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de Zwart B, Ruis C. An update on tests used for intraoperative monitoring of cognition during awake craniotomy. Acta Neurochir (Wien) 2024; 166:204. [PMID: 38713405 PMCID: PMC11076349 DOI: 10.1007/s00701-024-06062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/02/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Mapping higher-order cognitive functions during awake brain surgery is important for cognitive preservation which is related to postoperative quality of life. A systematic review from 2018 about neuropsychological tests used during awake craniotomy made clear that until 2017 language was most often monitored and that the other cognitive domains were underexposed (Ruis, J Clin Exp Neuropsychol 40(10):1081-1104, 218). The field of awake craniotomy and cognitive monitoring is however developing rapidly. The aim of the current review is therefore, to investigate whether there is a change in the field towards incorporation of new tests and more complete mapping of (higher-order) cognitive functions. METHODS We replicated the systematic search of the study from 2018 in PubMed and Embase from February 2017 to November 2023, yielding 5130 potentially relevant articles. We used the artificial machine learning tool ASReview for screening and included 272 papers that gave a detailed description of the neuropsychological tests used during awake craniotomy. RESULTS Comparable to the previous study of 2018, the majority of studies (90.4%) reported tests for assessing language functions (Ruis, J Clin Exp Neuropsychol 40(10):1081-1104, 218). Nevertheless, an increasing number of studies now also describe tests for monitoring visuospatial functions, social cognition, and executive functions. CONCLUSIONS Language remains the most extensively tested cognitive domain. However, a broader range of tests are now implemented during awake craniotomy and there are (new developed) tests which received more attention. The rapid development in the field is reflected in the included studies in this review. Nevertheless, for some cognitive domains (e.g., executive functions and memory), there is still a need for developing tests that can be used during awake surgery.
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Affiliation(s)
- Beleke de Zwart
- Experimental Psychology, Helmholtz Institution, Utrecht University, Utrecht, The Netherlands.
| | - Carla Ruis
- Experimental Psychology, Helmholtz Institution, Utrecht University, Utrecht, The Netherlands
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
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2
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Ribeiro M, Yordanova YN, Noblet V, Herbet G, Ricard D. White matter tracts and executive functions: a review of causal and correlation evidence. Brain 2024; 147:352-371. [PMID: 37703295 DOI: 10.1093/brain/awad308] [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: 10/08/2022] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023] Open
Abstract
Executive functions are high-level cognitive processes involving abilities such as working memory/updating, set-shifting and inhibition. These complex cognitive functions are enabled by interactions among widely distributed cognitive networks, supported by white matter tracts. Executive impairment is frequent in neurological conditions affecting white matter; however, whether specific tracts are crucial for normal executive functions is unclear. We review causal and correlation evidence from studies that used direct electrical stimulation during awake surgery for gliomas, voxel-based and tract-based lesion-symptom mapping, and diffusion tensor imaging to explore associations between the integrity of white matter tracts and executive functions in healthy and impaired adults. The corpus callosum was consistently associated with all executive processes, notably its anterior segments. Both causal and correlation evidence showed prominent support of the superior longitudinal fasciculus to executive functions, notably to working memory. More specifically, strong evidence suggested that the second branch of the superior longitudinal fasciculus is crucial for all executive functions, especially for flexibility. Global results showed left lateralization for verbal tasks and right lateralization for executive tasks with visual demands. The frontal aslant tract potentially supports executive functions, however, additional evidence is needed to clarify whether its involvement in executive tasks goes beyond the control of language. Converging evidence indicates that a right-lateralized network of tracts connecting cortical and subcortical grey matter regions supports the performance of tasks assessing response inhibition, some suggesting a role for the right anterior thalamic radiation. Finally, correlation evidence suggests a role for the cingulum bundle in executive functions, especially in tasks assessing inhibition. We discuss these findings in light of current knowledge about the functional role of these tracts, descriptions of the brain networks supporting executive functions and clinical implications for individuals with brain tumours.
