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Tariq R, Aziz HF, Paracha S, Ahmed N, Baqai MWS, Bakhshi SK, McAtee A, Ainger TJ, Mirza FA, Enam SA. Intraoperative mapping and preservation of executive functions in awake craniotomy: a systematic review. Neurol Sci 2024:10.1007/s10072-024-07475-y. [PMID: 38520640 DOI: 10.1007/s10072-024-07475-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
Awake craniotomy (AC) allows intraoperative brain mapping (ioBM) for maximum lesion resection while monitoring and preserving neurological function. Conventionally, language, visuospatial assessment, and motor functions are mapped, while the assessment of executive functions (EF) is uncommon. Impaired EF may lead to occupational, personal, and social limitations, thus, a compromised quality of life. A comprehensive literature search was conducted through Scopus, Medline, and Cochrane Library using a pre-defined search strategy. Articles were selected after duplicate removal, initial screening, and full-text assessment. The demographic details, ioBM techniques, intraoperative tasks, and their assessments, the extent of resection (EOR), post-op EF and neurocognitive status, and feasibility and potential adverse effects of the procedure were reviewed. The correlations of tumor locations with intraoperative EF deficits were also assessed. A total of 13 studies with intraoperative EF assessment of 351 patients were reviewed. Awake-asleep-awake protocol was most commonly used. Most studies performed ioBM using bipolar stimulation, with a frequency of 60 Hz, pulse durations ranging 1-2 ms, and intensity ranging 2-6 mA. Cognitive function was monitored with the Stroop task, spatial-2-back test, line-bisection test, trail-making-task, and digit-span tests. All studies reported similar or better EOR in patients with ioBM for EF. When comparing the neuropsychological outcomes of patients with ioBM of EF to those without it, all studies reported significantly better EF preservation in ioBM groups. Most authors reported EF mapping as a feasible tool to obtain satisfactory outcomes. Adverse effects included intraoperative seizures which were easily controlled. AC with ioBM of EF is a safe, effective, and feasible technique that allows satisfactory EOR and improved neurocognitive outcomes with minimal adverse effects.
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Affiliation(s)
- Rabeet Tariq
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Hafiza Fatima Aziz
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shahier Paracha
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Noman Ahmed
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Saqib Kamran Bakhshi
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Annabel McAtee
- College of Medicine, University of Kentucky, Lexington, USA
| | - Timothy J Ainger
- Department of Neurology, University of Kentucky College of Medicine, Kentucky Neuroscience Institute, Lexington, KY, USA
| | - Farhan A Mirza
- Department of Neurosurgery, Kentucky Neuroscience Institute (KNI), University of Kentucky, Lexington, USA
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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Personality and behavioral changes after brain tumor resection: a lesion mapping study. Acta Neurochir (Wien) 2021; 163:1257-1267. [PMID: 33576912 DOI: 10.1007/s00701-021-04756-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/01/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Cognitive functioning is generally well preserved in patients with diffuse low-grade glioma (DLGG), even in the case of extended tumor and resection. To date, the question of personality changes in these patients has received little attention. Our aim was to investigate to what extent certain aspects of personality and behaviors could be affected by DLGG resection. METHODS We used self-reported personality questionnaires (NOEPI-R and TCI-R) and hetero-evaluation of executive behavioral changes in a large sample of 98 patients operated on for DLGG. To compare the patients' scores from the personality questionnaires, we recruited 47 healthy controls participants. To identify the putative neural networks associated with behavioral changes, a combination of voxel-wise and tract-wise lesion-symptom mapping was performed. RESULTS First, results revealed no difference between patients and controls for each subdimension of the NOEPI-R. Regarding the TCI-R, the character dimensions and three out of four temperament dimensions did not differ. Second, behavioral changes (Irritability, Hypoactivity, Anticipative disorders, and disinterest) were reported between 40 and 50% of cases. Third, some personality dimensions (as neuroticism) were strongly predictive of postoperative behavioral disorders (as hypoactivity). Lastly, specific behavioral changes were associated with selective damage to cortical (left inferior frontal gyrus, supplementary motor area, and right fusiform gyrus) and white matter (left inferior fronto-occipital and uncinate fasciculi, right cingulum) structures. CONCLUSION This study demonstrates that extensive lesions caused by DLGGs and their surgical resection have no or minor impact on patients' personality. However, specific personality dimensions are strongly predictive of behavioral disorders suggesting that the observed surgically related behavioral changes are modulated by the personality profile. Finally, the lesion mapping analyses indicate that damage to differential cortical or white matter structures leads to distinct patterns of behavioral abnormalities.
