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de Zwart B, Ruis C. An update on tests used for intraoperative monitoring of cognition during awake craniotomy. Acta Neurochir (Wien) 2024; 166:204. [PMID: 38713405 PMCID: PMC11076349 DOI: 10.1007/s00701-024-06062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/02/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Mapping higher-order cognitive functions during awake brain surgery is important for cognitive preservation which is related to postoperative quality of life. A systematic review from 2018 about neuropsychological tests used during awake craniotomy made clear that until 2017 language was most often monitored and that the other cognitive domains were underexposed (Ruis, J Clin Exp Neuropsychol 40(10):1081-1104, 218). The field of awake craniotomy and cognitive monitoring is however developing rapidly. The aim of the current review is therefore, to investigate whether there is a change in the field towards incorporation of new tests and more complete mapping of (higher-order) cognitive functions. METHODS We replicated the systematic search of the study from 2018 in PubMed and Embase from February 2017 to November 2023, yielding 5130 potentially relevant articles. We used the artificial machine learning tool ASReview for screening and included 272 papers that gave a detailed description of the neuropsychological tests used during awake craniotomy. RESULTS Comparable to the previous study of 2018, the majority of studies (90.4%) reported tests for assessing language functions (Ruis, J Clin Exp Neuropsychol 40(10):1081-1104, 218). Nevertheless, an increasing number of studies now also describe tests for monitoring visuospatial functions, social cognition, and executive functions. CONCLUSIONS Language remains the most extensively tested cognitive domain. However, a broader range of tests are now implemented during awake craniotomy and there are (new developed) tests which received more attention. The rapid development in the field is reflected in the included studies in this review. Nevertheless, for some cognitive domains (e.g., executive functions and memory), there is still a need for developing tests that can be used during awake surgery.
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Affiliation(s)
- Beleke de Zwart
- Experimental Psychology, Helmholtz Institution, Utrecht University, Utrecht, The Netherlands.
| | - Carla Ruis
- Experimental Psychology, Helmholtz Institution, Utrecht University, Utrecht, The Netherlands
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Maurer S, Butenschoen VM, Kelm A, Schramm S, Schröder A, Meyer B, Krieg SM. Permanent deterioration of fine motor skills after the resection of tumors in the supplementary motor area. Neurosurg Rev 2024; 47:114. [PMID: 38480549 PMCID: PMC10937754 DOI: 10.1007/s10143-024-02330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
Supplementary motor area syndrome (SMAS) represents a common neurosurgical sequela. The incidence and time frame of its occurrence have yet to be characterized after surgery for brain tumors. We examined patients suffering from a brain tumor preoperatively, postoperatively, and during follow-up examinations after three months, including fine motor skills testing and transcranial magnetic stimulation (TMS). 13 patients suffering from a tumor in the dorsal part of the superior frontal gyrus underwent preoperative, early postoperative, and 3-month follow-up testing of fine motor skills using the Jebsen-Taylor Hand Function Test (JHFT) and the Nine-Hole Peg Test (NHPT) consisting of 8 subtests for both upper extremities. They completed TMS for cortical motor function mapping. Test completion times (TCTs) were recorded and compared. No patient suffered from neurological deficits before surgery. On postoperative day one, we detected motor deficits in two patients, which remained clinically stable at a 3-month follow-up. Except for page-turning, every subtest indicated a significant worsening of function, reflected by longer TCTs (p < 0.05) in the postoperative examinations for the contralateral upper extremity (contralateral to the tumor manifestation). At 3-month follow-up examinations for the contralateral upper extremity, each subtest indicated significant worsening compared to the preoperative status despite improvement to the immediate postoperative level. We also detected significantly longer TCTs (p < 0.05) postoperatively in the ipsilateral upper extremity. This study suggests a long-term worsening of fine motor skills even three months after SMA tumor resection, indicating the necessity of targeted physical therapy for these patients.
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Affiliation(s)
- Stefanie Maurer
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Vicki M Butenschoen
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Anna Kelm
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Severin Schramm
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Axel Schröder
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.