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Affiliation(s)
- Monica Ribeiro
- Service de neuro-oncologie, Hôpital La Pitié-Salpêtrière, Groupe Hospitalier Universitaire Pitié Salpêtrière-Charles Foix, Sorbonne Université, 75013 Paris, France
- Université Paris Saclay, ENS Paris Saclay, Service de Santé des Armées, CNRS, Université Paris Cité, INSERM, Centre Borelli UMR 9010, 75006 Paris, France
| | - Yordanka Nikolova Yordanova
- Service de neurochirurgie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, 92140 Clamart, France
| | - Vincent Noblet
- ICube, IMAGeS team, Université de Strasbourg, CNRS, UMR 7357, 67412 Illkirch, France
| | - Guillaume Herbet
- Praxiling, UMR 5267, CNRS, Université Paul Valéry Montpellier 3, 34090 Montpellier, France
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, 34295 Montpellier, France
- Institut Universitaire de France
| | - Damien Ricard
- Université Paris Saclay, ENS Paris Saclay, Service de Santé des Armées, CNRS, Université Paris Cité, INSERM, Centre Borelli UMR 9010, 75006 Paris, France
- Département de neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, 92140 Clamart, France
- Ecole du Val-de-Grâce, 75005 Paris, France
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Yang Z, Zhao C, Zong S, Piao J, Zhao Y, Chen X. A review on surgical treatment options in gliomas. Front Oncol 2023; 13:1088484. [PMID: 37007123 PMCID: PMC10061125 DOI: 10.3389/fonc.2023.1088484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/24/2023] [Indexed: 03/17/2023] Open
Abstract
Gliomas are one of the most common primary central nervous system tumors, and surgical treatment remains the principal role in the management of any grade of gliomas. In this study, based on the introduction of gliomas, we review the novel surgical techniques and technologies in support of the extent of resection to achieve long-term disease control and summarize the findings on how to keep the balance between cytoreduction and neurological morbidity from a list of literature searched. With modern neurosurgical techniques, gliomas resection can be safely performed with low morbidity and extraordinary long-term functional outcomes.
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Affiliation(s)
- Zhongxi Yang
- Department of Neurosurgery, The First Hospital of Jilin University, Jilin, China
| | - Chen Zhao
- Department of Neurosurgery, The First Hospital of Jilin University, Jilin, China
| | - Shan Zong
- Department of Gynecology Oncology, The First Hospital of Jilin University, Jilin, China
| | - Jianmin Piao
- Department of Neurosurgery, The First Hospital of Jilin University, Jilin, China
| | - Yuhao Zhao
- Department of Neurosurgery, The First Hospital of Jilin University, Jilin, China
| | - Xuan Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Jilin, China
- *Correspondence: Xuan Chen,
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4
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Gallet C, Clavreul A, Bernard F, Menei P, Lemée JM. Frontal aslant tract in the non-dominant hemisphere: A systematic review of anatomy, functions, and surgical applications. Front Neuroanat 2022; 16:1025866. [DOI: 10.3389/fnana.2022.1025866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022] Open
Abstract
Knowledge of both the spatial organization and functions of white-matter fiber tracts is steadily increasing. We report here the anatomy and functions of the frontal aslant tract (FAT) in the non-dominant hemisphere (usually the right hemisphere). Despite the structural symmetry between the right and left FAT, these two tracts seem to display functional asymmetry, with several brain functions in common, but others, such as visuospatial and social cognition, music processing, shifting attention or working memory, more exclusively associated with the right FAT. Further studies are required to determine whether damage to the right FAT causes permanent cognitive impairment. Such studies will constitute the best means of testing whether this tract is a critical pathway that must be taken into account during neurosurgical procedures and the essential tasks to be incorporated into intraoperative monitoring during awake craniotomy.
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Buunk AM, Gerritsen MJJ, Jeltema HR, Wagemakers M, Metzemaekers JDM, Groen RJM, Spikman JM. Emotion Recognition in Patients with Low-Grade Glioma before and after Surgery. Brain Sci 2022; 12:brainsci12091259. [PMID: 36138995 PMCID: PMC9497049 DOI: 10.3390/brainsci12091259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022] Open
Abstract
Research on patients with low-grade gliomas (LGGs) showed neurocognitive impairments in various domains. However, social cognition has barely been investigated. Facial emotion recognition is a vital aspect of social cognition, but whether emotion recognition is affected in LGG patients is unclear. Therefore, we aimed to investigate the effect of LGG and resection by examining emotion recognition pre- and postoperatively. Additionally, the relationships among emotion recognition and general cognition and tumor location were investigated. Thirty patients with LGG who underwent resective surgery were included and matched with 63 healthy control participants (HCs). Emotion recognition was measured with the Facial Expressions of Emotion–Stimuli and Tests (FEEST) and general cognition with neuropsychological tests. Correlations and within-group and between-group comparisons were calculated. Before surgery, patients performed significantly worse than the HCs on FEEST-Total and FEEST-Anger. Paired comparisons showed no significant differences between FEEST scores before and post-surgery. No significant correlations with general cognition and tumor location were found. To conclude, the results of this study indicate that the tumor itself contributes significantly to social cognitive dysfunction and that surgery causes no additional deficit. Impairments were not related to general cognitive deficits or tumor location. Consequently, incorporating tests for emotion recognition into the neuropsychological assessment of patients with LGG is important.
