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Colgan DD, Eddy A, Aulet-Leon M, Green K, Peters B, Shangraw R, Han SJ, Raslan A, Oken B. Compassion, communication, and the perception of control: a mixed methods study to investigate patients' perspectives on clinical practices for alleviating distress and promoting empowerment during awake craniotomies. Br J Neurosurg 2024; 38:911-922. [PMID: 34850642 PMCID: PMC9156730 DOI: 10.1080/02688697.2021.2005773] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/26/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To inquire into clinical practices perceived to mitigate patients' intraoperative distress during awake craniotomies. METHODS This mixed-methods study involved administration of Amsterdam Preoperative Anxiety and Information Scale and PTSD Checklist prior to the awake craniotomy to evaluate anxiety and information-seeking related to the procedure and symptoms of PTSD. Generalized Anxiety Disorder Scale and Depression Module of the Patient Health Questionnaire were administered before and after the procedure to evaluate generalized anxiety and depression. Patient interviews were conducted 2-weeks postprocedure and included a novel set of patient experience scales to assess patients' recollection of intraoperative pain, overall distress, anxiety, distress due to noise, perception of empowerment, perception of being well-prepared, overall satisfaction with anaesthesia management, and overall satisfaction with the procedure. Qualitative data were analysed using conventional content analysis. RESULTS Participants (n = 14) had undergone an awake craniotomy for tissue resection due to primary brain tumours or medically-refractory focal epilepsy. Validated self-report questionnaires demonstrated reduced levels of generalized anxiety (pre mean = 8.66; SD = 6.41; post mean= 4.36; SD = 4.24) following the awake craniotomy. Postprocedure interviews revealed very high satisfaction with the awake craniotomy and anaesthesia management and minimal levels of intraoperative pain, anxiety, and distress. The most stressful aspects of the procedure included global recognition of medical diagnosis, anxiety provoked by unfamiliar sights, sounds, and sensations, a perception of a lack of information or misinformation, and long periods of immobility. Important factors in alleviating intraoperative distress included the medical team's ability to promote patient perceptions of control, establish compassionate relationships, address unfamiliar intraoperative sensations, and deliver effective anaesthesia management. CONCLUSION Compassion, communication, and patient perception of control were critical in mitigating intraoperative distress. Clinical practice recommendations with implications for all clinicians involved in patient care during awake craniotomies are provided. Use of these interventions and strategies to reduce distress are important to holistic patient care and patient experiences of care and may improve the likelihood of optimal brain mapping procedures to improve clinical outcomes during awake craniotomies.
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Affiliation(s)
| | - Ashely Eddy
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | | | - Kaylie Green
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Betts Peters
- Institute on Development & Disability, Oregon Health and Science University, Portland, OR, USA
| | - Robert Shangraw
- Department of Anaesthesiology and Perioperative Medicine, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Ahmed Raslan
- Neurosurgery Department, Oregon Health and Science University, Portland, OR, USA
| | - Barry Oken
- Neurology Department, Oregon Health and Science University, Portland, OR, USA
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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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Yang X, Zhang X, Lin P, Liu Z, Deng S, Liang S, Zhu X, Qiao Q, Chen Q. Effect of dexmedetomidine on somatosensory- and motor-evoked potentials in patients receiving craniotomy under propofol-sevoflurane combined anesthesia. Front Surg 2024; 11:1386049. [PMID: 39045089 PMCID: PMC11263188 DOI: 10.3389/fsurg.2024.1386049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/19/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction Dexmedetomidine is often used as an adjunct to total intravenous anesthesia (TIVA) for procedures requiring intraoperative neurophysiologic monitoring (IONM). However, it has been reported that dexmedetomidine might mask the warning of a neurological deficit on intraoperative monitoring. Methods We reviewed the intraoperative neurophysiological monitoring data of 47 patients who underwent surgery and IONM from March 2019 to March 2021 at the Department of Neurosurgery, Renmin Hospital of Wuhan University. Pre- and postoperative motor function scores were recorded and analyzed. Dexmedetomidine was administered intravenously at 0.5 μg/kg/h 40 min after anesthesia and discontinued after 1 h in the dexmedetomidine group. Results We found that the amplitude of transcranial motor-evoked potentials (Tce-MEPs) was significantly lower in the dexmedetomidine group than in the negative control group (P < 0.0001). There was no statistically significant difference in the somatosensory-evoked potentials (SSEPs) amplitude or the Tce-MEPs or SSEPs latency. There was no significant decrease in postoperative motor function in the dexmedetomidine group compared with the preoperative group, suggesting that there is no evidence that dexmedetomidine affects patient prognosis. In addition, we noticed a synchronized bilateral decrease in the Tce-MEPs amplitude in the dexmedetomidine group and a mostly unilateral decrease on the side of the brain injury in the positive control group (P = 0.001). Discussion Although dexmedetomidine does not affect the prognosis of patients undergoing craniotomy, the potential risks and benefits of applying it as an adjunctive medication during craniotomy should be carefully evaluated. When dexmedetomidine is administered, Tce-MEPs should be monitored. When a decrease in the Tce-MEPs amplitude is detected, the cause of the decrease in the MEPs amplitude can be indirectly determined by whether the decrease is bilateral.
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Affiliation(s)
- Xue Yang
- Department of Neurosurgery, Wuhan University Renmin Hospital, Wuhan, China
| | - Xinyi Zhang
- Department of Neurosurgery, Wuhan University Renmin Hospital, Wuhan, China
| | - Puxuan Lin
- Department of Neurosurgery, Wuhan University Renmin Hospital, Wuhan, China
| | - Zeheng Liu
- Department of Neurosurgery, Wuhan University Renmin Hospital, Wuhan, China
| | - Shuhang Deng
- Department of Neurosurgery, Wuhan University Renmin Hospital, Wuhan, China
| | - Shanwen Liang
- Department of Neurosurgery, Wuhan University Renmin Hospital, Wuhan, China
| | - Xinyi Zhu
- Department of Neurosurgery, Wuhan University Renmin Hospital, Wuhan, China
| | - Qianqian Qiao
- Department of Anesthesiology, Wuhan University Renmin Hospital, Wuhan, China
| | - Qianxue Chen
- Department of Neurosurgery, Wuhan University Renmin Hospital, Wuhan, China
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Hamer RP, Praeger AJ. Facilitating complete resection of intrinsic motor cortex glioma with titration of high-frequency cortico-subcortical mapping train count informed by navigated transcranial magnetic stimulation: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 8:CASE24197. [PMID: 38976917 DOI: 10.3171/case24197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/18/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The dilemma of neuro-oncological surgery involving suspected eloquent cortex is to maximize the extent of resection while minimizing neurological morbidity, referred to as the "onco-functional balance." Diffuse lower-grade gliomas are capable of infiltrating or displacing neural function within cortical regions and subcortical white matter tracts, which can render classical anatomic associations of eloquent function misleading. OBSERVATIONS This study employed presurgical navigated transcranial magnetic stimulation (nTMS) to determine the motor eloquence of a diffuse lower-grade glioma at the superior frontal gyrus extending and intrinsic to the primary motor cortex in a 45-year-old female. Positive nTMS findings were confirmed intraoperatively with high-frequency direct cortico-subcortical stimulation (HF-DCS). Modification of the HF-DCS train count from train-of-five to train-of-two permitted resection beyond classic anatomical boundaries and conventional HF-DCS safe stopping criteria. LESSONS Anatomical correlates of function can inaccurately inform the surgical management of diffuse lower-grade glioma, which represents the utmost opportunity for progression-free survival. Integrating an individually tailored nTMS-DCS surgical strategy contributed to complete resection, negating the requirement for adjuvant therapy. Serial nTMS follow-up may assist with the characterization of tumor-induced functional reorganization. https://thejns.org/doi/10.3171/CASE24197.
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Affiliation(s)
- Ryan P Hamer
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine & Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian J Praeger
- Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia and
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Udayakumaran S, Karthika KS, Nair NS, George M, Gopinath S. Prognostication of the neurological outcome of tethered cord based on intraoperative neuromonitoring findings: how close can we get? Br J Neurosurg 2024; 38:604-612. [PMID: 34459322 DOI: 10.1080/02688697.2021.1940855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the correlation of intraoperative neuromonitoring (IONM) data in surgery for tethered cord syndrome (TCS) in children to the neurological outcome at 1-year follow-up. METHODS 208 consecutive patients operated on for TCS, between January 2011 to February 2020, under electrophysiological monitoring in the Division of Paediatric Neurosurgery, AIMS, Kochi, India, were included. Their preoperative neurological, urological and orthopaedic status were compared with the postoperative status at 1 year follow-up. RESULTS Our study prospectively collected the IONM data and retrospectively correlated it to the children's neurological outcome on follow-up. Out of 208 children, 28% (n = 59/208) had motor, 35% (n = 73/208) had bladder and 26% (n = 54/208) had bowel disturbances. Postsurgery, at one-year follow-up, 91% (n = 52/57) of the patients who had motor deficits had improvement, 82.3% (n = 51/62) of patients who had bladder deficits showed an improvement, and 88.8% (n = 48/54) with bowel deficits showed improvement. The monitorability for motor and sphincter potentials were 99.4% and 89.3%, respectively. Except for four patients (3 with bladder and 1 with motor worsening), all the patients who were monitorable with no deficits remained intact except for four patients, all the patients who had deficits and were monitorable improved after detethering (at 1 year). Clinical worsening corresponded to those who had a drop in amplitude of baseline TcMEP (n = 4). 18 events showed an increase in amplitude compared to the baseline TcMEP. These patients improved clinically on follow-up (at 1 year). CONCLUSIONS IONM complements the preoperative clinical details in predicting immediate and long-term outcomes.
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Affiliation(s)
- Suhas Udayakumaran
- Division of Paediatric Neurosurgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - K S Karthika
- Division of Paediatric Neurosurgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - Nivedita S Nair
- Department of Neurology, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - Mathew George
- Department of Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | - Siby Gopinath
- Department of Neurology, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
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Abu Mhanna HY, Omar AF, Radzi YM, Oglat AA, Akhdar HF, Ewaidat HA, Almahmoud A, Badarneh LA, Malkawi AA, Malkawi A. Systematic Review Between Resting-State fMRI and Task fMRI in Planning for Brain Tumour Surgery. J Multidiscip Healthc 2024; 17:2409-2424. [PMID: 38784380 PMCID: PMC11111578 DOI: 10.2147/jmdh.s470809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
As an alternative to task-based functional magnetic resonance imaging (T-fMRI), resting-state functional magnetic resonance imaging (Rs-fMRI) is suggested for preoperative mapping of patients with brain tumours, with an emphasis on treatment guidance and neurodegeneration prediction. A systematic review was conducted of 18 recent studies involving 1035 patients with brain tumours and Rs-fMRI protocols. This was accomplished by searching the electronic databases PubMed, Scopus, and Web of Science. For clinical benefit, we compared Rs-fMRI to standard T-fMRI and intraoperative direct cortical stimulation (DCS). The results of Rs-fMRI and T-fMRI were compared and their correlation with intraoperative DCS results was examined through a systematic review. Our exhaustive investigation demonstrated that Rs-fMRI is a dependable and sensitive preoperative mapping technique that detects neural networks in the brain with precision and identifies crucial functional regions in agreement with intraoperative DCS. Rs-fMRI comes in handy, especially in situations where T-fMRI proves to be difficult because of patient-specific factors. Additionally, our exhaustive investigation demonstrated that Rs-fMRI is a valuable tool in the preoperative screening and evaluation of brain tumours. Furthermore, its capability to assess brain function, forecast surgical results, and enhance decision-making may render it applicable in the clinical management of brain tumours.
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Affiliation(s)
| | - Ahmad Fairuz Omar
- School of Physics, Universiti Sains Malaysia (USM), Penang, 11800, Malaysia
| | - Yasmin Md Radzi
- School of Physics, Universiti Sains Malaysia (USM), Penang, 11800, Malaysia
| | - Ammar A Oglat
- Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, 13133, Jordan
| | - Hanan Fawaz Akhdar
- Physics Department, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 13318, Saudi Arabia
| | - Haytham Al Ewaidat
- Department of Allied Medical Sciences-Radiologic Technology, Jordan University of Science and Technology (J.U.S.T), Irbid, 22110, Jordan
| | - Abdallah Almahmoud
- Department of Allied Medical Sciences-Radiologic Technology, Jordan University of Science and Technology (J.U.S.T), Irbid, 22110, Jordan
| | - Laith Al Badarneh
- School of Physics, Universiti Sains Malaysia (USM), Penang, 11800, Malaysia
| | | | - Ahmed Malkawi
- Business Department, Al-Zaytoonah University, Amman, 594, Jordan
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Adkins G, Mirallave Pescador A, Koht A, Gosavi S. Intraoperative neuromonitoring in intracranial surgery. BJA Educ 2024; 24:173-182. [PMID: 38646449 PMCID: PMC11026914 DOI: 10.1016/j.bjae.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 04/23/2024] Open
Affiliation(s)
- G.B. Adkins
- South East School of Anaesthesia, London, UK
| | | | - A.H. Koht
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Ille S, Zhang H, Stassen N, Schwendner M, Schröder A, Wiestler B, Meyer B, Krieg SM. Noninvasive- and invasive mapping reveals similar language network centralities - A function-based connectome analysis. Cortex 2024; 174:189-200. [PMID: 38569257 DOI: 10.1016/j.cortex.2024.01.013] [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: 06/14/2023] [Revised: 09/11/2023] [Accepted: 01/23/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Former comparisons between direct cortical stimulation (DCS) and navigated transcranial magnetic stimulation (nTMS) only focused on cortical mapping. While both can be combined with diffusion tensor imaging, their differences in the visualization of subcortical and even network levels remain unclear. Network centrality is an essential parameter in network analysis to measure the importance of nodes identified by mapping. Those include Degree centrality, Eigenvector centrality, Closeness centrality, Betweenness centrality, and PageRank centrality. While DCS and nTMS have repeatedly been compared on the cortical level, the underlying network identified by both has not been investigated yet. METHOD 27 patients with brain lesions necessitating preoperative nTMS and intraoperative DCS language mapping during awake craniotomy were enrolled. Function-based connectome analysis was performed based on the cortical nodes obtained through the two mapping methods, and language-related network centralities were compared. RESULTS Compared with DCS language mapping, the positive predictive value of cortical nTMS language mapping is 74.1%, with good consistency of tractography for the arcuate fascicle and superior longitudinal fascicle. Moreover, network centralities did not differ between the two mapping methods. However, ventral stream tracts can be better traced based on nTMS mappings, demonstrating its strengths in acquiring language-related networks. In addition, it showed lower centralities than other brain areas, with decentralization as an indicator of language function loss. CONCLUSION This study deepens the understanding of language-related functional anatomy and proves that non-invasive mapping-based network analysis is comparable to the language network identified via invasive cortical mapping.