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Voets NL, Bartsch AJ, Plaha P. Functional MRI applications for intra-axial brain tumours: uses and nuances in surgical practise. Br J Neurosurg 2023; 37:1544-1559. [PMID: 36148501 DOI: 10.1080/02688697.2022.2123893] [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: 03/18/2022] [Accepted: 09/07/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Functional MRI (fMRI) has well-established uses to inform risks and plan maximally safe approaches in neurosurgery. In the field of brain tumour surgery, however, fMRI is currently in a state of clinical equipoise due to debate around both its sensitivity and specificity. MATERIALS AND METHODS In this review, we summarise the role and our experience of fMRI in neurosurgery for gliomas and metastases. We discuss nuances in the conduct and interpretation of fMRI that, based on our practise, most directly impact fMRI's usefulness in the neurosurgical setting. RESULTS Illustrated examples in which fMRI in our hands directly influences the neurosurgical treatment of brain tumours include evaluating the probability and nature of functional risks, especially for language functions. These presurgical risk assessments, in turn, help to predict the resectability of tumours, select or deselect patients for awake surgery, indicate the need for neurophysiological monitoring and guide the optimal use of intra-operative stimulation mapping. A further emerging application of fMRI is in measuring functional adaptation of functional networks after (partial) surgery, of potential use in the timing of further surgery. CONCLUSIONS In appropriately selected patients with a clearly defined surgical question, fMRI offers a valuable complementary tool in the pre-surgical evaluation of brain tumours. However, there is a great need for standards in the administration and analysis of fMRI as much as in the techniques that it is commonly evaluated against. Surprisingly little data exists that evaluates the accuracy of fMRI not just against complementary methods, but in terms of its ultimate clinical aim of minimising post-surgical morbidity.
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Affiliation(s)
- Natalie L Voets
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- GenesisCare Ltd, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andreas J Bartsch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Puneet Plaha
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Neurosurgery, University of Oxford, Oxford, UK
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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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Zheng A, Chen X, Li Q, Ling Y, Liu X, Li W, Liu Y, Chen H. Neural correlates of Type A personality: Type A personality mediates the association of resting-state brain activity and connectivity with eating disorder symptoms. J Affect Disord 2023; 333:331-341. [PMID: 37086800 DOI: 10.1016/j.jad.2023.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/05/2023] [Accepted: 04/16/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Type A personality (TAP) was characterized by impatience, competitiveness, aggressiveness, and hostility. Higher TAP was proved to be associated with more eating disorder symptoms (EDS). While little is known about the underlying neural substrates of TAP and how TAP is linked to EDS at the neural level. METHODS To investigate the neural basis of TAP, we adopted fractional amplitude of low-frequency fluctuations (fALFF) and resting-state functional connectivity (RSFC) via resting-state functional magnetic resonance imaging (rs-fMRI) (N = 1620). Mediation models were examined to explore the relationship between TAP, EDS, and brain activity. RESULTS TAP was associated with decreased fALFF in the left middle frontal gyrus (MFG) and increased fALFF in the left precentral gyrus (PreCG). Furthermore, TAP was positively correlated to RSFC between the left MFG and left inferior temporal gyrus (ITG) and between the left PreCG and right middle temporal gyrus (MTG). Mediation analysis showed TAP fully mediated the association of the left MFG activity, MFG-ITG connectivity, and PreCG-MTG connectivity with EDS. LIMITATIONS The cross-sectional design of this study precludes us from specifying the causal relationship in the associations we observed. CONCLUSIONS Our results suggested spontaneous activity in the left MFG and PreCG is associated with TAP, and even in general sample, people with higher TAP showed more EDS. The present study is the first to investigate the neurobiological underpinnings of TAP in a large sample and further offered new insights into the relation between TAP and EDS from a neural basis perspective.
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Affiliation(s)
- Anqi Zheng
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Ximei Chen
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Qingqing Li
- School of Psychology, Central China Normal University, China
| | - Ying Ling
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Xinyuan Liu
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Wei Li
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Yong Liu
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Hong Chen
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China; Research Center of Psychology and Social Development, Chongqing 400715, China.