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Affiliation(s)
- Anne M. Buunk
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
- Correspondence: ; Tel.: +31-5036-12408; Fax: +31-5036-14227
| | - Marleen J. J. Gerritsen
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Hanne-Rinck Jeltema
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Michiel Wagemakers
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Jan D. M. Metzemaekers
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Rob J. M. Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Jacoba M. Spikman
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Group-level stability but individual variability of neurocognitive status after awake resections of right frontal IDH-mutated glioma. Sci Rep 2022; 12:6126. [PMID: 35413966 PMCID: PMC9005659 DOI: 10.1038/s41598-022-08702-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/09/2022] [Indexed: 12/16/2022] Open
Abstract
Awake surgery for low-grade gliomas is currently considered the best procedure to improve the extent of resection and guarantee a "worth living life" for patients, meaning avoiding not only motor but also cognitive deficits. However, tumors located in the right hemisphere, especially in the right frontal lobe, are still rarely operated on in awake condition; one of the reasons possibly being that there is little information in the literature describing the rates and nature of long-lasting neuropsychological deficits following resection of right frontal glioma. To investigate long-term cognitive deficits after awake surgery in right frontal IDH-mutated glioma. We retrospectively analyzed a consecutive series of awake surgical resections between 2012 and 2020 for right frontal IDH-mutated glioma. We studied the patients' subjective complaints and objective neuropsychological evaluations, both before and after surgery. Our results were then put in perspective with the literature. Twenty surgical cases (including 5 cases of redo surgery) in eighteen patients (medium age: 42.5 [range 26-58]) were included in the study. The median preoperative volume was 37 cc; WHO grading was II, III and IV in 70%, 20%, and 10% of cases, respectively. Preoperatively, few patients had related subjective cognitive or behavioral impairment, while evaluations revealed mild deficits in 45% of cases, most often concerning executive functions, attention, working memory and speed processing. Immediate postoperative evaluations showed severe deficits of executive functions in 75% of cases but also attentional deficits (65%), spatial neglect (60%) and behavioral disturbances (apathy, aprosodia/amimia, emotional sensitivity, anosognosia). Four months after surgery, although psychometric z-scores were unchanged at the group level, individual evaluations showed a slight decrease of performance in 9/20 cases for at least one of the following domains: executive functions, speed processing, attention, semantic cognition, social cognition. Our results are generally consistent with those of the literature, confirming that the right frontal lobe is a highly eloquent area and suggesting the importance of operating these patients in awake conditions.
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A systematic review of the use of subcortical intraoperative electrical stimulation mapping for monitoring of executive deficits and neglect: what is the evidence so far? Acta Neurochir (Wien) 2022; 164:177-191. [PMID: 34674026 PMCID: PMC8761150 DOI: 10.1007/s00701-021-05012-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/21/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Over the past decade, the functional importance of white matter pathways has been increasingly acknowledged in neurosurgical planning. A method to directly study anatomo-functional correlations is direct electrical stimulation (DES). DES has been widely accepted by neurosurgeons as a reliable tool to minimize the occurrence of permanent postoperative motor, vision, and language deficits. In recent years, DES has also been used for stimulation mapping of other cognitive functions, such as executive functions and visuospatial awareness. METHODS The aim of this review is to summarize the evidence so far from DES studies on subcortical pathways that are involved in visuospatial awareness and in the following three executive functions: (1) inhibitory control, (2) working memory, and (3) cognitive flexibility. RESULTS Eleven articles reported on intraoperative electrical stimulation of white matter pathways to map the cognitive functions and explicitly clarified which subcortical tract was stimulated. The results indicate that the right SLF-II is involved in visuospatial awareness, the left SLF-III and possibly the right SLF-I are involved in working memory, and the cingulum is involved in cognitive flexibility. CONCLUSIONS We were unable to draw any more specific conclusions, nor unequivocally establish the critical involvement of pathways in executive functions or visuospatial awareness due to the heterogeneity of the study types and methods, and the limited number of studies that assessed these relationships. Possible approaches for future research to obtain converging and more definite evidence for the involvement of pathways in specific cognitive functions are discussed.
