-year-old man with frontal glioblastoma (Case 3) had language function on the inner surface of the frontal operculum. CONCLUSION We suggest that even perisylvian tumors located in the subcortex of the language area may be resectable via the nonfunctioning intrasylvian cortex by a transopercular approach without resultant language dysfunction.
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Affiliation(s)
- K Sakurada
- Department of Neurosurgery, Yamagata University, School of Medicine, Yamagata, Japan
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Kurimoto M, Asahi T, Shibata T, Takahashi C, Nagai S, Hayashi N, Matsui M, Endo S. Safe Removal of Glioblastoma Near the Angular Gyrus by Awake Surgery Preserving Calculation Ability-Case Report-. Neurol Med Chir (Tokyo) 2006; 46:46-50. [PMID: 16434827 DOI: 10.2176/nmc.46.46] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 67-year-old patient presented with progressive agraphia, alexia, and impaired ability to calculate persisting for 4 weeks. He showed preserved ability to do single-digit addition and subtraction. Magnetic resonance imaging demonstrated a tumor in the left parietal lobe. A malignant glioma was suspected, and awake craniotomy was performed to remove the tumor with functional cortical mapping to determine the cortices involved in calculation and language. His calculation ability was mapped on the angular gyrus, and partial resection of the tumor was achieved without deterioration of that ability. The histological diagnosis was glioblastoma multiforme. The patient's calculation ability improved dramatically after the operation.
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Abstract
Current surgical treatment of malignant gliomas largely depends on mechanistic reasoning and data collected in non-randomised studies. Technological advance has enabled more accurate resection of tumours and preservation of eloquent brain areas but ethical considerations have restricted randomised trials on the efficacy of surgery to one small trial that found a 3 month survival advantage for patients over age 65 years who received surgery and interim analysis of a larger trial. There is an argument for surgery as a palliative measure in patients with symptoms caused by mechanisms that are surgically remediable. Whether there is any survival advantage from surgery in patients other than those with immediately life-threatening, surgically remediable complications, such as raised intracranial pressure, is unclear. The available data show that if such an advantage does exist, it is modest at best. Adjuvant treatments given surgically are being studied. Chemotherapy wafers are the most prominent of the adjuvant treatments but the evidence available is insufficient to recommend their use in routine practice. In this review we examine the prevailing mechanistic model and observational data; we assess how these are applied and the priorities they indicate for future research.
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Proescholdt MA, Macher C, Woertgen C, Brawanski A. Level of evidence in the literature concerning brain tumor resection. Clin Neurol Neurosurg 2005; 107:95-8. [PMID: 15708222 DOI: 10.1016/j.clineuro.2004.02.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2003] [Revised: 02/12/2004] [Accepted: 02/22/2004] [Indexed: 11/23/2022]
Abstract
Microsurgical resection is a cornerstone in the treatment of brain tumors. However, the benefit of radical resection still remains controversial. We attempted to analyze the level of scientific evidence (LOE) and methodological aspects of studies concerning the impact of the extent of resection (EOR) on outcome. The LOE classification was Ia: 0%, Ib: 0%, IIa: 0.8%, IIb: 5.8%, IIc: 0%, IIIa: 13.3%, IIIb: 52.5%, IV: 10.8%, V:16.8%. 72.5% observed a positive effect of total tumor removal. 84.2% did not report the criteria for treatment assignment, 62.5% did not define the terms gross total; radical; partial; or subtotal resection. The average age of the treatment groups was reported in 29.2%, the Karnofsky index in 75.8%. Tumor size was reported in 32.5%, location in 51.7%. Assessment of EOR was based on the surgeon's impression in 75.0%, determined by postoperative CT/MRI scans in 20.8%, quantified by CT/MRI-based volumetry in 3.4%, and assessed by histological analysis in 0.8%. To date, no studies with high LOE are available addressing the benefit of gross total brain tumor removal. Although the majority of the reports found a positive effect of radical resection, the reviewed articles contain methodological limitations which may significantly influence the results.
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Affiliation(s)
- Martin A Proescholdt
- Department of Neurosurgery, University of Regensburg, Franz Josef Strauss Allee 11, Regensburg D-93042, Germany.
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Abstract
Meningiomas are by far the most common tumours arising from the meninges. Progressive enlargement of the tumour leads to focal or generalised seizure disorders or neurological deficits caused by compression of adjacent neural tissue. Surgery remains the primary treatment of choice, although the use of fractionated radiotherapy or stereotactic single-dose radiosurgery is increasing for meningiomas that are incompletely excised, surgically inaccessible, or recurrent and either atypical or anaplastic. Although most meningiomas have good long-term prognosis after treatment, there are still controversies over management in a proportion of cases. We review various features of meningioma biology, diagnosis, and treatment and provide an overview of the current rationale and evidence base for the various therapeutic approaches.
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Affiliation(s)
- Ian R Whittle
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU, UK.
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Abstract
BACKGROUND Patients with isolated supratentorial brain tumours, presumed to be primary on imaging, have two surgical management options - biopsy or resection. Surgical opinions appear to be equally divided when considering the relative risks and benefits of these two procedures. OBJECTIVES To estimate the clinical effectiveness of radical surgical resection compared to simple biopsy in patients with malignant glioma. SEARCH STRATEGY Electronic database searches of COCHRANE CONTROLLED TRIALS REGISTER (including the Cochrane Cancer Network Specialised Register of Trials), MEDLINE, CANCERLIT, EMBASE, BIOSIS and SCIENCE CITATION INDEX. Hand searching the references of all identified studies; hand searching the Journal of Neuro-Oncology over the previous 10 years, including all conference abstracts; personal communication. SELECTION CRITERIA Randomised and clinical controlled trials were included if they compared biopsy to resection, or looked at effect of extent of resection on survival, time to progression or quality of life, for malignant glioma patients of all ages. DATA COLLECTION AND ANALYSIS Studies were to be identified, critically appraised and data extracted by the author (SEM). For dichotomous data, Peto odds ratios (OR) with 95% confidence intervals (CI) were hoped to have been estimated. Normal continuous data were to have been summated using the weighted mean difference (WMD). MAIN RESULTS The electronic database search yielded 2100 citations. Of these, two articles were identified for possible inclusion, however both were excluded. The hand search and personal communication were similarly unproductive. No studies were included in the review and no data was synthesised. REVIEWER'S CONCLUSIONS Given that no qualifying studies were identified and because this is an important issue, both in terms of patient risk and benefit and health economics, the author feels it important to conduct a randomised controlled trial in this subject.
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Affiliation(s)
- S E Metcalfe
- c/o Edinburgh Centre of Neuro-Oncology, Western General Hospital, Crewe Road, Edinburgh, Scotland, UK, EH4 2XU.
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