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Affiliation(s)
- Sebastian Ille
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany; TUM-Neuroimaging Center, Technical University of Munich, Munich, Germany; Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - Haosu Zhang
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany; Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - Nina Stassen
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.
| | - Maximilian Schwendner
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany; Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - Axel Schröder
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany; TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Munich, Germany.
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany; TUM-Neuroimaging Center, Technical University of Munich, Munich, Germany; Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
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Tchoe Y, Wu T, U HS, Roth DM, Kim D, Lee J, Cleary DR, Pizarro P, Tonsfeldt KJ, Lee K, Chen PC, Bourhis AM, Galton I, Coughlin B, Yang JC, Paulk AC, Halgren E, Cash SS, Dayeh SA. An electroencephalogram microdisplay to visualize neuronal activity on the brain surface. Sci Transl Med 2024; 16:eadj7257. [PMID: 38657026 PMCID: PMC11093107 DOI: 10.1126/scitranslmed.adj7257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
Functional mapping during brain surgery is applied to define brain areas that control critical functions and cannot be removed. Currently, these procedures rely on verbal interactions between the neurosurgeon and electrophysiologist, which can be time-consuming. In addition, the electrode grids that are used to measure brain activity and to identify the boundaries of pathological versus functional brain regions have low resolution and limited conformity to the brain surface. Here, we present the development of an intracranial electroencephalogram (iEEG)-microdisplay that consists of freestanding arrays of 2048 GaN light-emitting diodes laminated on the back of micro-electrocorticography electrode grids. With a series of proof-of-concept experiments in rats and pigs, we demonstrate that these iEEG-microdisplays allowed us to perform real-time iEEG recordings and display cortical activities by spatially corresponding light patterns on the surface of the brain in the surgical field. Furthermore, iEEG-microdisplays allowed us to identify and display cortical landmarks and pathological activities from rat and pig models. Using a dual-color iEEG-microdisplay, we demonstrated coregistration of the functional cortical boundaries with one color and displayed the evolution of electrical potentials associated with epileptiform activity with another color. The iEEG-microdisplay holds promise to facilitate monitoring of pathological brain activity in clinical settings.
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Affiliation(s)
- Youngbin Tchoe
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan 44919, Korea
| | - Tianhai Wu
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Hoi Sang U
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - David M Roth
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
- Department of Anesthesiology, University of California, San Diego, La Jolla, CA 92093, USA
| | - Dongwoo Kim
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Jihwan Lee
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Daniel R Cleary
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
- Center for the Future of Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA 92093, USA
- Department of Neurological Surgery, University of California, San Diego, La Jolla, CA 92093, USA
| | - Patricia Pizarro
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
- Department of Neurological Surgery, Oregon Health & Science University, Mail code CH8N, 3303 SW Bond Avenue, Portland, OR 97239, USA
| | - Karen J Tonsfeldt
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Science and Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Keundong Lee
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Po Chun Chen
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Andrew M Bourhis
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Ian Galton
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Brian Coughlin
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Jimmy C Yang
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Neurological Surgery, Ohio State University, Columbus, OH 43210, USA
| | - Angelique C Paulk
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Eric Halgren
- Department of Neurological Surgery, University of California, San Diego, La Jolla, CA 92093, USA
| | - Sydney S Cash
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Shadi A Dayeh
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA 92093, USA
- Departments of Radiology and Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
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Ahmed Khan R, Rahman MM, Ziauddin M, Chowdhury M, Hasan M. Awake brain mapping by direct cortical stimulation; technical note to get higher resection rate and low morbidity in low-grade glioma patients. Ann Med Surg (Lond) 2024; 86:1861-1866. [PMID: 38576956 PMCID: PMC10990364 DOI: 10.1097/ms9.0000000000001837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/02/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Direct cortical stimulation has been used for brain mapping and localization of eloquent areas in awake patients. This simplified technique is to provide the positive areas, which can be preserved if the tumor or lesions are involved eloquent areas. Objective The main objective of this study is to determine whether direct cortical stimulation in awake brain mapping for low-grade glioma patients increases the rate of resection or not. Method The authors present a retrospective study between 2020 to 2022 that includes 35 cases in a single center, to get higher resection rate, and their consequences in awake craniotomy in low-grade glioma patients. Here, two neurosurgeons were involved and the minimum follow-up was 12 months. Results The authors achieved 80% removal of tumors. To get higher resection rate we emphasized negative mapping with prior anatomical analysis to understand functional realignment. Stimulation-related complications will be thoroughly discussed with a potential future direction to minimize the issues. The authors used PROMIS score to measure patients physical and mental health status and kernofsky score to measure performance status before and after successful surgery. The authors found three cases of transient deficit in repetitive stimulation. Repeated stimulation to identify the eloquent areas with low voltage frequency is a good option. Numbness in the face related to stimulation may continue for 6 weeks. Conclusion Functional realignment in shifted brain and edema can be seen while doing cortical and subcortical stimulation. Most of the stimulation from low to high for language mapping may vary from patient to patient. For safe removal of low-grade glioma a steep learning curve is needed to find out the negative areas, though the authors emphasize positive mapping of areas to secure the maximum eloquence.
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Affiliation(s)
| | | | - Md. Ziauddin
- Neurosurgery Department, National Institute of Neuroscience and Hospital
| | | | - Mahbub Hasan
- Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka, Bangladesh
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11
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van Ierschot FC, Veenstra W, Miozzo A, Santini B, Jeltema HR, Spena G, Miceli G. Written language preservation in glioma patients undergoing awake surgery: The value of tailored intra-operative assessment. J Neuropsychol 2024; 18 Suppl 1:205-229. [PMID: 37840529 DOI: 10.1111/jnp.12349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023]
Abstract
Written language is increasingly important, as contemporary society strongly relies on text-based communication. Nonetheless, in neurosurgical practice, language preservation has classically focused on spoken language. The current study aimed to evaluate the potential role of intra-operative assessments in the preservation of written language skills in glioma patients undergoing awake surgery. It is the first feasibility study to use a standardized and detailed Written language battery in glioma patients undergoing awakening surgery. Reading and spelling were assessed pre- and post-operatively in eleven patients. Intra-operatively, 7 cases underwent written language assessment in addition to spoken object naming. Results show that reading and spelling deficits may arise before and after glioma surgery and that written language may be differently affected than spoken language. In our case series, task-specific preservation of function was obtained in all cases when a specific written language skill was monitored intra-operatively. However, the benefits of intra-operative testing did not always generalize, and non-monitored written language tasks may not be preserved. Hence, when a specific written language skill needs to be preserved, to facilitate return to work and maintain quality of life, results indicate that intra-operative assessment of that skill is advised. An illustrative case report demonstrates how profile analyses can be used pre-operatively to identify cognitive components at risk and intra-operatively to preserve written language abilities in clinical practice.
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Affiliation(s)
- Fleur Céline van Ierschot
- Center for Mind/Brain Sciences (CiMeC), University of Trento, Rovereto, Italy
- International Doctorate for Experimental Approaches to Language and Brain (IDEALAB), Universities of Trento, Groningen, Newcastle, Potsdam and Macquarie University, Trento, Groningen, Newcastle, Potsdam, Sydney, Italy, Netherlands, Australia, Germany, Australia
| | - Wencke Veenstra
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands
| | - Antonio Miozzo
- Centre for Aging Brain and Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Barbara Santini
- Department of Neuroscience, Neurosurgery Clinic, University of Verona, Verona, Italy
| | - Hanne-Rinck Jeltema
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Giannantonio Spena
- Centre for Aging Brain and Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Gabriele Miceli
- Center for Mind/Brain Sciences (CiMeC), University of Trento, Rovereto, Italy
- International Doctorate for Experimental Approaches to Language and Brain (IDEALAB), Universities of Trento, Groningen, Newcastle, Potsdam and Macquarie University, Trento, Groningen, Newcastle, Potsdam, Sydney, Italy, Netherlands, Australia, Germany, Australia
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12
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Toader C, Eva L, Costea D, Corlatescu AD, Covache-Busuioc RA, Bratu BG, Glavan LA, Costin HP, Popa AA, Ciurea AV. Low-Grade Gliomas: Histological Subtypes, Molecular Mechanisms, and Treatment Strategies. Brain Sci 2023; 13:1700. [PMID: 38137148 PMCID: PMC10741942 DOI: 10.3390/brainsci13121700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Low-Grade Gliomas (LGGs) represent a diverse group of brain tumors originating from glial cells, characterized by their unique histopathological and molecular features. This article offers a comprehensive exploration of LGGs, shedding light on their subtypes, histological and molecular aspects. By delving into the World Health Organization's grading system, 5th edition, various specificities were added due to an in-depth understanding of emerging laboratory techniques, especially genomic analysis. Moreover, treatment modalities are extensively discussed. The degree of surgical resection should always be considered according to postoperative quality of life and cognitive status. Adjuvant therapies focused on chemotherapy and radiotherapy depend on tumor grading and invasiveness. In the current literature, emerging targeted molecular therapies are well discussed due to their succinctly therapeutic effect; in our article, those therapies are summarized based on posttreatment results and possible adverse effects. This review serves as a valuable resource for clinicians, researchers, and medical professionals aiming to deepen their knowledge on LGGs and enhance patient care.
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Affiliation(s)
- Corneliu Toader
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania
| | - Lucian Eva
- Department of Neurosurgery, Dunarea de Jos University, 800010 Galati, Romania
- Department of Neurosurgery, Clinical Emergency Hospital “Prof. Dr. Nicolae Oblu”, 700309 Iasi, Romania
| | - Daniel Costea
- Department of Neurosurgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Antonio Daniel Corlatescu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
| | - Luca Andrei Glavan
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
| | - Horia Petre Costin
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
| | - Andrei Adrian Popa
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (A.D.C.); (R.-A.C.-B.); (B.-G.B.); (L.A.G.); (H.P.C.); (A.A.P.); (A.V.C.)
- Neurosurgery Department, Sanador Clinical Hospital, 010991 Bucharest, Romania
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13
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Rammeloo E, Schouten JW, Krikour K, Bos EM, Berger MS, Nahed BV, Vincent AJPE, Gerritsen JKW. Preoperative assessment of eloquence in neurosurgery: a systematic review. J Neurooncol 2023; 165:413-430. [PMID: 38095774 DOI: 10.1007/s11060-023-04509-x] [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: 08/23/2023] [Accepted: 11/12/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Tumor location and eloquence are two crucial preoperative factors when deciding on the optimal treatment choice in glioma management. Consensus is currently lacking regarding the preoperative assessment and definition of eloquent areas. This systematic review aims to evaluate the existing definitions and assessment methods of eloquent areas that are used in current clinical practice. METHODS A computer-aided search of Embase, Medline (OvidSP), and Google Scholar was performed to identify relevant studies. This review includes articles describing preoperative definitions of eloquence in the study's Methods section. These definitions were compared and categorized by anatomical structure. Additionally, various techniques to preoperatively assess tumor eloquence were extracted, along with their benefits, drawbacks and ease of use. RESULTS This review covers 98 articles including 12,714 participants. Evaluation of these studies indicated considerable variability in defining eloquence. Categorization of these definitions yielded a list of 32 brain regions that were considered eloquent. The most commonly used methods to preoperatively determine tumor eloquence were anatomical classification systems and structural MRI, followed by DTI-FT, functional MRI and nTMS. CONCLUSIONS There were major differences in the definitions and assessment methods of eloquence, and none of them proved to be satisfactory to express eloquence as an objective, quantifiable, preoperative factor to use in glioma decision making. Therefore, we propose the development of a novel, objective, reliable, preoperative classification system to assess eloquence. This should in the future aid neurosurgeons in their preoperative decision making to facilitate personalized treatment paradigms and to improve surgical outcomes.