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De Martino M, Talacchi A, Capasso R, Mazzotta A, Miceli G. Language Assessment in Multilingualism and Awake Neurosurgery. Front Hum Neurosci 2021; 15:750013. [PMID: 34899217 PMCID: PMC8660632 DOI: 10.3389/fnhum.2021.750013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022] Open
Abstract
Multilingualism has become a worldwide phenomenon that poses critical issues about the language assessment in patients undergoing awake neurosurgery in eloquent brain areas. The accuracy and sensitivity of multilingual perioperative language assessment procedures is crucial for a number of reasons: they should be appropriate to detect deficits in each of the languages spoken by the patient; they should be suitable to identify language-specific cortical regions; they should ensure that each of the languages of a multilingual patient is tested at an adequate and comparable level of difficulty. In clinical practice, a patient-tailored approach is generally preferred. This is a necessary compromise since it is impossible to predict all the possible language combinations spoken by individuals and thus the availability of standardized testing batteries is a potentially unattainable goal. On the other hand, this leads to high inconsistency in how different neurosurgical teams manage the linguistic features that determine similarity or distance between the languages spoken by the patient and that may constrain the neuroanatomical substrate of each language. The manuscript reviews the perioperative language assessment methodologies adopted in awake surgery studies on multilingual patients with brain tumor published from 1991 to 2021 and addresses the following issues: (1) The language selected for the general neuropsychological assessment of the patient. (2) The procedures adopted to assess the dimensions that may constrain language organization in multilingual speakers: age and type of acquisition, exposure, proficiency, and use of the different languages. (3) The type of preoperative language assessment used for all the languages spoken by the patient. (4) The linguistic tasks selected in the intraoperative setting. The reviewed data show a great heterogeneity in the perioperative clinical workup with multilingual patients. The only exception is the task used during language mapping, as the picture naming task is highly preferred. The review highlights that an objective and accurate description of both the linguistic profile of multilingual patients and the specific properties of the languages under scrutiny can profitably support clinical management and decision making in multilingual awake neurosurgery settings.
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Affiliation(s)
- Maria De Martino
- Department of Political and Communication Sciences (POLICOM), University of Salerno, Fisciano, Italy
| | | | | | - Annapina Mazzotta
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gabriele Miceli
- Center for Mind/Brain Sciences, University of Trento, Trento, Italy
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Hartung SL, Mandonnet E, de Witt Hamer P, Klein M, Wager M, Rech F, Pallud J, Pessanha Viegas C, Ille S, Krieg SM, Robe PA, van Zandvoort MJE. Impaired Set-Shifting from Dorsal Stream Disconnection: Insights from a European Series of Right Parietal Lower-Grade Glioma Resection. Cancers (Basel) 2021; 13:cancers13133337. [PMID: 34283043 PMCID: PMC8267741 DOI: 10.3390/cancers13133337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Awake surgery with cognitive monitoring has increasingly been implemented to preserve brain networks and functionality. More recently, not only surgery in the left but also in the right hemisphere, i.c., the parietal lobe, was associated with potential risk for deficits in cognitive functions, such as cognitive flexibility. We describe an explorative pilot study in an international consortium within clinical care as usual. Careful interpretation of our findings indicates that disconnection of the lateral part of the dorsal stream correlated with impaired set-shifting. More importantly, it illustrates the need for international collaboration on neuropsychological tests and methodologies to improve our understanding of white matter networks at risk during awake surgery. Abstract Awake surgery with cognitive monitoring has increasingly been implemented to preserve brain networks and functionality. More recently, not only surgery in the left but also in the right hemisphere, i.c., the parietal lobe, was associated with potential risk for deficits in cognitive functions, such as cognitive flexibility. In this explorative pilot study, we compare cognitive performance more than three months after surgery with baseline measurements and explore the association between cognitive decline and subcortical tracts that may have been severed during surgery in the right hemisphere. Twenty-two patients who underwent surgery for a right parietal low-grade glioma were assessed pre- and postoperatively using the Trail Making Test and the Stroop task to administer set-shifting abilities and inhibition. Volume measurements and lesion–symptom mapping analyses were performed on postoperative MRI scans. Careful interpretation of the results shows a change in TMT performance and not on the Stroop Task when the lateral part of the arcuate fasciculus is damaged, indicating that disconnection of the lateral part of the dorsal stream might be correlated specifically with impaired set-shifting and not with inhibition. More importantly, this study underlines the need for international concertation to allow larger studies to increase power and perform more detailed analyses.
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Affiliation(s)
- Suzanne L. Hartung
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (P.A.R.); (M.J.E.v.Z.)