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Rech F, Duffau H. Beyond Avoiding Hemiplegia after Glioma Surgery: The Need to Map Complex Movement in Awake Patient to Preserve Conation. Cancers (Basel) 2023; 15:cancers15051528. [PMID: 36900318 PMCID: PMC10001205 DOI: 10.3390/cancers15051528] [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: 02/13/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Improving the onco-functional balance has always been a challenge in glioma surgery, especially regarding motor function. Given the importance of conation (i.e., the willingness which leads to action) in patient's quality of life, we propose here to review the evolution of its intraoperative assessment through a reminder of the increasing knowledge of its neural foundations-based upon a meta-networking organization at three levels. Historical preservation of the primary motor cortex and pyramidal pathway (first level), which was mostly dedicated to avoid hemiplegia, has nonetheless shown its limits to prevent the occurrence of long-term deficits regarding complex movement. Then, preservation of the movement control network (second level) has permitted to prevent such more subtle (but possibly disabling) deficits thanks to intraoperative mapping with direct electrostimulations in awake conditions. Finally, integrating movement control in a multitasking evaluation during awake surgery (third level) enabled to preserve movement volition in its highest and finest level according to patients' specific demands (e.g., to play instrument or to perform sports). Understanding these three levels of conation and its underlying cortico-subcortical neural basis is therefore critical to propose an individualized surgical strategy centered on patient's choice: this implies an increasingly use of awake mapping and cognitive monitoring regardless of the involved hemisphere. Moreover, this also pleads for a finer and systematic assessment of conation before, during and after glioma surgery as well as for a stronger integration of fundamental neurosciences into clinical practice.
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Affiliation(s)
- Fabien Rech
- Department of Neurosurgery, CHRU de Nancy, Université de Lorraine, F-54000 Nancy, France
- Le Centre de Recherche en Automatique de Nancy, Le Centre National de la Recherche Scientifique, Université de Lorraine, F-54000 Nancy, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, F-34295 Montpellier, France
- Team ‘Plasticity of Central Nervous System, Stem Cells and Glial Tumours’, INSERM U1191, Institute of Genomics of Montpellier, University of Montpellier, F-34295 Montpellier, France
- Correspondence:
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Identification of cerebral cortices processing acceleration, velocity, and position during directional reaching movement with deep neural network and explainable AI. Neuroimage 2023; 266:119783. [PMID: 36528312 DOI: 10.1016/j.neuroimage.2022.119783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/22/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Cerebral cortical representation of motor kinematics is crucial for understanding human motor behavior, potentially extending to efficient control of the brain-computer interface. Numerous single-neuron studies have found the existence of a relationship between neuronal activity and motor kinematics such as acceleration, velocity, and position. Despite differences between kinematic characteristics, it is hard to distinguish neural representations of these kinematic characteristics with macroscopic functional images such as electroencephalography (EEG) and magnetoencephalography (MEG). The reason might be because cortical signals are not sensitive enough to segregate kinematic characteristics due to their limited spatial and temporal resolution. Considering different roles of each cortical area in producing movement, there might be a specific cortical representation depending on characteristics of acceleration, velocity, and position. Recently, neural network modeling has been actively pursued in the field of decoding. We hypothesized that neural features of each kinematic parameter could be identified with a high-performing model for decoding with an explainable AI method. Time-series deep neural network (DNN) models were used to measure the relationship between cortical activity and motor kinematics during reaching movement. With DNN models, kinematic parameters of reaching movement in a 3D space were decoded based on cortical source activity obtained from MEG data. An explainable artificial intelligence (AI) method was then adopted to extract the map of cortical areas, which strongly contributed to decoding each kinematics from DNN models. We found that there existed differed as well as shared cortical areas for decoding each kinematic attribute. Shared areas included bilateral supramarginal gyri and superior parietal lobules known to be related to the goal of movement and sensory integration. On the other hand, dominant areas for each kinematic parameter (the contralateral motor cortex for acceleration, the contralateral parieto-frontal network for velocity, and bilateral visuomotor areas for position) were mutually exclusive. Regarding the visuomotor reaching movement, the motor cortex was found to control the muscle force, the parieto-frontal network encoded reaching movement from sensory information, and visuomotor areas computed limb and gaze coordination in the action space. To the best of our knowledge, this is the first study to discriminate kinematic cortical areas using DNN models and explainable AI.