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Affiliation(s)
- Emma Rammeloo
- Department of Neurosurgery, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Joost Willem Schouten
- Department of Neurosurgery, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Keghart Krikour
- Department of Neurosurgery, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Eelke Marijn Bos
- Department of Neurosurgery, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Mitchel Stuart Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Brian Vala Nahed
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Jasper Kees Wim Gerritsen
- Department of Neurosurgery, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Vigren P, Eriksson M, Gauffin H, Duffau H, Milos P, Eek T, Dizdar N. Awake craniotomy in epilepsy surgery includes previously inoperable patients with preserved efficiency and safety. Int J Neurosci 2023:1-6. [PMID: 37929598 DOI: 10.1080/00207454.2023.2279498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
Introduction: Whilst awake craniotomy has been widely used historically in epilepsy surgery, the safety and efficacy of this approach in epilepsy surgery has been sparsely investigated in controlled studies. The objective of this study is to investigate the safety and efficacy of awake resection in epilepsy surgery and focuses on the possibility to widen surgical indications with awake surgery. Methods: Fifteen patients operated with awake epilepsy surgery were compared to 30 matched controls undergoing conventional/asleep epilepsy surgery. The groups were compared with regard to neurological complications, seizure control and location of resection. Results: Regarding seizure control, 86% of patients in the awake group reached Engel grade 1-2 compared to 73% in the control group, operated with conventional/asleep surgery, not a statistically significant difference. Neither was there a statistical significant difference regarding postoperative neurological complications. However, there was a significant difference in location of the resection when comparing the two groups. Of the 15 patients operated with awake intraoperative mapping, four had previously been considered as non-operable by epilepsy surgery centres, due to vicinity to eloquent brain regions and predicted risk of post-operative neurological deficits. Discussion: The results show that awake epilepsy surgery yields similar level of seizure control when compared to conventional asleep surgery, with maintained safety in regard to neurological complications. Furthermore, the results indicate that awake craniotomy in epilepsy surgery is feasible and possible in patients otherwise regarded as inoperable with epileptigenic zone in proximity to eloquent brain structures.
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Affiliation(s)
- Patrick Vigren
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Neurosurgery, Region Östergötland, Östergötland, Sweden
- Department of Neurology, Region Östergötland, Östergötland, Sweden
- Department of Neurosurgery, Region Örebro Län, Örebro Län, Sweden
| | - Martin Eriksson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Neurosurgery, Region Östergötland, Östergötland, Sweden
| | - Helena Gauffin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Neurology, Region Östergötland, Östergötland, Sweden
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Peter Milos
- Department of Neurosurgery, Region Östergötland, Östergötland, Sweden
| | - Tom Eek
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Neurology, Region Östergötland, Östergötland, Sweden
| | - Nil Dizdar
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Neurology, Region Östergötland, Östergötland, Sweden
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15
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Mofatteh M, Mashayekhi MS, Arfaie S, Wei H, Kazerouni A, Skandalakis GP, Pour-Rashidi A, Baiad A, Elkaim L, Lam J, Palmisciano P, Su X, Liao X, Das S, Ashkan K, Cohen-Gadol AA. Awake craniotomy during pregnancy: A systematic review of the published literature. Neurosurg Rev 2023; 46:290. [PMID: 37910275 PMCID: PMC10620271 DOI: 10.1007/s10143-023-02187-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Abstract
Neurosurgical pathologies in pregnancy pose significant complications for the patient and fetus, and physiological stressors during anesthesia and surgery may lead to maternal and fetal complications. Awake craniotomy (AC) can preserve neurological functions while reducing exposure to anesthetic medications. We reviewed the literature investigating AC during pregnancy. PubMed, Scopus, and Web of Science databases were searched from the inception to February 7th, 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Studies in English investigating AC in pregnant patients were included in the final analysis. Nine studies composed of nine pregnant patients and ten fetuses (one twin-gestating patient) were included. Glioma was the most common pathology reported in six (66.7%) patients. The frontal lobe was the most involved region (4 cases, 44.4%), followed by the frontoparietal region (2 cases, 22.2%). The awake-awake-awake approach was the most common protocol in seven (77.8%) studies. The shortest operation time was two hours, whereas the longest one was eight hours and 29 min. The mean gestational age at diagnosis was 13.6 ± 6.5 (2-22) and 19.6 ± 6.9 (9-30) weeks at craniotomy. Seven (77.8%) studies employed intraoperative fetal heart rate monitoring. None of the AC procedures was converted to general anesthesia. Ten healthy babies were delivered from patients who underwent AC. In experienced hands, AC for resection of cranial lesions of eloquent areas in pregnant patients is safe and feasible and does not alter the pregnancy outcome.
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Affiliation(s)
- Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
- Neuro International Collaboration (NIC), London, UK.
| | - Mohammad Sadegh Mashayekhi
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Neuro International Collaboration (NIC), Ottawa, ON, Canada
| | - Saman Arfaie
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA
- Neuro International Collaboration (NIC), Montreal, QC, Canada
| | - Hongquan Wei
- Department of 120 Emergency Command Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Arshia Kazerouni
- Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Georgios P Skandalakis
- First Department of Neurosurgery, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ahmad Pour-Rashidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abed Baiad
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Lior Elkaim
- Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Jack Lam
- Department of 120 Emergency Command Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | | | - Xiumei Su
- Obstetrical Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuxing Liao
- Department of Neurosurgery, Foshan Sanshui District People's Hospital, Foshan, China
- Department of Surgery of Cerebrovascular Diseases, Foshan First People's Hospital, Foshan, China
| | - Sunit Das
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Keyoumars Ashkan
- Neuro International Collaboration (NIC), London, UK
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- King's Health Partners Academic Health Sciences Centre, London, UK
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Aaron A Cohen-Gadol
- The Neurosurgical Atlas, Carmel, IN, USA
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, USA
- Neuro International Collaboration, Indianapolis, IN, USA
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Freund BE, Sherman WJ, Sabsevitz DS, Middlebrooks EH, Feyissa AM, Garcia DM, Grewal SS, Chaichana KL, Quinones-Hinojosa A, Tatum WO. Can we improve electrocorticography using a circular grid array in brain tumor surgery? Biomed Phys Eng Express 2023; 9:065027. [PMID: 37871586 DOI: 10.1088/2057-1976/ad05dd] [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: 05/21/2023] [Accepted: 10/23/2023] [Indexed: 10/25/2023]
Abstract
Intraoperative electrocorticography (iECoG) is used as an adjunct to localize the epileptogenic zone during surgical resection of brain tumors in patients with focal epilepsies. It also enables monitoring of after-discharges and seizures with EEG during functional brain mapping with electrical stimulation. When seizures or after-discharges are present, they complicate accurate interpretation of the mapping strategy to outline the brain's eloquent function and can affect the surgical procedure. Recurrent seizures during surgery requires urgent treatment and, when occurring during awake craniotomy, often leads to premature termination of brain mapping due to post-ictal confusion or sedation from acute rescue therapy. There are mixed results in studies on efficacy with iECoG in patients with epilepsy and brain tumors influencing survival and functional outcomes following surgery. Commercially available electrode arrays have inherent limitations. These could be improved with customization potentially leading to greater precision in safe and maximal resection of brain tumors. Few studies have assessed customized electrode grid designs as an alternative to commercially available products. Higher density electrode grids with intercontact distances less than 1 cm improve spatial delineation of electrophysiologic sources, including epileptiform activity, electrographic seizures, and afterdischarges on iECoG during functional brain mapping. In response to the shortcomings of current iECoG grid technologies, we designed and developed a novel higher-density hollow circular electrode grid array. The 360-degree iECoG monitoring capability allows continuous EEG recording during surgical intervention through the aperture with and without electrical stimulation mapping. Compared with linear strip electrodes that are commonly used for iECoG during surgery, the circular grid demonstrates significant benefits in brain tumor surgery. This includes quicker recovery of post-operative motor deficits (2.4 days versus 9 days, p = 0.05), more extensive tumor resection (92.0% versus 77.6%, p = 0.003), lesser reduction in Karnofsky Performance scale postoperatively (-2 versus -11.6, p = 0.007), and more sensitivity to recording afterdischarges. In this narrative review, we discuss the advantages and disadvantages of commercially available recording devices in the operating room and focus on the usefulness of the higher-density circular grid.
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Affiliation(s)
- Brin E Freund
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Wendy J Sherman
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - David S Sabsevitz
- Department of Psychiatry, Division of Neuropsychology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Erik H Middlebrooks
- Department of Radiology, Division of Neuroradiology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Anteneh M Feyissa
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Diogo Moniz Garcia
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Sanjeet S Grewal
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Kaisorn L Chaichana
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Alfredo Quinones-Hinojosa
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - William O Tatum
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
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Valdes PA, Ng S, Bernstock JD, Duffau H. Development of an educational method to rethink and learn oncological brain surgery in an "a la carte" connectome-based perspective. Acta Neurochir (Wien) 2023; 165:2489-2500. [PMID: 37199758 DOI: 10.1007/s00701-023-05626-2] [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: 03/31/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Understanding the structural connectivity of white matter tracts (WMT) and their related functions is a prerequisite to implementing an "a la carte" "connectomic approach" to glioma surgery. However, accessible resources facilitating such an approach are lacking. Here we present an educational method that is readily accessible, simple, and reproducible that enables the visualization of WMTs on individual patient images via an atlas-based approach. METHODS Our method uses the patient's own magnetic resonance imaging (MRI) images and consists of three main steps: data conversion, normalization, and visualization; these are accomplished using accessible software packages and WMT atlases. We implement our method on three common cases encountered in glioma surgery: a right supplementary motor area tumor, a left insular tumor, and a left temporal tumor. RESULTS Using patient-specific perioperative MRIs with open-sourced and co-registered atlas-derived WMTs, we highlight the critical subnetworks requiring specific surgical monitoring identified intraoperatively using direct electrostimulation mapping with cognitive monitoring. The aim of this didactic method is to provide the neurosurgical oncology community with an accessible and ready-to-use educational tool, enabling neurosurgeons to improve their knowledge of WMTs and to better learn their oncologic cases, especially in glioma surgery using awake mapping. CONCLUSIONS Taking no more than 3-5 min per patient and irrespective of their resource settings, we believe that this method will enable junior surgeons to develop an intuition, and a robust 3-dimensional imagery of WMT by regularly applying it to their cases both before and after surgery to develop an "a la carte" connectome-based perspective to glioma surgery.
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Affiliation(s)
- Pablo A Valdes
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, 77555, USA.
- Department of Neurosurgery, Hôpital Gui de Chauliac, CHU Montpellier, 80 Av Augustin Fliche, 34295, Montpellier, France.
| | - Sam Ng
- Department of Neurosurgery, Hôpital Gui de Chauliac, CHU Montpellier, 80 Av Augustin Fliche, 34295, Montpellier, France
- Team "Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors", Institute of Functional Genomics, INSERM U1191, University of Montpellier, 141 Rue de la cardonille, 34091, Montpellier, France
| | - Joshua D Bernstock
- Department of Neurosurgery, Harvard Medical School/Brigham and Women's Hospital, Boston, MA, 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, CHU Montpellier, 80 Av Augustin Fliche, 34295, Montpellier, France
- Team "Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors", Institute of Functional Genomics, INSERM U1191, University of Montpellier, 141 Rue de la cardonille, 34091, Montpellier, France
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18
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Wajer IMCH, Kal J, Robe PA, van Zandvoort MJE, Ruis C. Awake craniotomy does not lead to increased psychological complaints. Acta Neurochir (Wien) 2023; 165:2505-2512. [PMID: 37225975 PMCID: PMC10477129 DOI: 10.1007/s00701-023-05615-5] [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: 11/04/2022] [Accepted: 04/20/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Patients with brain tumours are increasingly treated by using the awake craniotomy technique. Some patients may experience anxiety when subjected to brain surgery while being fully conscious. However, there has been only limited research into the extent to which such surgeries actually result in anxiety or other psychological complaints. Previous research suggests that undergoing awake craniotomy surgery does not lead to psychological complaints, and that post-traumatic stress disorders (PTSD) are uncommon following this type of surgery. It must be noted, however, that many of these studies used small random samples. METHOD In the current study, 62 adult patients completed questionnaires to identify the degree to which they experienced anxiety, depressive and post-traumatic stress complaints following awake craniotomy using an awake-awake-awake procedure. All patients were cognitively monitored and received coaching by a clinical neuropsychologist during the surgery. RESULTS In our sample, 21% of the patients reported pre-operative anxiety. Four weeks after surgery, 19% of the patients reported such complaints, and 24% of the patients reported anxiety complaints after 3 months. Depressive complaints were present in 17% (pre-operative), 15% (4 weeks post-operative) and 24% (3 months post-operative) of the patients. Although there were some intra-individual changes (improvement or deterioration) in the psychological complaints over time, on group-level postoperative levels of psychological complaints were not increased relative to the preoperative level of complaints. The severity of post-operative PTSD-related complaints were rarely suggestive of a PTSD. Moreover, these complaints were seldom attributed to the surgery itself, but appeared to be more related to the discovery of the tumour and the postoperative neuropathological diagnosis. CONCLUSIONS The results of the present study do not indicate that undergoing awake craniotomy is associated with increased psychological complaints. Nevertheless, psychological complaints may well exist as a result of other factors. Consequently, monitoring the patient's mental wellbeing and offering psychological support where necessary remain important.