- Correspondence:
| | | | - Philip de Witt Hamer
- Department of Neurosurgery, Location VUmc, Cancer Center Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands;
| | - Martin Klein
- Department of Medical Psychology and Brain Tumor Center Amsterdam at Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Michel Wager
- Department of Neurological Surgery, Poitiers University Hospital, 86021 Poitiers, France;
| | - Fabien Rech
- CHRU-Nancy, Service de Neurochirurgie, Université de Lorraine, F-54000 Nancy, France;
- CNRS, CRAN, Université de Lorraine, F-54000 Nancy, France
| | - Johan Pallud
- Department of Neursurgery, Saint-Anne Hospital, 75014 Paris, France;
| | | | - Sebastian Ille
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany; (S.I.); (S.M.K.)
| | - Sandro M. Krieg
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany; (S.I.); (S.M.K.)
| | - Pierre A. Robe
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (P.A.R.); (M.J.E.v.Z.)
| | - Martine J. E. van Zandvoort
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (P.A.R.); (M.J.E.v.Z.)
- Department of Experimental Psychology, Utrecht University, 3584 CS Utrecht, The Netherlands
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Leonetti A, Puglisi G, Rossi M, Viganò L, Conti Nibali M, Gay L, Sciortino T, Howells H, Fornia L, Riva M, Cerri G, Bello L. Factors Influencing Mood Disorders and Health Related Quality of Life in Adults With Glioma: A Longitudinal Study. Front Oncol 2021; 11:662039. [PMID: 34094955 PMCID: PMC8173148 DOI: 10.3389/fonc.2021.662039] [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: 01/31/2021] [Accepted: 04/15/2021] [Indexed: 11/20/2022] Open
Abstract
Objective At present, it is not clear whether Mood Disorders (MD) and poor Health Related Quality of Life (HRQoL) in the glioma population correlate with features of the tumor, or rather with secondary symptoms associated with treatment. The aim of this study was to assess the prevalence of MD and decline in HRQoL in glioma patients, and to determine the main factors associated with these two variables. Methods 80 patients affected by lower-grade gliomas (LGGs) and 65 affected by high-grade gliomas (HGGs) were evaluated, from admission up to 12 months after surgery, for MD, HRQoL, clinical characteristics, and cognitive functions. Independent factors associated with MD and low HRQoL were identified by using bivariate analysis. Results Data showed that prevalence of low HRQoL was comparable in both groups during all the time points assessed (pre, 1, 3, 6 and 12 months after surgery). In contrast at 6 months following surgery, HGGs showed a higher prevalence of MD compared to LGGs;. Bivariate analysis revealed that factors associated with MD and HRQoL in LGGs and HGGs were different over the course of the disease. In LGGs, from the pre-operative period to one year post surgery, MD and low HRQOL were associated with the occurrence of cognitive deficits and, from the third month after surgery onward, they were also associated with the effect exerted by adjuvant treatments. In HGGs, MD were associated with cognitive deficits at 3 and 6 months after surgery, along with older age (65-75 years); HRQoL, in its Physical component in particular, was associated with older age only from 6 months after surgery. Conclusion Factors associated with MD and low HRQoL were different in LGGs and HGGs over the course of the disease. In LGGs the effect of adjuvant treatments was prominent in determining the prevalence of both MD and poor HRQoL from the third month after surgery onward. In HGGs, MD and HRQoL were associated with age, at 3 and 6 months after surgery. In both, the occurrence of cognitive deficits was significantly associated with MD.