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de Oliveira-Souza R, Paranhos T, Moll J, Grafman J. Gender and Hemispheric Asymmetries in Acquired Sociopathy. Front Psychol 2019; 10:346. [PMID: 30941065 PMCID: PMC6433972 DOI: 10.3389/fpsyg.2019.00346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 02/04/2019] [Indexed: 01/22/2023] Open
Abstract
The emergence of enduring antisocial personality changes in previously normal individuals, or "acquired sociopathy," has consistently been reported in patients with bilateral injuries of the ventromedial prefrontal cortex. Over the past three decades, cases of acquired sociopathy with (a) bilateral or (b) unilateral sparing of the ventromedial prefrontal cortex have been reported. These cases indicate that at least in a few individuals (a') neural structures beyond the ventromedial prefrontal cortex are also critical for normal social behavior, and (b') the neural underpinnings of social cognition may be lateralized to one cerebral hemisphere. Moreover, researchers have presented evidence that lesion laterality and gender may interact in the production of acquired sociopathy. In the present review, we carried out a comprehensive literature survey seeking possible interactions between gender and hemispheric asymmetry in acquired sociopathy. We found 85 cases of acquired sociopathy due to bilateral (N = 48) and unilateral (N = 37) hemispheric injuries. A significant association between acquired sociopathy and right hemisphere damage was found in men, whereas lesions were bilateral in most women with acquired sociopathy. The present survey shows that: (i) the number of well-documented single-cases of acquired sociopathy is surprisingly small given the length of the historical record; (ii) acquired sociopathy was significantly more frequent in men after an injury of the right or of both cerebral hemispheres; and (iii) in most women who developed acquired sociopathy the injuries affected both cerebral hemispheres. These findings may be especially valuable to neuroscientists and to functional neurosurgeons in particular for the planning of tumor resections as well as for the choice of the best targets for therapeutic neuromodulation.
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Affiliation(s)
- Ricardo de Oliveira-Souza
- Department of Neurology and Neuropsychiatry, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Departments of Neurology and Psychiatry, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thiago Paranhos
- Department of Neurology and Neuropsychiatry, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- School of Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge Moll
- Department of Neurology and Neuropsychiatry, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Jordan Grafman
- Shirley Ryan AbilityLab, Department of Physical Medicine, Rehabilitation, and Psychology, Neurology, Cognitive Neurology and Alzheimer's Center, Feinberg School of Medicine, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, United States
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Ruis C. Monitoring cognition during awake brain surgery in adults: A systematic review. J Clin Exp Neuropsychol 2018; 40:1081-1104. [DOI: 10.1080/13803395.2018.1469602] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Carla Ruis
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Psychology, Utrecht University, Utrecht, The Netherlands
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Lemaitre AL, Herbet G, Duffau H, Lafargue G. Preserved metacognitive ability despite unilateral or bilateral anterior prefrontal resection. Brain Cogn 2017; 120:48-57. [PMID: 29122369 DOI: 10.1016/j.bandc.2017.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/28/2017] [Accepted: 10/31/2017] [Indexed: 11/30/2022]
Abstract
Brodmann area 10 (BA10) is thought to be at the summit of the prefrontal cortex's hierarchical organization. It is widely accepted that metacognitive abilities depend on the structural and functional properties of BA10. Our objective was to assess whether metacognition can be maintained after low-grade glioma surgery with BA10 resection. Three groups of participants were recruited: (i) patients having undergone resection of the right prefrontal cortex, including BA10 (n = 9); (ii) patients having undergone resection of the right prefrontal cortex but not BA10 (n = 10); and (iii) healthy controls (n = 38). Importantly, we also included a patient (referred to as "PR") with resection of BA10 in the two hemispheres. The patients with resection of right BA10 had metacognitive performances that were indistinguishable from those of brain-damaged control patients and healthy controls. Crucially, PR's metacognitive ability was not only maintained but was even in the upper quartile of normal performances. Our findings demonstrate that the brain can redistribute and remap metacognition in response to injury. We thus provide experimental evidence against the conventional hypothesis whereby cognitive functions are directly and lastingly linked to particular cortical structures. The latter hypothesis seems to be particularly false for the highest levels of human cognition and for BA10.