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Affiliation(s)
- I M C Huenges Wajer
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
| | - J Kal
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - P A Robe
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J E van Zandvoort
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - C Ruis
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
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Vavassori L, Venturini M, Zigiotto L, Annicchiarico L, Corsini F, Avesani P, Petit L, De Benedictis A, Sarubbo S. The arcuate fasciculus: Combining structure and function into surgical considerations. Brain Behav 2023; 13:e3107. [PMID: 37280786 PMCID: PMC10454270 DOI: 10.1002/brb3.3107] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/19/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Two Centuries from today, Karl Friedrich Burdach attributed the nomenclature "arcuate fasciculus" to a white matter (WM) pathway connecting the frontal to the temporal cortices by arching around the Sylvian fissure. Although this label remained essentially unvaried, the concepts related to it and the characterization of the structural properties of this bundle evolved along with the methodological progress of the past years. Concurrently, the functional relevance of the arcuate fasciculus (AF) classically restricted to the linguistic domain has extended to further cognitive abilities. These features make it a relevant structure to consider in a large variety of neurosurgical procedures. OBJECTIVE Herein, we build on our previous review uncovering the connectivity provided by the Superior Longitudinal System, including the AF, and provide a handy representation of the structural organization of the AF by considering the frequency of defined reports in the literature. By adopting the same approach, we implement an account of which functions are mediated by this WM bundle. We highlight how this information can be transferred to the neurosurgical field by presenting four surgical cases of glioma resection requiring the evaluation of the relationship between the AF and the nearby structures, and the safest approaches to adopt. CONCLUSIONS Our cumulative overview reports the most common wiring patterns and functional implications to be expected when approaching the study of the AF, while still considering seldom descriptions as an account of interindividual variability. Given its extension and the variety of cortical territories it reaches, the AF is a pivotal structure for different cognitive functions, and thorough understanding of its structural wiring and the functions it mediates is necessary for preserving the patient's cognitive abilities during glioma resection.
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Affiliation(s)
- Laura Vavassori
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
- Center for Mind and Brain Sciences (CIMeC)University of TrentoTrento Provincia Autonoma di TrentoItaly
| | - Martina Venturini
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Luca Zigiotto
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Luciano Annicchiarico
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Francesco Corsini
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Paolo Avesani
- Center for Mind and Brain Sciences (CIMeC)University of TrentoTrento Provincia Autonoma di TrentoItaly
- Neuroinfrmatics Laboratory (NiLab)Bruno Kessler FoundationPovo Provincia Autonoma di TrentoItaly
| | - Laurent Petit
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives (GIN‐IMN), UMR5293, CNRS, CEAUniversity of BordeauxBordeauxFrance
| | | | - Silvio Sarubbo
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
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20
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Mofatteh M, Mashayekhi MS, Arfaie S, Adeleye AO, Jolayemi EO, Ghomsi NC, Shlobin NA, Morsy AA, Esene IN, Laeke T, Awad AK, Labuschagne JJ, Ruan R, Abebe YN, Jabang JN, Okunlola AI, Barrie U, Lekuya HM, Idi Marcel E, Kabulo KDM, Bankole NDA, Edem IJ, Ikwuegbuenyi CA, Nguembu S, Zolo Y, Bernstein M. Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges. Neurosurgery 2023; 93:274-291. [PMID: 36961213 PMCID: PMC10319364 DOI: 10.1227/neu.0000000000002453] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/10/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Awake craniotomy (AC) is a common neurosurgical procedure for the resection of lesions in eloquent brain areas, which has the advantage of avoiding general anesthesia to reduce associated complications and costs. A significant resource limitation in low- and middle-income countries constrains the usage of AC. OBJECTIVE To review the published literature on AC in African countries, identify challenges, and propose pragmatic solutions by practicing neurosurgeons in Africa. METHODS We conducted a scoping review under Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review guidelines across 3 databases (PubMed, Scopus, and Web of Science). English articles investigating AC in Africa were included. RESULTS Nineteen studies consisting of 396 patients were included. Egypt was the most represented country with 8 studies (42.1%), followed by Nigeria with 6 records (31.6%). Glioma was the most common lesion type, corresponding to 120 of 396 patients (30.3%), followed by epilepsy in 71 patients (17.9%). Awake-awake-awake was the most common protocol used in 7 studies (36.8%). Sixteen studies (84.2%) contained adult patients. The youngest reported AC patient was 11 years old, whereas the oldest one was 92. Nine studies (47.4%) reported infrastructure limitations for performing AC, including the lack of funding, intraoperative monitoring equipment, imaging, medications, and limited human resources. CONCLUSION Despite many constraints, AC is being safely performed in low-resource settings. International collaborations among centers are a move forward, but adequate resources and management are essential to make AC an accessible procedure in many more African neurosurgical centers.
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Affiliation(s)
- Mohammad Mofatteh
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Saman Arfaie
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, UK
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Amos Olufemi Adeleye
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Nathalie C. Ghomsi
- Neurosurgery Department, Felix Houphouet Boigny Unversity Abidjan, Cote d’Ivoire
| | - Nathan A. Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ahmed A. Morsy
- Department of Neurosurgery, Zagazig University, Zagazig, Egypt
| | - Ignatius N. Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Tsegazeab Laeke
- Neurosurgery Division, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed K. Awad
- Faculty of Medicine, Ain-shams University, Cairo, Egypt
| | - Jason J. Labuschagne
- Department of Neurosurgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Ruan
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Yared Nigusie Abebe
- Department of Neurosurgery, Haramaya University Hiwot Fana Comprehensive Specialized Hospital, Harar, Ethiopia
| | | | - Abiodun Idowu Okunlola
- Department of Surgery, Federal Teaching Hospital Ido Ekiti and Afe Babalola University, Ado Ekiti, Nigeria
| | - Umaru Barrie
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hervé Monka Lekuya
- Department of Neurosurgery, Makerere University/Mulago Hospital, Kampala, Uganda
| | - Ehanga Idi Marcel
- Department of Neurosurgery, College of Surgeons of East, Central and Southern Africa/Mulago Hospital, Kampala, Uganda
| | - Kantenga Dieu Merci Kabulo
- Department of Neurosurgery, Jason Sendwe General Provincial Hospital, Lubumbashi, Democratic Republic of the Congo
| | - Nourou Dine Adeniran Bankole
- Department of Neurosurgery, Hôpital Des Spécialités, WFNS Rabat Training Center For Young, African Neurosurgeons, Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Idara J. Edem
- Department of Surgery, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | | | - Stephane Nguembu
- Department of Neurosurgery, Higher Institute of Health Sciences, Université des Montagnes, Bangangté, Cameroon
| | - Yvan Zolo
- Global Surgery Division, University of Cape Town, Cape Town, South Africa
| | - Mark Bernstein
- Division of Neurosurgery, Department of Surgery, University of Toronto, University Health Network, Toronto, Ontario, Canada
- Temmy Latner Center for Palliative Care, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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21
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Tchoe Y, Wu T, U HS, Roth DM, Kim D, Lee J, Cleary DR, Pizarro P, Tonsfeldt KJ, Lee K, Chen PC, Bourhis AM, Galton I, Coughlin B, Yang JC, Paulk AC, Halgren E, Cash SS, Dayeh SA. The Brain Electroencephalogram Microdisplay for Precision Neurosurgery. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.19.549735. [PMID: 37503216 PMCID: PMC10370209 DOI: 10.1101/2023.07.19.549735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Brain surgeries are among the most delicate clinical procedures and must be performed with the most technologically robust and advanced tools. When such surgical procedures are performed in functionally critical regions of the brain, functional mapping is applied as a standard practice that involves direct coordinated interactions between the neurosurgeon and the clinical neurology electrophysiology team. However, information flow during these interactions is commonly verbal as well as time consuming which in turn increases the duration and cost of the surgery, possibly compromising the patient outcomes. Additionally, the grids that measure brain activity and identify the boundaries of pathological versus functional brain regions suffer from low resolution (3-10 mm contact to contact spacing) with limited conformity to the brain surface. Here, we introduce a brain intracranial electroencephalogram microdisplay (Brain-iEEG-microdisplay) which conforms to the brain to measure the brain activity and display changes in near real-time (40 Hz refresh rate) on the surface of the brain in the surgical field. We used scalable engineered gallium nitride (GaN) substrates with 6" diameter to fabricate, encapsulate, and release free-standing arrays of up to 2048 GaN light emitting diodes (μLEDs) in polyimide substrates. We then laminated the μLED arrays on the back of micro-electrocorticography (μECoG) platinum nanorod grids (PtNRGrids) and developed hardware and software to perform near real-time intracranial EEG analysis and activation of light patterns that correspond to specific cortical activities. Using the Brain-iEEG-microdisplay, we precisely ideFSntified and displayed important cortical landmarks and pharmacologically induced pathological activities. In the rat model, we identified and displayed individual cortical columns corresponding to individual whiskers and the near real-time evolution of epileptic discharges. In the pig animal model, we demonstrated near real-time mapping and display of cortical functional boundaries using somatosensory evoked potentials (SSEP) and display of responses to direct electrical stimulation (DES) from the surface or within the brain tissue. Using a dual-color Brain-iEEG-microdisplay, we demonstrated co-registration of the functional cortical boundaries with one color and displayed the evolution of electrical potentials associated with epileptiform activity with another color. The Brain-iEEG-microdisplay holds the promise of increasing the efficiency of diagnosis and possibly surgical treatment, thereby reducing the cost and improving patient outcomes which would mark a major advancement in neurosurgery. These advances can also be translated to broader applications in neuro-oncology and neurophysiology.
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Affiliation(s)
- Youngbin Tchoe
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan 44919, Korea
| | - Tianhai Wu
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
| | - Hoi Sang U
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
| | - David M Roth
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
- Center for the Future of Surgery, Department of Surgery, University of California San Diego, La Jolla, California 92093, United States
- Department of Anesthesiology, University of California San Diego, La Jolla, California 92093, United States
| | - Dongwoo Kim
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
| | - Jihwan Lee
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
| | - Daniel R Cleary
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
- Department of Neurological Surgery, Oregon Health & Science University, Mail code CH8N, 3303 SW Bond Avenue, Portland, Oregon 97239- 3098, United States
| | - Patricia Pizarro
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
- Center for the Future of Surgery, Department of Surgery, University of California San Diego, La Jolla, California 92093, United States
| | - Karen J Tonsfeldt
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Science and Medicine, University of California San Diego, La Jolla, California 92093, United States
| | - Keundong Lee
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
| | - Po Chun Chen
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
| | - Andrew M Bourhis
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
| | - Ian Galton
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
| | - Brian Coughlin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Jimmy C Yang
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Department of Neurological Surgery, Ohio State University, Columbus, Ohio 43210, United States
| | - Angelique C Paulk
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Eric Halgren
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
- Department of Radiology, University of California San Diego, La Jolla, California 92093, United States
| | - Sydney S Cash
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Science and Medicine, University of California San Diego, La Jolla, California 92093, United States
| | - Shadi A Dayeh
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California 92093, United States
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22
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Ng S, Duffau H. Brain Plasticity Profiling as a Key Support to Therapeutic Decision-Making in Low-Grade Glioma Oncological Strategies. Cancers (Basel) 2023; 15:3698. [PMID: 37509359 PMCID: PMC10378506 DOI: 10.3390/cancers15143698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
The ability of neural circuits to compensate for damage to the central nervous system is called postlesional plasticity. In diffuse low-grade gliomas (LGGs), a crosstalk between the brain and the tumor activates modulations of plasticity, as well as tumor proliferation and migration, by means of paracrine and electrical intercommunications. Such adaptative mechanisms have a major impact on the benefits and risks of oncological treatments but are still disregarded by current neuro-oncological guidelines. In this review, the authors first aimed to highlight clinical, radiological, and oncological markers that robustly reflect the plasticity potentials and limitations in LGG patients, including the location of the tumor and the degree of critical white matter tract infiltration, the velocity of tumor expansion, and the reactional changes of neuropsychological performances over time. Second, the interactions between the potential/limitations of cerebral plasticity and the efficacy/tolerance of treatment options (i.e., surgery, chemotherapy, and radiotherapy) are reviewed. Finally, a longitudinal and multimodal treatment approach accounting for the evolutive profiles of brain plasticity is proposed. Such an approach integrates personalized predictive models of plasticity potentials with a step-by-step therapeutic decision making and supports onco-functional balanced strategies in patients with LGG, with the ultimate aim of optimizing overall survival and quality of life.
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Affiliation(s)
- Sam Ng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 34295 Montpellier, France
- Institute of Functional Genomics, University of Montpellier, Centre National de le Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale 1191, 34094 Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 34295 Montpellier, France
- Institute of Functional Genomics, University of Montpellier, Centre National de le Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale 1191, 34094 Montpellier, France
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23
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Lettieri C, Pauletto G, Valiante G, Ius T, Verriello L, Valente M, Skrap M, Gigli GL, Budai R. Fast or Slow? A Comparison Between Two Transcranial Electrical Stimulation Techniques for Eliciting Motor-Evoked Potentials During Supratentorial Surgery. J Clin Neurophysiol 2023; 40:465-470. [PMID: 35452204 DOI: 10.1097/wnp.0000000000000902] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE During intraoperative neurophysiological monitoring of motor pathways, two types of transcranial electrical stimulation are available, i.e., constant-current and constant-voltage stimulation. Few previous studies, performed only during spinal surgery, analyzed and compared them during intraoperative neurophysiological monitoring. The aim of our study was to compare these two stimulation techniques for eliciting motor-evoked potentials during intraoperative neurophysiological monitoring in a group of patients affected by supratentorial lesions. METHODS Supratentorial lesions from 16 patients were retrospectively collected and analyzed. Motor-evoked potentials were performed only from transcranial electrical stimulation because the inability to place the subdural strip electrodes correctly did not permit to perform direct cortical stimulation. At the beginning of surgery, in each patient, motor-evoked potentials were monitored by using both "fast-charge" constant-voltage and "slow-charge" constant-current stimulation. Several neurophysiological parameters were collected and compared between the two stimulation techniques by means of statistical analysis. RESULTS "Fast-charge" constant-voltage stimulation allowed statistically higher efficiency rates for eliciting motor-evoked potentials compared with "slow-charge" constant-current stimulation, both for upper and lower limbs. We also found that threshold and maximal charge as well as charge density were significantly lower during constant-voltage stimulation, thus lowering the potential tissue damage. CONCLUSIONS "Fast-charge" constant-voltage transcranial electrical stimulation is feasible and safe during intraoperative neurophysiological monitoring for supratentorial surgery and may be preferable to "slow-charge" constant-current stimulation.