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Affiliation(s)
- Antonella Leonetti
- Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Milano, Italy
| | - Guglielmo Puglisi
- Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Milano, Italy
| | - Marco Rossi
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
| | - Luca Viganò
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
| | - Marco Conti Nibali
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
| | - Lorenzo Gay
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
| | - Tommaso Sciortino
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
| | - Henrietta Howells
- Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Milano, Italy
| | - Luca Fornia
- Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Milano, Italy
| | - Marco Riva
- Neurosurgical Oncology Unit, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Milano, Italy
| | - Gabriella Cerri
- Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Milano, Italy.,BIOMETRA Department, Humanitas Research Hospital IRCSS, Milano, Italy
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
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11
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Erez Y, Assem M, Coelho P, Romero-Garcia R, Owen M, McDonald A, Woodberry E, Morris RC, Price SJ, Suckling J, Duncan J, Hart MG, Santarius T. Intraoperative mapping of executive function using electrocorticography for patients with low-grade gliomas. Acta Neurochir (Wien) 2021; 163:1299-1309. [PMID: 33222010 PMCID: PMC8053659 DOI: 10.1007/s00701-020-04646-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/09/2020] [Indexed: 01/03/2023]
Abstract
Background Intraoperative functional mapping with direct electrical stimulation during awake surgery for patients with diffuse low-grade glioma has been used in recent years to optimize the balance between surgical resection and quality of life following surgery. Mapping of executive functions is particularly challenging because of their complex nature, with only a handful of reports published so far. Here, we propose the recording of neural activity directly from the surface of the brain using electrocorticography to map executive functions and demonstrate its feasibility and potential utility. Methods To track a neural signature of executive function, we recorded neural activity using electrocorticography during awake surgery from the frontal cortex of three patients judged to have an appearance of diffuse low-grade glioma. Based on existing functional magnetic resonance imaging (fMRI) evidence from healthy participants for the recruitment of areas associated with executive function with increased task demands, we employed a task difficulty manipulation in two counting tasks performed intraoperatively. Following surgery, the data were extracted and analyzed offline to identify increases in broadband high-gamma power with increased task difficulty, equivalent to fMRI findings, as a signature of activity related to executive function. Results All three patients performed the tasks well. Data were recorded from five electrode strips, resulting in data from 15 channels overall. Eleven out of the 15 channels (73.3%) showed significant increases in high-gamma power with increased task difficulty, 26.6% of the channels (4/15) showed no change in power, and none of the channels showed power decrease. High-gamma power increases with increased task difficulty were more likely in areas that are within the canonical frontoparietal network template. Conclusions These results are the first step toward developing electrocorticography as a tool for mapping of executive function complementarily to direct electrical stimulation to guide resection. Further studies are required to establish this approach for clinical use.
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12
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Ng S, Herbet G, Lemaitre AL, Moritz-Gasser S, Duffau H. Disrupting self-evaluative processing with electrostimulation mapping during awake brain surgery. Sci Rep 2021; 11:9386. [PMID: 33931714 PMCID: PMC8087680 DOI: 10.1038/s41598-021-88916-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/19/2021] [Indexed: 02/08/2023] Open
Abstract
Brain awake surgery with cognitive monitoring for tumor removal has become a standard of treatment for functional purpose. Yet, little attention has been given to patients' interpretation and awareness of their own responses to selected cognitive tasks during direct electrostimulation (DES). We aim to report disruptions of self-evaluative processing evoked by DES during awake surgery. We further investigate cortico-subcortical structures involved in self-assessment process and report the use of an intraoperative self-assessment tool, the self-confidence index (SCI). Seventy-two patients who had undergone awake brain tumor resections were selected. Inclusion criteria were the occurrence of a DES-induced disruption of an ongoing task followed by patient's failure to remember or criticize these impairments, or a dissociation between patient's responses to an ongoing task and patient's SCI. Disruptions of self-evaluation were frequently associated with semantic disorders and critical sites were mostly found along the left/right ventral semantic streams. Disconnectome analyses generated from a tractography-based atlas confirmed the high probability of the inferior fronto-occipital fasciculus to be transitory 'disconnected'. These findings suggest that white matters pathways belonging to the ventral semantic stream may be critically involved in human self-evaluative processing. Finally, the authors discuss the implementation of the SCI task during multimodal intraoperative monitoring.
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Affiliation(s)
- Sam Ng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Av Augustin Fliche, 34295, Montpellier, France. .,Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM U1191, Montpellier, France.