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Affiliation(s)
- Anne-Laure Lemaitre
- Psychologie: Interactions, Temps, Emotions, Cognition, PSITEC, EA 4072, Université de Lille, France; Département de Neurochirurgie, Hôpital Gui de Chauliac, Université de Montpellier, France
| | - Guillaume Herbet
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Université de Montpellier, France; Institut des Neurosciences de Montpellier, INSERM U1051, Hôpital Saint Eloi, Université de Montpellier, France
| | - Hugues Duffau
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Université de Montpellier, France; Institut des Neurosciences de Montpellier, INSERM U1051, Hôpital Saint Eloi, Université de Montpellier, France
| | - Gilles Lafargue
- Laboratoire Cognition, Santé, Socialisation, C2S, EA 6291, Université de Reims Champagne-Ardenne, Reims, France.
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Besnard J, Allain P, Lerma V, Aubin G, Chauviré V, Etcharry-Bouyx F, Le Gall D. Frontal versus dysexecutive syndromes: relevance of an interactionist approach in a case series of patients with prefrontal lobe damage. Neuropsychol Rehabil 2016; 28:919-936. [DOI: 10.1080/09602011.2016.1209420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jérémy Besnard
- Laboratoire de Psychologie des Pays de la Loire (UPRES EA 4638), LUNAM Université, University of Angers, Angers, France
- Neuropsychological Unit, Department of Neurology, University Hospital of Angers, Angers, France
| | - Philippe Allain
- Laboratoire de Psychologie des Pays de la Loire (UPRES EA 4638), LUNAM Université, University of Angers, Angers, France
- Neuropsychological Unit, Department of Neurology, University Hospital of Angers, Angers, France
| | - Vanesa Lerma
- Department of Psychology, St. Edward’s University, Austin, TX, USA
| | - Ghislaine Aubin
- Laboratoire de Psychologie des Pays de la Loire (UPRES EA 4638), LUNAM Université, University of Angers, Angers, France
- Neuropsychological Unit, Department of Neurology, University Hospital of Angers, Angers, France
- Department of Rehabilitation Medicine, Regional Centre for Functional Rehabilitation, Angers, France
| | - Valérie Chauviré
- Laboratoire de Psychologie des Pays de la Loire (UPRES EA 4638), LUNAM Université, University of Angers, Angers, France
- Neuropsychological Unit, Department of Neurology, University Hospital of Angers, Angers, France
| | - Frédérique Etcharry-Bouyx
- Laboratoire de Psychologie des Pays de la Loire (UPRES EA 4638), LUNAM Université, University of Angers, Angers, France
- Neuropsychological Unit, Department of Neurology, University Hospital of Angers, Angers, France
| | - Didier Le Gall
- Laboratoire de Psychologie des Pays de la Loire (UPRES EA 4638), LUNAM Université, University of Angers, Angers, France
- Neuropsychological Unit, Department of Neurology, University Hospital of Angers, Angers, France
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[Unusual course of a chalazion]. Ophthalmologe 2015; 112:269-71. [PMID: 25566734 DOI: 10.1007/s00347-014-3108-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND A chalazion is a benign, inflammatory tumor of the eyelid caused by an obstruction of the excretory duct of a meibomian gland. Usually a chalazion shows a slow painless and non-inflammatory progression. Interestingly, sinus infections can initially simulate chalazia by causing an orbital involvement with eyelid swelling. CASE REPORT We report the case of a 15-year-old boy with frontal and ethmoidal sinusitis with inflammatory orbital infiltration and subacute eyelid swelling. The cerebral imaging showed an encapsulated brain abscess so that an urgent surgical removal of the abscess cavity was indicated. After several neurosurgical procedures a complete remission of the abscess could be achieved. In spite of the large abscess in the frontal lobe the boy never showed any neurological or psychiatric symptoms. CONCLUSION In atypical courses of a chalazion the clinical picture requires further diagnosis including evaluation and imaging in otorhinolaryngology and neurology.
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