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Affiliation(s)
- Christian Lettieri
- Neurology and Clinical Neurophysiology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Giada Pauletto
- Neurology and Clinical Neurophysiology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Gabriele Valiante
- Neurology and Clinical Neurophysiology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Tamara Ius
- Neurosurgery Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Lorenzo Verriello
- Neurology and Clinical Neurophysiology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy ; and
- Departments of Medicine (DAME) and
| | - Miran Skrap
- Neurosurgery Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
| | - Gian L Gigli
- Clinical Neurology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy ; and
- Mathematics, Informatics and Physics (DMIF), University of Udine, Udine, Italy
| | - Riccardo Budai
- Neurology and Clinical Neurophysiology Unit, "S. Maria della Misericordia" University-Hospital, Udine, Italy
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24
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Lawrence A, Carvajal M, Ormsby J. Beyond Broca's and Wernicke's: Functional Mapping of Ancillary Language Centers Prior to Brain Tumor Surgery. Tomography 2023; 9:1254-1275. [PMID: 37489468 PMCID: PMC10366753 DOI: 10.3390/tomography9040100] [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: 04/20/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
Functional MRI is a well-established tool used for pre-surgical planning to help the neurosurgeon have a roadmap of critical functional areas that should be avoided, if possible, during surgery to minimize morbidity for patients with brain tumors (though this also has applications for surgical resection of epileptogenic tissue and vascular lesions). This article reviews the locations of secondary language centers within the brain along with imaging findings to help improve our confidence in our knowledge on language lateralization. Brief overviews of these language centers and their contributions to the language networks will be discussed. These language centers include primary language centers of "Broca's Area" and "Wernicke's Area". However, there are multiple secondary language centers such as the dorsal lateral prefrontal cortex (DLPFC), frontal eye fields, pre- supplemental motor area (pre-SMA), Basal Temporal Language Area (BTLA), along with other areas of activation. Knowing these foci helps to increase self-assurance when discussing the nature of laterality with the neurosurgeon. By knowing secondary language centers for language lateralization, via fMRI, one can feel confident on providing neurosurgeon colleagues with appropriate information on the laterality of language in preparation for surgery.
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Affiliation(s)
- Ashley Lawrence
- Center for Neuropsychological Services, University of New Mexico, MSC 10 5530 1 University of New Mexico, Albuquerque, NM 87131-5001, USA
| | - Michael Carvajal
- Center for Neuropsychological Services, University of New Mexico, MSC 10 5530 1 University of New Mexico, Albuquerque, NM 87131-5001, USA
| | - Jacob Ormsby
- Department of Radiology, University of New Mexico, MSC 10 5530 1 University of New Mexico, Albuquerque, NM 87131-5001, USA
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25
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van den Bent MJ. Thirty years of progress in the management of low-grade gliomas. Rev Neurol (Paris) 2023; 179:425-429. [PMID: 37029057 DOI: 10.1016/j.neurol.2023.03.001] [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: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 04/09/2023]
Abstract
This paper reviews 30 years of developments in the area of low-grade gliomas. This includes the changes in diagnostics with the incorporation of 1p/19q and IDH mutations in the diagnostic classifier, the improved surgical techniques, improved delivery of radiotherapy and chemotherapy. More recently, the better understanding of the altered cellular processes has lead to the development of novel drugs that may alter completely alter the management of patients early in the course of their disease.
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Affiliation(s)
- M J van den Bent
- Brain Tumor Center, ErasmusMC Cancer Institute, ErasmusMC University Medical Center, Doctor Molenwaterplein, 40, 3015GD Rotterdam, The Netherlands.
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26
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Şahin MH, Akyüz ME, Karadağ MK, Yalçın A. Supramarginal Gyrus and Angular Gyrus Subcortical Connections: A Microanatomical and Tractographic Study for Neurosurgeons. Brain Sci 2023; 13:brainsci13030430. [PMID: 36979240 PMCID: PMC10046402 DOI: 10.3390/brainsci13030430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Background and Objectives: This article aims to investigate the subcortical microanatomy of the supramarginal gyrus (SMG) and angular gyrus (AnG) using a microfiber dissection technique and diffusion tensor imaging (DTI)/fiber tractography (FT). The cortical and subcortical structures of this region are highly functional, and their lesions often present clinically. For this reason, the possibility of post-surgical deficits is high. We focused on the supramarginal gyrus and the angular gyrus and reviewed their anatomy from a topographic, functional and surgical point of view, and aimed to raise awareness especially for neurosurgeons. Methods: Four previously frozen, formalin-fixed human brains were examined under the operating microscope using the fiber dissection technique. Four hemispheres were dissected from medial to lateral under the surgical microscope. Brain magnetic resonance imaging (MRI) of 20 healthy adults was examined. Pre-central and post-central gyrus were preserved to achieve topographic dominance in dissections of brain specimens. Each stage was photographed. Tractographic brain magnetic resonance imaging of 10 healthy adults was examined radiologically. Focusing on the supramarginal and angular gyrus, the white matter fibers passing under this region and their intersection areas were examined. These two methods were compared anatomically from the lateral view and radiologically from the sagittal view. Results: SMG and AnG were determined in brain specimens. The pre-central and post-central gyrus were topographically preserved. The superior and medial temporal gyrus, and inferior and superior parietal areas were decorticated from lateral to medial. U fibers, superior longitudinal fasciculus II (SLF II), superior longitudinal fasciculus III (SLF III), arcuat fasciculus (AF) and middle longitudinal fasciculus (MdLF) fiber groups were shown and subcortical fiber structures belonging to these regions were visualized by the DTI/FT method. The subcortical fiber groups under the SMG and the AnG were observed anatomically and radiologically to have a dense and complex structure. Conclusions: Due to the importance of the subcortical connections of SMG and AnG on speech function, tumoral lesions and surgeries of this region are of particular importance. The anatomical architecture of the complex subcortical structure, which is located on the projection of the SMG and AnG areas, was shown with a DTI/FT examination under a topographic dominance, preserving the pre-central and post-central gyrus. In this study, the importance of the anatomical localization, connections and functions of the supramarginal and angular gyrus was examined. More anatomical and radiological studies are needed to better understand this region and its connections.
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27
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Li S, Mu Y, Rao Y, Sun C, Li X, Liu H, Yu X, Yan X, Ding Y, Wang Y, Fei Z. Preoperative individual-target transcranial magnetic stimulation demonstrates an effect comparable to intraoperative direct electrical stimulation in language-eloquent glioma mapping and improves postsurgical outcome: A retrospective fiber-tracking and electromagnetic simulation study. Front Oncol 2023; 13:1089787. [PMID: 36816968 PMCID: PMC9936080 DOI: 10.3389/fonc.2023.1089787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Background Efforts to resection of glioma lesions located in brain-eloquent areas must balance the extent of resection (EOR) and functional preservation. Currently, intraoperative direct electrical stimulation (DES) is the gold standard for achieving the maximum EOR while preserving as much functionality as possible. However, intraoperative DES inevitably involves risks of infection and epilepsy. The aim of this study was to verify the reliability of individual-target transcranial magnetic stimulation (IT-TMS) in preoperative mapping relative to DES and evaluate its effectiveness based on postsurgical outcomes. Methods Sixteen language-eloquent glioma patients were enrolled. Nine of them underwent preoperative nTMS mapping (n=9, nTMS group), and the other seven were assigned to the non-nTMS group and did not undergo preoperative nTMS mapping (n=7). Before surgery, online IT-TMS was performed during a language task in the nTMS group. Sites in the cortex at which this task was disturbed in three consecutive trials were recorded and regarded as positive and designated nTMS hotspots (HSnTMS). Both groups then underwent awake surgery and intraoperative DES mapping. DES hotspots (HSDES) were also determined in a manner analogous to HSnTMS. The spatial distribution of HSnTMS and HSDES in the nTMS group was recorded, registered in a single brain template, and compared. The center of gravity (CoG) of HSnTMS (HSnTMS-CoG)-based and HSDES-CoG-based diffusion tensor imaging-fiber tracking (DTI-FT) was performed. The electromagnetic simulation was conducted, and the values were then compared between the nTMS and DES groups, as were the Western Aphasia Battery (WAB) scale and fiber-tracking values. Results HSnTMS and HSDES showed similar distributions (mean distance 6.32 ± 2.6 mm, distance range 2.2-9.3 mm, 95% CI 3.9-8.7 mm). A higher fractional anisotropy (FA) value in nTMS mapping (P=0.0373) and an analogous fiber tract length (P=0.2290) were observed. A similar distribution of the electric field within the brain tissues induced by nTMS and DES was noted. Compared with the non-nTMS group, the integration of nTMS led to a significant improvement in language performance (WAB scores averaging 78.4 in the nTMS group compared with 59.5 in the non-nTMS group, P=0.0321 < 0.05) as well as in brain-structure preservation (FA value, P=0.0156; tract length, P=0.0166). Conclusion Preoperative IT-TMS provides data equally crucial to DES and thus facilitates precise brain mapping and the preservation of linguistic function.
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Affiliation(s)
- Sanzhong Li
- Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China,*Correspondence: Sanzhong Li, ; Zhou Fei,
| | - Yunfeng Mu
- Department of Gynecological Oncology, Shaanxi Provincial Cancer Hospital, Xi’an, China
| | - Yang Rao
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, China
| | - Chuanzhu Sun
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, China
| | - Xiang Li
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, China,The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Huan Liu
- School of Mathematics and Statistics, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xun Yu
- Product Department, Solide Brain Medical Technology, Ltd., Xi’an, Shaanxi, China
| | - Xiao Yan
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, China
| | - Yunxia Ding
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, China
| | - Yangtao Wang
- Shaanxi Brain Modulation and Scientific Research Center, Xi'an, Shaanxi, China
| | - Zhou Fei
- Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China,*Correspondence: Sanzhong Li, ; Zhou Fei,
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Mofatteh M, Mashayekhi MS, Arfaie S, Chen Y, Hendi K, Kwan ATH, Honarvar F, Solgi A, Liao X, Ashkan K. Stress, Anxiety, and Depression Associated With Awake Craniotomy: A Systematic Review. Neurosurgery 2023; 92:225-240. [PMID: 36580643 DOI: 10.1227/neu.0000000000002224] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/09/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Awake craniotomy (AC) enables real-time monitoring of cortical and subcortical functions when lesions are in eloquent brain areas. AC patients are exposed to various preoperative, intraoperative, and postoperative stressors, which might affect their mental health. OBJECTIVE To conduct a systematic review to better understand stress, anxiety, and depression in AC patients. METHODS PubMed, Scopus, and Web of Science databases were searched from January 1, 2000, to April 20, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. RESULTS Four hundred forty-seven records were identified that fit our inclusion and exclusion criteria for screening. Overall, 24 articles consisting of 1450 patients from 13 countries were included. Sixteen studies (66.7%) were prospective, whereas 8 articles (33.3%) were retrospective. Studies evaluated stress, anxiety, and depression during different phases of AC. Twenty-two studies (91.7%) were conducted on adults, and 2 studies were on pediatrics (8.3 %). Glioma was the most common AC treatment with 615 patients (42.4%). Awake-awake-awake and asleep-awake-asleep were the most common protocols, each used in 4 studies, respectively (16.7%). Anxiety was the most common psychological outcome evaluated in 19 studies (79.2%). The visual analog scale and self-developed questionnaire by the authors (each n = 5, 20.8%) were the most frequently tools used. Twenty-three studies (95.8%) concluded that AC does not increase stress, anxiety, and/or depression in AC patients. One study (4.2%) identified younger age associated with panic attack. CONCLUSION In experienced hands, AC does not cause an increase in stress, anxiety, and depression; however, the psychiatric impact of AC should not be underestimated.
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Affiliation(s)
- Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, UK
| | | | - Saman Arfaie
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.,Department of Molecular and Cell Biology, University of California Berkeley, California, USA
| | - Yimin Chen
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | - Kasra Hendi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Faraz Honarvar
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Arad Solgi
- School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada
| | - Xuxing Liao
- Department of Neurosurgery, Foshan Sanshui District People's Hospital, Foshan, China.,Department of Surgery of Cerebrovascular Diseases, Foshan First People's Hospital, Foshan, China
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,King's Health Partners Academic Health Sciences Centre, London, UK.,School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
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Lavalle L, D'Elia A, Ciavarro M, Esposito V. Subpial technique in supratentorial glioma resection: state of the art and analysis of costs and effectiveness in a single institute experience. J Neurosurg Sci 2023; 67:73-82. [PMID: 32989970 DOI: 10.23736/s0390-5616.20.05046-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many neurosurgeons advocate subpial technique as the best technique to remove supratentorial gliomas. However, few authors clearly defined advantages and features of this technique. The aim of our study is to describe microsurgical subpial technique related to glioma surgery, with regard to its safety and cost effectiveness. METHODS We analyzed retrospectively all consecutive patients surgically treated for supratentorial glioma from January 2017 to April 2018 at Neurosurgery Department of Neuromed Institute. All patients underwent to surgical glioma resection performing microsurgical subpial technique. Extent of resection and neurological complications were evaluated as primary outcomes; Karnofsky Performance Status and postoperative edema extent were secondary outcomes. Statistical analysis was obtained. RESULTS The study included 70 patients. Gross Total Removal was obtained in 91.3% of patients with low grade glioma (LGG) and in 81% of patients with high grade glioma. Neurological complications amounted to 34% at early assessment in LGG patients, which were permanent at 3 months in 17% of patients. In high grade glioma patients, neurological complications amounted to 51% at early assessment, which were permanent at 3 months in 25% of them. CONCLUSIONS We obtained good postoperative results with regard to the extent of tumor resection using this technique. Subpial resection is an effective surgical technique to get a safer and more complete tumor resection. It should be combined with other modern neurosurgical tools such as neuronavigation, ultrasound and cortical mapping to obtain the best tumor resection and functional neurological preservation.