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Av Augustin Fliche, 34295, Montpellier, France.,Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM U1191, Montpellier, France.,Department of Speech-Language Pathology, University of Montpellier, Montpellier, France
| | - Anne-Laure Lemaitre
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Av Augustin Fliche, 34295, Montpellier, France.,Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM U1191, Montpellier, France
| | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Av Augustin Fliche, 34295, Montpellier, France.,Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM U1191, Montpellier, France.,Department of Speech-Language Pathology, University of Montpellier, Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Av Augustin Fliche, 34295, Montpellier, France.,Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM U1191, Montpellier, France.,Department of Speech-Language Pathology, University of Montpellier, Montpellier, France
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13
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Burkhardt E, Kinoshita M, Herbet G. Functional anatomy of the frontal aslant tract and surgical perspectives. J Neurosurg Sci 2021; 65:566-580. [PMID: 33870673 DOI: 10.23736/s0390-5616.21.05344-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The frontal aslant tract (FAT) is an intralobar white matter fasciculus providing dense connections between the medial part of the superior frontal gyrus, in particular the pre-supplementary motor area (SMA) and the SMA proper, and the lateral part of the frontal lobe, especially the inferior frontal gyrus. Although this tract has been characterized belatedly, it has received important attention in recent years due notably to its increasingly evidenced role in the speech and language networks. As cerebral tumors frequently affect the frontal lobe, an improved knowledge of the functional anatomy of the FAT is mandatory to refine the way neurosurgeries are performed and to give the patients the best opportunities to recover after surgery. In this work, we first describe the spatial arrangement of the FAT and detail its cortical projections. We then provide a comprehensive review of the functions supposedly mediated by this transverse frontal connectivity. It is structured following a tripartite organization where the linguistic (i.e. speech and language), supralinguistic (i.e. functions that interact with speech and language: executive functions, working memory, and social communication) and extralinguistic implications (i.e. functions outside the linguistic domain: visuospatial processing, praxis and motor skills) are successively addressed. We lastly discussed this knowledge in the context of wide-awake neurosurgeries for brain tumors. We emphasize the need to evaluate thoroughly the functions conveyed by FAT by means of longitudinally-designed studies to first estimate its plasticity potential and then to determine which tasks should be selected to avoid lasting impairments due to its disconnective breakdown.
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Affiliation(s)
- Eléonor Burkhardt
- Praxiling, CNRS UMR 5267, Paul Valéry Montpellier 3 University, Montpellier, France
| | - Masashi Kinoshita
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Guillaume Herbet
- University of Montpellier, CNRS UMR5203, INSERM U1191, Institute of Functional Genomics, Montpellier, France - .,Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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14
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Herbet G. Should Complex Cognitive Functions Be Mapped With Direct Electrostimulation in Wide-Awake Surgery? A Network Perspective. Front Neurol 2021; 12:635439. [PMID: 33912124 PMCID: PMC8072013 DOI: 10.3389/fneur.2021.635439] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Affiliation(s)
- Guillaume Herbet
- Institute of Functional Genomics, INSERM, CNRS, University of Montpellier, Montpellier, France.,Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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15
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Duffau H. Updated perspectives on awake neurosurgery with cognitive and emotional assessment for patients with low-grade gliomas. Expert Rev Neurother 2021; 21:463-473. [PMID: 33724148 DOI: 10.1080/14737175.2021.1901583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Thanks to early extensive surgical resection combined with medical oncological therapies, life expectancy dramatically increased in low-grade glioma (LGG), with an overall survival currently over 15 years. Therefore, patients should be able to maintain valuable family and socio-professional activities.Areas covered: For many decades, cognitive and emotional aspects were neglected by surgical and medical neurooncologists. The goal of surgery was to avoid hemiplegia and/or aphasia, with no considerations regarding behavior. However, because LGG patients live longer, they must be cognitively and affectively able to make long-term projects. Preservation of higher-order functions should be considered systematically in LGG surgery by means of awake cognitive/emotional mapping and monitoring.Expert opinion: The aim is to incorporate recent advances in neurosciences, which proposed revisited models of cerebral processing relying on a meta-network perspective, into the pre-, intra- and postoperative procedure. In this connectomal approach, brain functions result from complex interactions within and between neural networks. This improved understanding of a constant instability of the neural system allows a better cognitive/emotional assessment before and after each treatment over years, in order to preserve personality and adaptive behavior for each LGG patient, based on his/her own definition of quality of life. It is time to create oncological neurosciences.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery Gui De Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1191 Laboratory Team "Brain Plasticity, Stem Cells and Low-Grade Gliomas", Institute of Functional Genomic, University of Montpellier, Montpellier, France
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16
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Bu L, Lu J, Zhang J, Wu J. Intraoperative Cognitive Mapping Tasks for Direct Electrical Stimulation in Clinical and Neuroscientific Contexts. Front Hum Neurosci 2021; 15:612891. [PMID: 33762913 PMCID: PMC7982856 DOI: 10.3389/fnhum.2021.612891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Direct electrical stimulation (DES) has been widely applied in both guidance of lesion resection and scientific research; however, the design and selection of intraoperative cognitive mapping tasks have not been updated in a very long time. We introduce updated mapping tasks for language and non-language functions and provide recommendations for optimal design and selection of intraoperative mapping tasks. In addition, with DES becoming more critical in current neuroscientific research, a task design that has not been widely used in DES yet (subtraction and conjunction paradigms) was introduced for more delicate mapping of brain functions especially for research purposes. We also illustrate the importance of designing a common task series for DES and other non-invasive mapping techniques. This review gives practical updated guidelines for advanced application of DES in clinical and neuroscientific research.