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Wang P, Wang J, Jiang Y, Wang Z, Meng C, Castellanos FX, Biswal BB. Cerebro-cerebellar Dysconnectivity in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:1372-1384. [PMID: 35661770 DOI: 10.1016/j.jaac.2022.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/16/2022] [Accepted: 03/30/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Abnormal cerebellar development has been implicated in attention-deficit/hyperactivity disorder (ADHD), although cerebro-cerebellar functional connectivity (FC) has yet to be examined in ADHD. Our objective is to investigate the disturbed cerebro-cerebellar FC in children and adolescents with ADHD. METHOD We analyzed a dataset of 106 individuals with ADHD (68 children, 38 adolescents) and 62 healthy comparison individuals (34 children, 28 adolescents) from the publicly available ADHD-200 dataset. We identified 7 cerebellar subregions based on cerebro-cerebellar FC and subsequently obtained the FC maps of cerebro-cerebellar networks. The main effects of ADHD and age and their interaction were examined using 2-way analysis of variance. RESULTS Compared to comparisons, ADHD showed higher cerebro-cerebellar FC in the superior temporal gyrus within the somatomotor network. Interactions of diagnosis and age were identified in the supplementary motor area and postcentral gyrus within the somatomotor network and middle temporal gyrus within the ventral attention network. Follow-up Pearson correlation analysis revealed decreased cerebro-cerebellar FC in these regions with increasing age in comparisons, whereas the opposite pattern of increased cerebro-cerebellar FC occurred in ADHD. CONCLUSION Increased cerebro-cerebellar FC in the superior temporal gyrus within the somatomotor network could underlie impairments in cognitive control and somatic motor function in ADHD. In addition, increasing cerebro-cerebellar FC in older participants with ADHD suggests that enhanced cerebellar involvement may compensate for dysfunctions of the cerebral cortex in ADHD.
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Affiliation(s)
- Pan Wang
- Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Jianlin Wang
- Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Jiang
- Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Zedong Wang
- Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Chun Meng
- Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - F Xavier Castellanos
- New York University School of Medicine, New York, and the Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Bharat B Biswal
- Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China; New Jersey Institute of Technology, Newark.
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Sato S, Shibahara I, Inukai M, Komai H, Hide T, Kumabe T. Anatomical and neurophysiological localization of the leg motor area at the medial central sulcus. Clin Neurophysiol 2022; 143:67-74. [PMID: 36126357 DOI: 10.1016/j.clinph.2022.08.021] [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: 06/02/2022] [Revised: 08/01/2022] [Accepted: 08/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The exact location of the leg motor area is still in debate due to the lack of landmarks such as 'precentral knob' in the medial cortex. This study tried to identify the leg motor area based on intraoperative neurophysiological data and neuroimaging techniques. METHODS Intraoperative data of somatosensory evoked potential (SEP) elicited by tibial nerve stimulation and motor evoked potential (MEP) of the leg muscles induced by direct cortical stimulation were recorded using subdural electrodes placed in the medial cortex. We displayed the neurophysiological data on the individual MR images and the MNI52. RESULTS Definite N40-P40 phase reversal was observed with the shallow grooves in the medial cortex in 5 cases. Leg MEP was successfully obtained in all 12 cases preserving the leg motor function. Superimposed SEP and leg MEP data on the MNI152 indicated the leg motor area was predominantly located in the posterior two-thirds between the vertical lines passing through the anterior commissure and the posterior commissure (VCP). CONCLUSIONS Our study revealed the location of the leg motor area and the presence of the 'medial central sulcus' in the medial cortex. SIGNIFICANCE The VCP can be useful landmark to identify the sensorimotor border in the medial cortex.
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Affiliation(s)
- Sumito Sato
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Madoka Inukai
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hideto Komai
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takuichiro Hide
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Gray Matter Abnormalities in Patients with Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis of Voxel-Based Morphometry Studies. Brain Sci 2022; 12:brainsci12081115. [PMID: 36009176 PMCID: PMC9405829 DOI: 10.3390/brainsci12081115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Current findings on brain structural alterations in complex regional pain syndrome (CRPS) are heterogenous and controversial. This study aimed to perform a systematic review and meta-analysis to explore the significant gray matter volume (GMV) abnormalities between patients with CRPS and healthy controls (HCs). A systematic search of the PubMed, Web of Science, and MEDLINE databases was performed, updated through 27 January 2022. A total of five studies (93 CRPS patients and 106 HCs) were included. Peak coordinates and effect sizes were extracted and meta-analyzed by anisotropic effect size-signed differential mapping (AES-SDM). Heterogeneity, sensitivity, and publication bias of the main results were checked by the Q test, jackknife analysis, and the Egger test, respectively. Meta-regression analysis was performed to explore the potential impact of risk factors on GMV alterations in patients with CRPS. The main analysis exhibited that patients with CRPS had increased GMV in the left medial superior frontal gyrus (SFGmedial.L), left striatum, and an undefined area (2, 0, -8) that may be in hypothalamus, as well as decreased GMV in the corpus callosum (CC) (extending to right supplementary motor area (SMA.R), right median cingulate/paracingulate gyri (MCC.R)), and an undefined area (extending to the right caudate nucleus (CAU.R), and right thalamus (THA.R)). Meta-regression analysis showed a negative relationship between increased GMV in the SFGmedial.L and disease duration, and the percentage of female patients with CRPS. Brain structure abnormalities in the sensorimotor regions (e.g., SFGmedial.L, SMA.R, CAU.R, MCC.R, and THA.R) may be susceptible in patients with CRPS. Additionally, sex differences and disease duration may have a negative effect on the increased GMV in SFGmedial.L.