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Affiliation(s)
- Laura Lavalle
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Isernia, Italy -
| | - Alessandro D'Elia
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Marco Ciavarro
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Vincenzo Esposito
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Isernia, Italy
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30
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Silverstein JW, Shah HA, Unadkat P, Vilaysom S, Boockvar JA, Langer DJ, Ellis JA, D'Amico RS. Short and long-term prognostic value of intraoperative motor evoked potentials in brain tumor patients: a case series of 121 brain tumor patients. J Neurooncol 2023; 161:127-133. [PMID: 36629962 DOI: 10.1007/s11060-022-04229-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/24/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Iatrogenic neurologic deficits adversely affect patient outcomes following brain tumor resection. Motor evoked potential (MEP) monitoring allows surgeons to assess the integrity of motor-eloquent areas in real-time during tumor resection to lessen the risk of iatrogenic insult. We retrospectively associate intraoperative transcranial and direct cortical MEPs (TC-MEPs, DC-MEPs) to early and late post-operative motor function to prognosticate short- and long-term motor recovery in brain tumor patients undergoing surgical resection in peri-eloquent regions. METHODS We reviewed 121 brain tumor patients undergoing craniotomies with DC-MEP and/or TC-MEP monitoring. Motor function scores were recorded at multiple time-points up to 1 year postoperatively. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated at each time point. RESULTS The sensitivity, specificity, PPV, and NPV of TC-MEP in the immediate postoperative period was 17.5%, 100%, 100%, and 69.4%, respectively. For DC-MEP monitoring, the respective values were 25.0%, 100%, 100%, and 68.8%. By discharge, sensitivity had increased for both TC-MEP and DC MEPs to 43.8%, and 50.0% respectively. Subset analysis on patients without tumor recurrence/progression at long term follow-up (n = 62 pts, 51.2%) found that all patients with stable monitoring maintained or improved from preoperative status. One patient with transient intraoperative TC-MEP loss and permanent DC-MEP loss suffered a permanent deficit. CONCLUSION Brain tumor patients who undergo surgery with intact MEP monitoring and experience new postoperative deficits likely suffer transient deficits that will improve over the postoperative course in the absence of disease progression.
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Affiliation(s)
- Justin W Silverstein
- Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Harshal A Shah
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, New York, NY, 11549, USA.
| | - Prashin Unadkat
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/ Northwell Health & The Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
| | - Sabena Vilaysom
- Department of Clinical Neurophysiology, Neuro Protective Solutions, New York, NY, USA
| | - John A Boockvar
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - David J Langer
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - Jason A Ellis
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
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31
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Asman P, Pellizzer G, Tummala S, Tasnim I, Bastos D, Bhavsar S, Prabhu S, Ince NF. Long-latency gamma modulation after median nerve stimulation delineates the central sulcus and contrasts the states of consciousness. Clin Neurophysiol 2023; 145:1-10. [PMID: 36370685 DOI: 10.1016/j.clinph.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the functional use of sub-band modulations in somatosensory evoked potentials (SSEPs) to discriminate between the primary somatosensory (S1) and motor (M1) areas and contrast the states of consciousness. METHODS During routine intraoperative cortical mapping, SSEPs were recorded with electrocorticography (ECoG) grids from the sensorimotor cortex of eight patients in the anesthetized and awake states. We conducted a time-frequency analysis on the SSEP trace to extract the spectral modulations in each state and visualize their spatial topography. RESULTS We observed late gamma modulation (60-250 Hz) in all subjects approximately 50 ms after stimulation onset, extending up to 250 ms in each state. The late gamma activity enhancement was predominant in S1 in the awake state, where it discriminated S1 from M1 at a higher accuracy (92 %) than in the anesthetized state (accuracy = 70 %). CONCLUSIONS These results showed that sensorimotor mapping does not need to rely on only SSEP phase reversal. The long latency gamma modulation can serve as a biomarker for primary sensorimotor localization and monitor the level of consciousness in neurosurgical practice. SIGNIFICANCE While the intraoperative assessment of SSEP phase reversal with ECoG is widely employed to delineate the central sulcus, the median nerve stimulation-induced spatio-spectral patterns can distinctly localize it and distinguish between conscious states.
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Affiliation(s)
- Priscella Asman
- Biomedical Engineering Department, University of Houston, Houston, TX, USA
| | - Giuseppe Pellizzer
- Research Service, Minneapolis VA Health Care System, and Departments of Neurology, and of Neuroscience, University of Minnesota, Minnesota, MN, USA
| | - Sudhakar Tummala
- Department of Neurosurgery, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Israt Tasnim
- Biomedical Engineering Department, University of Houston, Houston, TX, USA
| | - Dhiego Bastos
- Department of Neurosurgery, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Shreyas Bhavsar
- Department of Anesthesiology and Perioperative Medicine, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Sujit Prabhu
- Department of Neurosurgery, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Nuri F Ince
- Biomedical Engineering Department, University of Houston, Houston, TX, USA.
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Ichinose T, Kinoshita M, Nakajima R, Tanaka S, Nakada M. Recovery of Visual Field After Awake Stimulation Mapping of the Optic Pathway in Glioma Patients. Brain Topogr 2023; 36:87-98. [PMID: 36327063 DOI: 10.1007/s10548-022-00922-z] [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: 06/06/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Brain mapping during awake craniotomy for gliomas can help preserve neurological functions, including maintenance of central and peripheral vision. However, the consecutive changes in the visual field remain unknown. We retrospectively assessed 14 patients who underwent awake craniotomy for gliomas infiltrating into the optic radiation. Cortico-subcortical direct electrical stimulation (DES) was intraoperatively applied until transient visual symptoms were elicited and recorded. The visual fields were examined consecutively in the preoperative period and postoperative subacute and chronic periods. To evaluate the anatomo-functional validity of the recordings, all DES-elicited points were overlaid onto a three-dimensional template that included the optic radiation, using voxel-based morphometry (VBM) mapping. All patients experienced visual symptoms that were classified as phosphenes, blurred vision, or hallucinations during DES, and surgical resection was limited to within the functional boundaries. In VBM, almost all the subcortical positive mapping points overlapped with the surface of the optic radiation, and the distribution of sites that induced visual phenomena in the upper or lower visual fields could be differentiated in the anatomical space. We observed no postoperative visual deficit in four patients (29%), time-dependent improvements in five out of eight patients that presented transient quadrantanopia or partial visual defect (36% out of 57%), and permanent hemianopsia (14%) in two patients with occipital lesions. Intraoperative DES that identifies and preserves optic radiation in awake craniotomy for gliomas is a reliable and effective technique to reduce risk of permanent deficits, but has a low success rate in patients with occipital involvement.
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Affiliation(s)
- Toshiya Ichinose
- Department of Neurosurgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Masashi Kinoshita
- Department of Neurosurgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Riho Nakajima
- Department of Occupational Therapy, Faculty of Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shingo Tanaka
- Department of Neurosurgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
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Silverstein JW, Greisman JD, Dadario NB, Park J, D'Amico RS. A Cost-Effective, Adjustable, Dynamic Subcortical Stimulation Device - Technical Note. Neurodiagn J 2022; 62:193-205. [PMID: 36179326 DOI: 10.1080/21646821.2022.2121544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Brain mapping and neuromonitoring remain the gold standard for identifying and preserving functional neuroanatomic regions during safe, maximal brain tumor resection. Subcortical stimulation (SCS) can identify white matter tracts and approximate their distance from the leading edge of an advancing resection cavity. Dynamic (continuous) devices permitting simultaneous suction and stimulation have recently emerged as time-efficient alternatives to traditional static (discontinuous) techniques. However, the high cost, fixed cap size, and fixed tube diameter of commercially available suction devices preclude universal adoption. Our objective is to modify available suction devices into monopolar probes for subcortical stimulation mapping. We describe our technique using a novel, cost-effective, dynamic SCS technique as part of our established neuromonitoring protocol. We electrified and insulated a conventional variable suction device using an alligator clip and red rubber catheter, respectively. We adjusted the catheter's length to expose metal on both sides, effectively converting the suction device into a monopolar stimulation probe capable of cortical and subcortical monopolar stimulation that does not differ from commercially available discontinuous or continuous devices. We fashioned a dynamic SCS suction probe using inexpensive materials compatible with all suction styles and sizes. Qualitative and quantitative analysis in future prospective case series is needed to assess efficacy and utility.
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Affiliation(s)
- Justin W Silverstein
- Department of NeurologyLenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Clinical Neurophysiology Neuro Protective Solutions, New York, New York
| | - Jacob D Greisman
- Department of Neurological Surgery Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Nicholas B Dadario
- Department of Neurological Surgery Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Jung Park
- Department of Neurological Surgery Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Randy S D'Amico
- Department of Neurological Surgery Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
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Review of Intraoperative Adjuncts for Maximal Safe Resection of Gliomas and Its Impact on Outcomes. Cancers (Basel) 2022; 14:cancers14225705. [PMID: 36428797 PMCID: PMC9688206 DOI: 10.3390/cancers14225705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/12/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
Maximal safe resection is the mainstay of treatment in the neurosurgical management of gliomas, and preserving functional integrity is linked to favorable outcomes. How these modalities differ in their effectiveness on the extent of resection (EOR), survival, and complications remains unknown. A systematic literature search was performed with the following inclusion criteria: published between 2005 and 2022, involving brain glioma surgery, and including one or a combination of intraoperative modalities: intraoperative magnetic resonance imaging (iMRI), awake/general anesthesia craniotomy mapping (AC/GA), fluorescence-guided imaging, or combined modalities. Of 525 articles, 464 were excluded and 61 articles were included, involving 5221 glioma patients, 7(11.4%) articles used iMRI, 21(36.8%) used cortical mapping, 15(24.5%) used 5-aminolevulinic acid (5-ALA) or fluorescein sodium, and 18(29.5%) used combined modalities. The heterogeneity in reporting the amount of surgical resection prevented further analysis. Progression-free survival/overall survival (PFS/OS) were reported in 18/61(29.5%) articles, while complications and permanent disability were reported in 38/61(62.2%) articles. The reviewed studies demonstrate that intraoperative adjuncts such as iMRI, AC/GA mapping, fluorescence-guided imaging, and a combination of these modalities improve EOR. However, PFS/OS were underreported. Combining multiple intraoperative modalities seems to have the highest effect compared to each adjunct alone.
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Tomasino B, Guarracino I, Pauletto G, Pez S, Ius T, Furlan D, Nilo A, Isola M, De Martino M, Mauro S, Verriello L, Lettieri C, Gigli GL, Valente M, Deana C, Skrap M. Performing real time neuropsychological testing during awake craniotomy: are dexmedetomidine or propofol the same? A preliminary report. J Neurooncol 2022; 160:707-716. [DOI: 10.1007/s11060-022-04191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
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Fang S, Weng S, Li L, Guo Y, Fan X, Zhang Z, Jiang T, Wang Y. Association of homotopic areas in the right hemisphere with language deficits in the short term after tumor resection. J Neurosurg 2022; 138:1206-1215. [PMID: 36308477 DOI: 10.3171/2022.9.jns221475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
It is important to identify language deficit and recovery in the week following a tumor resection procedure. The homotopic Broca’s area and the superior longitudinal fasciculus in the right hemisphere participate in language functional compensation. However, the nodes in these structures, as well as their contributions to language rehabilitation, remain unknown. In this study, the authors investigated the association of homotopic areas in the right hemisphere with language deficit.
METHODS
The authors retrospectively reviewed the records of 50 right-handed patients with left hemispheric lower-grade glioma that had been surgically treated between June 2020 and May 2022. The patients were divided into normal and aphasia groups based on their postoperative aphasia quotient (AQ) from the Western Aphasia Battery. Preoperative (within 24 hours before surgery) and postoperative (7 days after tumor resection) diffusion tensor images were used to reveal alterations of structural networks by using graphic theory analysis. The shortest distance between the glioma and the nodes belonging to the language network (SDTN) was quantitatively assessed. Pearson’s correlation and causal mediation analyses were used to identify correlations and mediator factors among SDTN, topological properties, and AQs.
RESULTS
Postoperative nodal local efficiency of the node dorsal Brodmann area (BA) 44 (A44d; p = 0.0330), nodal clustering coefficient of the nodes A44d (p = 0.0402) and dorsal lateral BA6 (A6dl; p = 0.0097), and nodal degree centrality (p = 0.0058) of the node medial BA7 (A7m) were higher in the normal group than in the aphasia group. SDTN was positively correlated with postoperative AQ (r = 0.457, p = 0.0009) and ΔAQ (r = 0.588, p < 0.0001). The nodal local efficiency of node A44d and the nodal efficiency, nodal betweenness centrality, and degree centrality of node A7m were mediators of SDTN and postoperative AQs.