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Affiliation(s)
- Linghao Bu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China.,Zhangjiang Lab, Institute of Brain-Intelligence Technology, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Junfeng Lu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China.,Zhangjiang Lab, Institute of Brain-Intelligence Technology, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Jie Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China.,Zhangjiang Lab, Institute of Brain-Intelligence Technology, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China.,Zhangjiang Lab, Institute of Brain-Intelligence Technology, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
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17
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Executive functional deficits during electrical stimulation of the right frontal aslant tract. Brain Imaging Behav 2021; 15:2731-2735. [PMID: 33462780 PMCID: PMC8500906 DOI: 10.1007/s11682-020-00439-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 10/29/2022]
Abstract
Direct electrical stimulation mapping was used to map executive functions during awake surgery of a patient with a right frontal low-grade glioma. We specifically targeted the frontal aslant tract, as this pathway had been infiltrated by the tumor. The right frontal aslant tract has been implicated in executive functions in the neuroscientific literature, but is yet of unknown relevance for clinical practice. Guided by tractography, electrical stimulation of the frontal aslant tract disrupted working memory and inhibitory functions. In this report we illustrate the dilemmas that neurosurgeons face when balancing maximal tumor resection against optimal cognitive performance. In particular, we emphasize that intraoperative tasks that target cognitive functions should be carefully introduced in clinical practice to prevent clinically irrelevant responses and too early termination of the resection.
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18
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Mandonnet E, Vincent M, Valero-Cabré A, Facque V, Barberis M, Bonnetblanc F, Rheault F, Volle E, Descoteaux M, Margulies DS. Network-level causal analysis of set-shifting during trail making test part B: A multimodal analysis of a glioma surgery case. Cortex 2020; 132:238-249. [PMID: 33007639 DOI: 10.1016/j.cortex.2020.08.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/18/2020] [Accepted: 08/24/2020] [Indexed: 02/04/2023]
Abstract
The trail making test part B (TMT-B) is one of the most widely used task for the assessment of set-shifting ability in patients. However, the set of brain regions impacting TMT-B performance when lesioned is still poorly known. In this case report, we provide a multimodal analysis of a patient operated on while awake for a diffuse low-grade glioma located in the right supramarginal gyrus. TMT-B performance was probed intraoperatively. Direct electrical stimulation of the white matter in the depth of the resection generated shifting errors. Using the recent methodology of axono-cortical-evoked potentials (ACEP), we demonstrated that the eloquent fibers were connected to the posterior end of the middle temporal gyrus (MTG). This was further confirmed by a tractography analysis of the postoperative diffusion MRI. Finally, the functional connectivity maps of this MTG seed were assessed in both pre- and post-operative resting state MRI. These maps matched with the Control network B (13th) and Default B (17th) from the 17-networks parcellation of (Yeo et al., 2011). Last but not least, we showed that the dorsal attention B (6th), the control A & B networks (12th and 13th) and the default A (16th) have been preserved here but disconnected after a more extensive resection in a previous glioma case within the same area, and in whom TMT-B was definitively impaired. Taken together, these data support the need of a network-level approach to identify the neural basis of the TMT-B and point to the Control network B as playing an important role in set-shifting.
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Affiliation(s)
- Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France; University Paris 7, Paris, France; Frontlab, CNRS UMR 7225, Inserm U1127, Sorbonne Université ICM, Paris, France.
| | - Marion Vincent
- University of Lille, CNRS, CHU Lille, UMR 9193, SCALab - Affectives and Cognitives Sciences Lab, Lille, France; INRIA, University of Montpellier, LIRMM, CAMIN Team, Montpellier, France
| | - Antoni Valero-Cabré
- Frontlab, CNRS UMR 7225, Inserm U1127, Sorbonne Université ICM, Paris, France; Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, Catalunya, Spain
| | - Valentine Facque
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France; Frontlab, CNRS UMR 7225, Inserm U1127, Sorbonne Université ICM, Paris, France
| | - Marion Barberis
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France
| | | | - François Rheault
- Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, Catalunya, Spain
| | - Emmanuelle Volle
- Frontlab, CNRS UMR 7225, Inserm U1127, Sorbonne Université ICM, Paris, France
| | - Maxime Descoteaux
- Sherbrook Connectivity Imaging Lab, Department of Computer Science, Faculty of Sciences, Université de Sherbrook, Sherbrook, Canada
| | - Daniel S Margulies
- Frontlab, CNRS UMR 7225, Inserm U1127, Sorbonne Université ICM, Paris, France
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