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Zhou Y, Zhao Z, Zhang J, Hameed NUF, Zhu F, Feng R, Zhang X, Lu J, Wu J. Electrical stimulation-induced speech-related negative motor responses in the lateral frontal cortex. J Neurosurg 2022; 137:496-504. [PMID: 34952509 DOI: 10.3171/2021.9.jns211069] [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: 05/26/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Speech arrest is a common but crucial negative motor response (NMR) recorded during intraoperative brain mapping. However, recent studies have reported nonspeech-specific NMR sites in the ventral precentral gyrus (vPrCG), where stimulation halts both speech and ongoing hand movement. The aim of this study was to investigate the spatial relationship between speech-specific NMR sites and nonspeech-specific NMR sites in the lateral frontal cortex. METHODS In this prospective cohort study, an intraoperative mapping strategy was designed to identify positive motor response (PMR) sites and NMR sites in 33 consecutive patients undergoing awake craniotomy for the treatment of left-sided gliomas. Patients were asked to count, flex their hands, and simultaneously perform these two tasks to map NMRs. Each site was plotted onto a standard atlas and further analyzed. The speech and hand motor arrest sites in the supplementary motor area of 2 patients were resected. The 1- and 3-month postoperative language and motor functions of all patients were assessed. RESULTS A total of 91 PMR sites and 72 NMR sites were identified. NMR and PMR sites were anteroinferiorly and posterosuperiorly distributed in the precentral gyrus, respectively. Three distinct NMR sites were identified: 24 pure speech arrest (speech-specific NMR) sites (33.33%), 7 pure hand motor arrest sites (9.72%), and 41 speech and hand motor arrest (nonspeech-specific NMR) sites (56.94%). Nonspeech-specific NMR sites and speech-specific NMR sites were dorsoventrally distributed in the vPrCG. For language function, 1 of 2 patients in the NMA resection group had language dysfunction at the 1-month follow-up but had recovered by the 3-month follow-up. All patients in the NMA resection group had fine motor dysfunction at the 1- and 3-month follow-ups. CONCLUSIONS The study results demonstrated a functional segmentation of speech-related NMRs in the lateral frontal cortex and that most of the stimulation-induced speech arrest sites are not specific to speech. A better understanding of the spatial distribution of speech-related NMR sites will be helpful in surgical planning and intraoperative mapping and provide in-depth insight into the motor control of speech production.