CONCLUSIONS
The decreased ability of nodes A44d, A6dl, and A7m to convey information in the right hemisphere was associated with short-term language deficits after tumor resection. A smaller SDTN induced a worsened postoperative language deficit through a significant decrease in the ability to convey information from these three nodes.
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Affiliation(s)
- Shengyu Fang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- Beijing Neurosurgical Institute, Capital Medical University, Beijing; and
| | - Shimeng Weng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing; and
| | - Lianwang Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing; and
| | - Yuhao Guo
- Beijing Neurosurgical Institute, Capital Medical University, Beijing; and
| | - Xing Fan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing; and
| | - Zhong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- Research Unit of Accurate Diagnosis, Treatment, and Translational Medicine of Brain Tumors, Chinese Academy of Medical Sciences, Beijing, China
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
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Surgical Treatment of Glioblastoma: State-of-the-Art and Future Trends. J Clin Med 2022; 11:jcm11185354. [PMID: 36143001 PMCID: PMC9505564 DOI: 10.3390/jcm11185354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022] Open
Abstract
Glioblastoma (GBM) is a highly aggressive disease and is associated with poor prognosis despite treatment advances in recent years. Surgical resection of tumor remains the main therapeutic option when approaching these patients, especially when combined with adjuvant radiochemotherapy. In the present study, we conducted a comprehensive literature review on the state-of-the-art and future trends of the surgical treatment of GBM, emphasizing topics that have been the object of recent study.
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38
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Axelson HW, Latini F, Jemstedt M, Ryttlefors M, Zetterling M. Continuous subcortical language mapping in awake glioma surgery. Front Oncol 2022; 12:947119. [PMID: 36033478 PMCID: PMC9416475 DOI: 10.3389/fonc.2022.947119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
Abstract
Repetitive monopolar short-train stimulation (STS) delivered from a suction probe enables continuous mapping and distance assessment of corticospinal tracts during asleep glioma resection. In this study, we explored this stimulation technique in awake glioma surgery. Fourteen patients with glioma involving language-related tracts were prospectively included. Continuous (3-Hz) cathodal monopolar STS (five pulses, 250 Hz) was delivered via the tip of a suction probe throughout tumor resection while testing language performance. At 70 subcortical locations, surgery was paused to deliver STS in a steady suction probe position. Monopolar STS influence on language performance at different subcortical locations was separated into three groups. Group 1 represented locations where STS did not produce language disturbance. Groups 2 and 3 represented subcortical locations where STS produced language interference at different threshold intensities (≥7.5 and ≤5 mA, respectively). For validation, bipolar Penfield stimulation (PS; 60 Hz for 3 s) was used as a “gold standard” comparison method to detect close proximity to language-related tracts and classified as positive or negative regarding language interference. There was no language interference from STS in 28 locations (Group 1), and PS was negative for all sites. In Group 2 (STS threshold ≥ 7.5 mA; median, 10 mA), there was language interference at 18 locations, and PS (median, 4 mA) was positive in only one location. In Group 3 (STS threshold ≤ 5 mA; median, 5 mA), there was language interference at 24 locations, and positive PS (median 4 mA) was significantly (p < 0.01) more common (15 out of 24 locations) compared with Groups 1 and 2. Despite the continuous stimulation throughout tumor resection, there were no seizures in any of the patients. In five patients, temporary current spread to the facial nerve was observed. We conclude that continuous subcortical STS is feasibly also in awake glioma surgery and that no language interference from STS or interference at ≥7.5 mA seems to indicate safe distance to language tracts as judged by PS comparisons. STS language interference at STS ≤ 5 mA was not consistently confirmed by PS, which needs to be addressed.
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Affiliation(s)
- Hans W. Axelson
- Department of Medical Sciences, Section of Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
- *Correspondence: Hans W. Axelson,
| | - Francesco Latini
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Malin Jemstedt
- Department of Medical Sciences, Speech-Language Pathology, Uppsala University, Uppsala, Sweden
| | - Mats Ryttlefors
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Maria Zetterling
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
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Palmisciano P, Ferini G, Watanabe G, Ogasawara C, Lesha E, Bin-Alamer O, Umana GE, Yu K, Cohen-Gadol AA, El Ahmadieh TY, Haider AS. Gliomas Infiltrating the Corpus Callosum: A Systematic Review of the Literature. Cancers (Basel) 2022; 14:2507. [PMID: 35626112 PMCID: PMC9139932 DOI: 10.3390/cancers14102507] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/01/2022] [Accepted: 05/18/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Gliomas infiltrating the corpus callosum (G-I-CC) majorly impact patient quality-of-life, but maximally safe tumor resection is challenging. We systematically reviewed the literature on G-I-CC. Methods: PubMed, EMBASE, Scopus, Web of Science, and Cochrane were searched following the PRISMA guidelines to include studies of patients with G-I-CC. Clinicopathological features, treatments, and outcomes were analyzed. Results: We included 52 studies comprising 683 patients. Most patients experienced headache (33%), cognitive decline (18.7%), and seizures (17.7%). Tumors mostly infiltrated the corpus callosum genu (44.2%) with bilateral extension (85.4%) into frontal (68.3%) or parietal (8.9%) lobes. Most G-I-CC were glioblastomas (84.5%) with IDH-wildtype (84.9%) and unmethylated MGMT promoter (53.5%). Resection (76.7%) was preferred over biopsy (23.3%), mostly gross-total (33.8%) and subtotal (32.5%). The tumor-infiltrated corpus callosum was resected in 57.8% of cases. Radiation was delivered in 65.8% of patients and temozolomide in 68.3%. Median follow-up was 12 months (range, 0.1−116). In total, 142 patients (31.8%) experienced post-surgical complications, including transient supplementary motor area syndrome (5.1%) and persistent motor deficits (4.3%) or abulia (2.5%). Post-treatment symptom improvement was reported in 42.9% of patients. No differences in rates of complications (p = 0.231) and symptom improvement (p = 0.375) were found in cases with resected versus preserved corpus callosum. Recurrences occurred in 40.9% of cases, with median progression-free survival of 9 months (0.1−72). Median overall survival was 10.7 months (range, 0.1−116), significantly longer in low-grade tumors (p = 0.013) and after resection (p < 0.001), especially gross-total (p = 0.041) in patients with high-grade tumors. Conclusions: G-I-CC show clinicopathological patterns comparable to other more frequent gliomas. Maximally safe resection significantly improves survival with low rates of persistent complications.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, 95029 Viagrande, Italy;
| | - Gina Watanabe
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (G.W.); (C.O.)
| | - Christian Ogasawara
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (G.W.); (C.O.)
| | - Emal Lesha
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Othman Bin-Alamer
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Giuseppe E. Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Kenny Yu
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.Y.); (T.Y.E.A.)
| | - Aaron A. Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Tarek Y. El Ahmadieh
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.Y.); (T.Y.E.A.)
| | - Ali S. Haider
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA;
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Motomura K, Ohka F, Aoki K, Saito R. Supratotal Resection of Gliomas With Awake Brain Mapping: Maximal Tumor Resection Preserving Motor, Language, and Neurocognitive Functions. Front Neurol 2022; 13:874826. [PMID: 35645972 PMCID: PMC9133877 DOI: 10.3389/fneur.2022.874826] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Gliomas are a category of infiltrating glial neoplasms that are often located within or near the eloquent areas involved in motor, language, and neurocognitive functions. Surgical resection being the first-line treatment for gliomas, plays a crucial role in patient outcome. The role of the extent of resection (EOR) was evaluated, and we reported significant correlations between a higher EOR and better clinical prognosis of gliomas. However, recurrence is inevitable, even after aggressive tumor removal. Thus, efforts have been made to achieve extended tumor resection beyond contrast-enhanced mass lesions in magnetic resonance imaging (MRI)-defined areas, a process known as supratotal resection. Since it has been reported that tumor cells invade beyond regions visible as abnormal areas on MRI, imaging underestimates the true spatial extent of tumors. Furthermore, tumor cells have the potential to spread 10–20 mm away from the MRI-verified tumor boundary. The primary goal of supratotal resection is to maximize EOR and prolong the progression-free and overall survival of patients with gliomas. The available data, as well as our own work, clearly show that supratotal resection of gliomas is a feasible technique that has improved with the aid of awake functional mapping using intraoperative direct electrical stimulation. Awake brain mapping has enabled neurosurgeons achieve supratotal resection with favorable motor, language, and neurocognitive outcomes, ensuring a better quality of life in patients with gliomas.
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Jensdottir M, Beniaminov S, Jakola AS, Persson O, Norrelgen F, Hylin S, Fletcher-Sandersjöö A, Bartek J. Standardized reporting of adverse events and functional status from the first 5 years of awake surgery for gliomas: a population-based single-institution consecutive series. Acta Neurochir (Wien) 2022; 164:1995-2008. [PMID: 35420374 DOI: 10.1007/s00701-022-05191-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report our experience and investigate frequencies of adverse events and functional status from the first 5 years of performing awake surgery for gliomas in a single-center population-based setting. METHODS We conducted a review of all patients with a glioma treated with awake surgery during the first 5 years following introduction of awake surgery at our center (February 2015 to February 2020). We assessed functional and radiological outcome, with adverse events classified according to the Landriel-Ibanez classification for neurosurgical complications, while neurological deficits were further subdivided into transient vs permanent. We sought to analyze our initial results and learning curve, as well as compare our results with literature. RESULTS Forty-two patients were included. The median age was 38 years (range 18-66) and 13 (31%) were female. The indication for awake surgery was a presumed glioma in or near an eloquent area. The overall 30-day complication rate was 25 (59%), with 19 (45%) grade I complications, 3 (7%) grade II complications, and 3 (7%) grade III complications. Fifteen patients (36%) experienced transient neurological deficits, and 11 (26%) permanent neurological deficits. At 3-month follow-up, the Karnofsky Performance Score was 80 or higher for the entire cohort. The median extent of resection was 87%, with GTR achieved in 11 (26%). In search of potential learning curve difficulties, patients were divided into the 21 patients treated first (Early Group) versus the remaining 21 patients treated later (Late Group); no statistically significant difference in operating time, amount of tumor removed, or incidence of long-term postoperative neurological deficit was identified between groups. No awake surgery was aborted due to seizures. Comparison to the literature was limited by the diverse and unsystematic way in which previous studies have reported adverse events after awake craniotomy for gliomas. CONCLUSION We provide a standardized report of adverse events and functional status following awake surgery for glioma during a single-center 5-year learning period, with similar rates of severe adverse events and functional outcome compared to literature without concerns of substantial learning curve difficulties. However, this comparison was flawed by non-standardized reporting of complications, highlighting a demand for more standardized reporting of adverse events after awake craniotomies.
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Affiliation(s)
- Margret Jensdottir
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Stanislav Beniaminov
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Asgeir S Jakola
- Sahlgrenska Academy and Department of Neurosurgery, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Oscar Persson
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Fritjof Norrelgen
- Department of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Sofia Hylin
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Fletcher-Sandersjöö
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jiri Bartek
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
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Gray K, Avitsian R, Kakumanu S, Venkatraghavan L, Chowdhury T. The Effects of Anesthetics on Glioma Progression: A Narrative Review. J Neurosurg Anesthesiol 2022; 34:168-175. [PMID: 32658099 DOI: 10.1097/ana.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/15/2020] [Indexed: 11/26/2022]
Abstract
There are many established factors that influence glioma progression, including patient age, grade of tumor, genetic mutations, extent of surgical resection, and chemoradiotherapy. Although the exposure time to anesthetics during glioma resection surgery is relatively brief, the hemodynamic changes involved and medications used, as well as the stress response throughout the perioperative period, may also influence postoperative outcomes in glioma patients. There are numerous studies that have demonstrated that choice of anesthesia influences non-brain cancer outcomes; of particular interest are those describing that the use of total intravenous anesthesia may yield superior outcomes compared with volatile agents in in vitro and human studies. Much remains to be discovered on the topic of anesthesia's effect on glioma progression.
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Affiliation(s)
| | - Rafi Avitsian
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Saranya Kakumanu
- Department of Radiation Oncology, Cancer Care Manitoba, Winnipeg, MB
| | - Lashmi Venkatraghavan
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, ON, Canada
| | - Tumul Chowdhury
- Department of Anesthesiology, Perioperative, and Pain Medicine, Health Sciences Center, University of Manitoba
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Current Status of Neuromodulation-Induced Cortical Prehabilitation and Considerations for Treatment Pathways in Lower-Grade Glioma Surgery. LIFE (BASEL, SWITZERLAND) 2022; 12:life12040466. [PMID: 35454957 PMCID: PMC9024440 DOI: 10.3390/life12040466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/19/2022] [Accepted: 03/19/2022] [Indexed: 12/15/2022]
Abstract
The infiltrative character of supratentorial lower grade glioma makes it possible for eloquent neural pathways to remain within tumoural tissue, which renders complete surgical resection challenging. Neuromodulation-Induced Cortical Prehabilitation (NICP) is intended to reduce the likelihood of premeditated neurologic sequelae that otherwise would have resulted in extensive rehabilitation or permanent injury following surgery. This review aims to conceptualise current approaches involving Repetitive Transcranial Magnetic Stimulation (rTMS-NICP) and extraoperative Direct Cortical Stimulation (eDCS-NICP) for the purposes of inducing cortical reorganisation prior to surgery, with considerations derived from psychiatric, rehabilitative and electrophysiologic findings related to previous reports of prehabilitation. Despite the promise of reduced risk and incidence of neurologic injury in glioma surgery, the current data indicates a broad but compelling possibility of effective cortical prehabilitation relating to perisylvian cortex, though it remains an under-explored investigational tool. Preliminary findings may prove sufficient for the continued investigation of prehabilitation in small-volume lower-grade tumour or epilepsy patients. However, considering the very low number of peer-reviewed case reports, optimal stimulation parameters and duration of therapy necessary to catalyse functional reorganisation remain equivocal. The non-invasive nature and low risk profile of rTMS-NICP may permit larger sample sizes and control groups until such time that eDCS-NICP protocols can be further elucidated.