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Affiliation(s)
- Yuyao Zhou
- 1Neurologic Surgery Department, Huashan Hospital, Fudan University
- 2Brain Function Laboratory, Neurosurgical Institute of Fudan University
| | - Zehao Zhao
- 1Neurologic Surgery Department, Huashan Hospital, Fudan University
- 2Brain Function Laboratory, Neurosurgical Institute of Fudan University
| | - Jie Zhang
- 1Neurologic Surgery Department, Huashan Hospital, Fudan University
- 2Brain Function Laboratory, Neurosurgical Institute of Fudan University
| | - N U Farrukh Hameed
- 1Neurologic Surgery Department, Huashan Hospital, Fudan University
- 2Brain Function Laboratory, Neurosurgical Institute of Fudan University
| | - Fengping Zhu
- 1Neurologic Surgery Department, Huashan Hospital, Fudan University
| | - Rui Feng
- 1Neurologic Surgery Department, Huashan Hospital, Fudan University
| | - Xiaoluo Zhang
- 1Neurologic Surgery Department, Huashan Hospital, Fudan University
| | - Junfeng Lu
- 1Neurologic Surgery Department, Huashan Hospital, Fudan University
- 2Brain Function Laboratory, Neurosurgical Institute of Fudan University
- 3Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
| | - Jinsong Wu
- 1Neurologic Surgery Department, Huashan Hospital, Fudan University
- 2Brain Function Laboratory, Neurosurgical Institute of Fudan University
- 3Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
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12
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Obaid S, Qureshi HM, Aljishi A, Shaikh N, Kundishora AJ, Bronen RA, DiLuna M, Damisah EC. Child Neurology: Functional Reorganization Mediating Supplementary Motor Area Syndrome Recovery in Agenesis of the Corpus Callosum. Neurology 2022; 99:161-165. [PMID: 35618432 PMCID: PMC9421776 DOI: 10.1212/wnl.0000000000200772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/08/2022] [Indexed: 11/24/2022] Open
Abstract
Supplementary motor area (SMA) syndrome is a typically transient condition resulting from damage to the medial premotor cortex. The exact mechanism of recovery remains unknown but is traditionally described as a process involving functional compensation by the contralateral SMA through corpus callosal fibers. The purpose of this case study is to highlight a distinct extracallosal mechanism of functional recovery from an SMA syndrome in a patient with agenesis of the corpus callosum (ACC). We present the clinical presentation and perioperative functional neuroimaging features of a 16-year-old patient with complete ACC who exhibited recovery from an SMA syndrome resulting from surgical resection of a right-sided low-grade glioma. Preoperative fMRI revealed anatomically concordant activation areas during finger and toe tapping tasks bilaterally. Three months after surgery, the patient had fully recovered, and a repeat fMRI revealed shift of the majority of the left toe tapping area from the expected contralateral hemisphere to the ipsilateral left paracentral lobule and SMA. The fMRI signal remodeling observed in this acallosal patient suggests that within-hemisphere plasticity of the healthy hemisphere may constitute an alternative critical process in SMA syndrome resolution and challenges the traditional view that transcallosal fibers are necessary for functional recovery.
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Affiliation(s)
- Sami Obaid
- From the Department of Neurosurgery and Department of Radiology, Yale School of Medicine, New Haven, CT
| | - Hanya M Qureshi
- From the Department of Neurosurgery and Department of Radiology, Yale School of Medicine, New Haven, CT
| | - Ayman Aljishi
- From the Department of Neurosurgery and Department of Radiology, Yale School of Medicine, New Haven, CT
| | - Neelam Shaikh
- From the Department of Neurosurgery and Department of Radiology, Yale School of Medicine, New Haven, CT
| | - Adam J Kundishora
- From the Department of Neurosurgery and Department of Radiology, Yale School of Medicine, New Haven, CT
| | - Richard A Bronen
- From the Department of Neurosurgery and Department of Radiology, Yale School of Medicine, New Haven, CT
| | - Michael DiLuna
- From the Department of Neurosurgery and Department of Radiology, Yale School of Medicine, New Haven, CT
| | - Eyiyemisi C Damisah
- From the Department of Neurosurgery and Department of Radiology, Yale School of Medicine, New Haven, CT.