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Impact of awake mapping on overall survival and extent of resection in patients with adult diffuse gliomas within or near eloquent areas: a retrospective propensity score-matched analysis of awake craniotomy vs. general anesthesia. Acta Neurochir (Wien) 2022; 164:395-404. [PMID: 34605985 DOI: 10.1007/s00701-021-04999-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Awake craniotomy (AC) with intraoperative mapping is the best approach to preserve neurological function for glioma surgery in eloquent or near eloquent areas, but whether AC improves the extent of resection (EOR) and overall survival (OS) is controversial. This study aimed to compare the long-term clinical outcomes of glioma resection under AC with those under general anesthesia (GA). METHODS Data of 335 patients who underwent surgery with intraoperative magnetic resonance imaging for newly diagnosed gliomas of World Health Organization (WHO) grades II-IV between 2000 and 2013 were reviewed. EOR and OS were quantitatively compared between the AC and GA groups after 1:1 propensity score matching. The two groups were matched for age, preoperative Karnofsky performance status (KPS), tumor location, and pathology. RESULTS After propensity score matching, 91 pairs were obtained. The median EOR was 96.1% (interquartile range [IQR] 7.3) and 97.4% (IQR 14.4) in the AC and GA groups, respectively (p = 0.31). Median KPS score 3 months after surgery was 90 (IQR 20) in both groups (p = 0.384). The median survival times were 163.3 months (95% confidence interval [CI] 77.9-248.7) and 143.5 months (95% CI 94.4-192.7) in the AC and GA groups, respectively (p = 0.585). CONCLUSION Even if the glioma was within or close to the eloquent area, AC was comparable with GA in terms of EOR and OS. In case of difficulties in randomizing patients with eloquent or near eloquent glioma, our propensity score-matched analysis provides retrospective evidence that AC can obtain EOR and OS equivalent to removing glioma under GA.
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Staged Resection of Multilobar Lower-Grade Glioma: Case Report and Review of the Literature. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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46
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Tchoe Y, Bourhis AM, Cleary DR, Stedelin B, Lee J, Tonsfeldt KJ, Brown EC, Siler DA, Paulk AC, Yang JC, Oh H, Ro YG, Lee K, Russman SM, Ganji M, Galton I, Ben-Haim S, Raslan AM, Dayeh SA. Human brain mapping with multithousand-channel PtNRGrids resolves spatiotemporal dynamics. Sci Transl Med 2022; 14:eabj1441. [PMID: 35044788 DOI: 10.1126/scitranslmed.abj1441] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Electrophysiological devices are critical for mapping eloquent and diseased brain regions and for therapeutic neuromodulation in clinical settings and are extensively used for research in brain-machine interfaces. However, the existing clinical and experimental devices are often limited in either spatial resolution or cortical coverage. Here, we developed scalable manufacturing processes with a dense electrical connection scheme to achieve reconfigurable thin-film, multithousand-channel neurophysiological recording grids using platinum nanorods (PtNRGrids). With PtNRGrids, we have achieved a multithousand-channel array of small (30 μm) contacts with low impedance, providing high spatial and temporal resolution over a large cortical area. We demonstrated that PtNRGrids can resolve submillimeter functional organization of the barrel cortex in anesthetized rats that captured the tissue structure. In the clinical setting, PtNRGrids resolved fine, complex temporal dynamics from the cortical surface in an awake human patient performing grasping tasks. In addition, the PtNRGrids identified the spatial spread and dynamics of epileptic discharges in a patient undergoing epilepsy surgery at 1-mm spatial resolution, including activity induced by direct electrical stimulation. Collectively, these findings demonstrated the power of the PtNRGrids to transform clinical mapping and research with brain-machine interfaces.
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Affiliation(s)
- Youngbin Tchoe
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Andrew M Bourhis
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Daniel R Cleary
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA.,Department of Neurological Surgery, University of California San Diego, La Jolla, CA 92093, USA
| | - Brittany Stedelin
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR 97239, USA
| | - Jihwan Lee
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Karen J Tonsfeldt
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, Center for Reproductive Science and Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Erik C Brown
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR 97239, USA
| | - Dominic A Siler
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR 97239, USA
| | - Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jimmy C Yang
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Hongseok Oh
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Yun Goo Ro
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Keundong Lee
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Samantha M Russman
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Mehran Ganji
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Ian Galton
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Sharona Ben-Haim
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA.,Department of Neurological Surgery, University of California San Diego, La Jolla, CA 92093, USA
| | - Ahmed M Raslan
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR 97239, USA
| | - Shadi A Dayeh
- Integrated Electronics and Biointerfaces Laboratory, Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA 92093, USA.,Department of Neurological Surgery, University of California San Diego, La Jolla, CA 92093, USA.,Graduate Program of Materials Science and Engineering, University of California San Diego, La Jolla, CA 92093, USA
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Lee CZ, Poon CCM. An Update of Neuroanesthesia for Intraoperative Brain Mapping Craniotomy. Neurosurgery 2022; 90:1-6. [PMID: 33647962 DOI: 10.1093/neuros/nyab022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/13/2020] [Indexed: 01/06/2023] Open
Abstract
The perioperative multidisciplinary team approach has probably been best exemplified by the care of awake craniotomy patients. Advancement in anesthesia and meticulous perioperative care has supported the safety and complexity of the surgical and mapping efforts in glioma resection. The discussions in this review will emphasize on anesthetic and perioperative management strategies to prevent complications and minimize their effects if they occur, including current practice guidelines in anesthesia, updates on the applications of anesthetic medications, and emerging devices. Planning the anesthetic and perioperative management is based on understanding the pharmacology of the medications, the goals of different stages of the surgery and mapping, and anticipating potential problems.
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Affiliation(s)
- Chanhung Z Lee
- Department of Anesthesia and Perioperative Care, University of California , San Francisco, San Francisco, California, USA
| | - Clara C M Poon
- Department of Anaesthesiology, Queen Mary Hospital, University of Hong Kong , Hong Kong
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Tomasino B, Guarracino I, Ius T, Maieron M, Skrap M. Real-Time Neuropsychological Testing Protocol for Left Temporal Brain Tumor Surgery: A Technical Note and Case Report. Front Hum Neurosci 2021; 15:760569. [PMID: 34924981 PMCID: PMC8678085 DOI: 10.3389/fnhum.2021.760569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background: The risk of surgery in eloquent areas is related to neuropsychological dysfunctions. Maximizing the extent of resection increases the overall survival. The onco-functional balance is mandatory when surgery involves cognitive areas, and maximal information on the cognitive status of patients during awake surgery is needed. This can be achieved using direct cortical stimulation mapping and, in addition to this, a neuropsychological monitoring technique called real-time neuropsychological testing (RTNT). The RTNT includes testing protocols based on the area where the surgery is performed. We reported on tests used for left temporal lobe surgery and our RTNT decision tree. Case Report: We reported our RTNT experience with a 25-year-old right-handed man with 13 years of schooling. He reported daily partial seizures. MRI revealed the presence of a low-grade glioma involving the temporo-insular cortex. The neuropsychological status presurgery which was within the normal range was combined with functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) information. Awake surgery plus RTNT was performed. Direct electrical stimulation during object naming elicited a motor speech arrest. Resection was continuously accompanied by the RTNT. The RTNT provided enriched information to the surgeon. Performance never dropped. A slight decrement in accuracy emerged for pseudoword repetition, short-term memory and working memory, phonological processing, and verbal comprehension. Total resection was performed, and the histological examination confirmed the nature of the lesion. Immediate postsurgery performance was within the normal range as it was the fMRI and DTI assessment. Conclusion: The RTNT provides essential information that can be used online, during surgery, for clinical aims to provide the surgeon with useful feedback on the cognitive status of patients.
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Affiliation(s)
- Barbara Tomasino
- Scientific Institute, IRCCS E. Medea, Dipartimento/Unità Operativa Pasian di Prato, Udine, Italy
| | - Ilaria Guarracino
- Scientific Institute, IRCCS E. Medea, Dipartimento/Unità Operativa Pasian di Prato, Udine, Italy
| | - Tamara Ius
- SOC Neurochirurgia, Azienda Sanitaria Universitaria Friuli Centrale ASU FC, Udine, Italy
| | - Marta Maieron
- Fisica Sanitaria, Azienda Sanitaria Universitaria Friuli Centrale ASU FC, Udine, Italy
| | - Miran Skrap
- SOC Neurochirurgia, Azienda Sanitaria Universitaria Friuli Centrale ASU FC, Udine, Italy
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Lemaitre AL, Herbet G, Ng S, Moritz-Gasser S, Duffau H. Cognitive preservation following awake mapping-based neurosurgery for low-grade gliomas: a longitudinal, within-patient design study. Neuro Oncol 2021; 24:781-793. [PMID: 34850187 DOI: 10.1093/neuonc/noab275] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Awake surgery with intraoperative electrical mapping emerged as a gold-standard approach in newly diagnosed diffuse low-grade glioma (DLGG) to optimize the extent of resection (EOR) while sparing critical brain structures. However, no study has assessed to what extent cognitive recovery occurs following awake mapping-guided neurosurgery in a large, longitudinal and homogeneous series of DLGG. METHODS A longitudinal study on the cognitive status of 157 DLGG patients was performed. Neuropsychological assessments were done before and three months after awake mapping-based surgery. Z-scores and variations of Z-scores were computed to determine the number of patients with cognitive deficit(s) or decline. Clinical, surgical, and histopathological variables were studied to investigate factors contributing to neurocognitive outcomes. RESULTS 87 patients (55.4%) had preoperative cognitive impairments. Statistical analysis between the preoperative (baseline) and postoperative assessments demonstrated a significant difference in three domains (Executive, Psychomotor Speed and Attention, Verbal Episodic Memory). 86% of patients exhibited no postoperative cognitive decline and among them 10% exhibited cognitive improvement. The mean EOR was 92.3%±7.8%. The EOR, postoperative volume, and tumor lateralization had a significant association with cognitive decline. No patients demonstrated permanent post-operative neurologic deficits, but 5.8% did not resume their preoperative professional activities. The 5-year survival rate was 82.2%. CONCLUSIONS This is the largest series ever reported with systematic longitudinal neuropsychological assessment. 86% of patients demonstrated no cognitive decline despite large resections and only 5.8% did not return to work. This work supports the practice of awake surgery with cognitive mapping as safe and effective in DLGG patients.
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Affiliation(s)
- Anne-Laure Lemaitre
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, 34091, France
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, 34091, France
| | - Sam Ng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, 34091, France
| | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, 34091, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, 34091, France
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Predicting the Extent of Resection of Motor-Eloquent Gliomas Based on TMS-Guided Fiber Tracking. Brain Sci 2021; 11:brainsci11111517. [PMID: 34827516 PMCID: PMC8615964 DOI: 10.3390/brainsci11111517] [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: 09/30/2021] [Revised: 11/05/2021] [Accepted: 11/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Surgical planning with nTMS-based tractography is proven to increase safety during surgery. A preoperative risk stratification model has been published based on the M1 infiltration, RMT ratio, and tumor to corticospinal tract distance (TTD). The correlation of TTD with corticospinal tract to resection cavity distance (TRD) and outcome is needed to further evaluate the validity of the model. Aim of the study: To use the postop MRI-derived resection cavity to measure how closely the resection cavity approximated the preoperatively calculated corticospinal tract (CST) and how this correlates with the risk model and the outcome. Methods: We included 183 patients who underwent nTMS-based DTI and surgical resection for presumed motor-eloquent gliomas. TTD, TRD, and motor outcome were recorded and tested for correlations. The intraoperative monitoring documentation was available for a subgroup of 48 patients, whose responses were correlated to TTD and TRD. Results: As expected, TTD and TRD showed a good correlation (Spearman’s ρ = 0.67, p < 0.001). Both the TTD and the TRD correlated significantly with the motor outcome at three months (Kendall’s Tau-b 0.24 for TTD, 0.31 for TRD, p < 0.001). Interestingly, the TTD and TRD correlated only slightly with residual tumor volume, and only after correction for outliers related to termination of resection due to intraoperative monitoring events or the proximity of other eloquent structures (TTD ρ = 0.32, p < 0.001; TRD ρ = 0.19, p = 0.01). This reflects the fact that intraoperative monitoring (IOM) phenomena do not always correlate with preoperative structural analysis, and that additional factors influence the intraoperative decision to abort resection, such as the adjacency of other vulnerable structures. The TTD was also significantly correlated with variations in motor evoked potential (MEP) responses (no/reversible decrease vs. irreversible decrease; p = 0.03). Conclusions: The TTD approximates the TRD well, confirming the best predictive parameter and giving strength to the nTMS-based risk stratification model. Our analysis of TRD supports the use of the nTMS-based TTD measurement to estimate the resection preoperatively, also confirming the 8 mm cutoff. Nevertheless, the TRD proved to have a slightly stronger correlation with the outcome as the surgeon’s experience, anatomofunctional knowledge, and MEP observations influence the expected EOR.
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