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13
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Young JS, Gogos AJ, Aabedi AA, Morshed RA, Pereira MP, Lashof-Regas S, Mansoori Z, Luks T, Hervey-Jumper SL, Villanueva-Meyer JE, Berger MS. Resection of supplementary motor area gliomas: revisiting supplementary motor syndrome and the role of the frontal aslant tract. J Neurosurg 2022; 136:1278-1284. [PMID: 34598138 DOI: 10.3171/2021.4.jns21187] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The supplementary motor area (SMA) is an eloquent region that is frequently a site for glioma, or the region is included in the resection trajectory to deeper lesions. Although the clinical relevance of SMA syndrome has been well described, it is still difficult to predict who will become symptomatic. The object of this study was to define which patients with SMA gliomas would go on to develop a postoperative SMA syndrome. METHODS The University of California, San Francisco, tumor registry was searched for patients who, between 2010 and 2019, had undergone resection for newly diagnosed supratentorial diffuse glioma (WHO grades II-IV) performed by the senior author and who had at least 3 months of follow-up. Pre- and postoperative MRI studies were reviewed to confirm the tumor was located in the SMA region, and the extent of SMA resection was determined by volumetric assessment. Patient, tumor, and outcome data were collected retrospectively from documents available in the electronic medical record. Tumors were registered to a standard brain atlas to create a frequency heatmap of tumor volumes and resection cavities. RESULTS During the study period, 56 patients (64.3% male, 35.7% female) underwent resection of a newly diagnosed glioma in the SMA region. Postoperatively, 60.7% developed an SMA syndrome. Although the volume of tumor within the SMA region did not correlate with the development of SMA syndrome, patients with the syndrome had larger resection cavities in the SMA region (25.4% vs 14.2% SMA resection, p = 0.039). The size of the resection cavity in the SMA region did not correlate with the severity of the SMA syndrome. Patients who developed the syndrome had cavities that were located more posteriorly in the SMA region and in the cingulate gyrus. When the frontal aslant tract (FAT) was preserved, 50% of patients developed the SMA syndrome postoperatively, whereas 100% of the patients with disruption of the FAT during surgery developed the SMA syndrome (p = 0.06). Patients with SMA syndrome had longer lengths of stay (5.6 vs 4.1 days, p = 0.027) and were more likely to be discharged to a rehabilitation facility (41.9% vs 0%, p < 0.001). There was no difference in overall survival for newly diagnosed glioblastoma patients with SMA syndrome compared to those without SMA syndrome (1.6 vs 3.0 years, p = 0.33). CONCLUSIONS For patients with SMA glioma, more extensive resections and resections involving the posterior SMA region and posterior cingulate gyrus increased the likelihood of a postoperative SMA syndrome. Although SMA syndrome occurred in all cases in which the FAT was resected, FAT preservation does not reliably avoid SMA syndrome postoperatively.
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Affiliation(s)
- Jacob S Young
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Andrew J Gogos
- 1Department of Neurological Surgery, University of California, San Francisco
| | | | - Ramin A Morshed
- 1Department of Neurological Surgery, University of California, San Francisco
| | | | | | - Ziba Mansoori
- 3Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Tracy Luks
- 3Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | | | - Javier E Villanueva-Meyer
- 3Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Mitchel S Berger
- 1Department of Neurological Surgery, University of California, San Francisco
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14
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Elin K, Malyutina S, Bronov O, Stupina E, Marinets A, Zhuravleva A, Dragoy O. A New Functional Magnetic Resonance Imaging Localizer for Preoperative Language Mapping Using a Sentence Completion Task: Validity, Choice of Baseline Condition, and Test–Retest Reliability. Front Hum Neurosci 2022; 16:791577. [PMID: 35431846 PMCID: PMC9006995 DOI: 10.3389/fnhum.2022.791577] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
Abstract
To avoid post-neurosurgical language deficits, intraoperative mapping of the language function in the brain can be complemented with preoperative mapping with functional magnetic resonance imaging (fMRI). The validity of an fMRI “language localizer” paradigm crucially depends on the choice of an optimal language task and baseline condition. This study presents a new fMRI “language localizer” in Russian using overt sentence completion, a task that comprehensively engages the language function by involving both production and comprehension at the word and sentence level. The paradigm was validated in 18 neurologically healthy volunteers who participated in two scanning sessions, for estimating test–retest reliability. For the first time, two baseline conditions for the sentence completion task were compared. At the group level, the paradigm significantly activated both anterior and posterior language-related regions. Individual-level analysis showed that activation was elicited most consistently in the inferior frontal regions, followed by posterior temporal regions and the angular gyrus. Test–retest reliability of activation location, as measured by Dice coefficients, was moderate and thus comparable to previous studies. Test–retest reliability was higher in the frontal than temporo-parietal region and with the most liberal statistical thresholding compared to two more conservative thresholding methods. Lateralization indices were expectedly left-hemispheric, with greater lateralization in the frontal than temporo-parietal region, and showed moderate test-retest reliability. Finally, the pseudoword baseline elicited more extensive and more reliable activation, although the syllable baseline appears more feasible for future clinical use. Overall, the study demonstrated the validity and reliability of the sentence completion task for mapping the language function in the brain. The paradigm needs further validation in a clinical sample of neurosurgical patients. Additionally, the study contributes to general evidence on test–retest reliability of fMRI.
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Affiliation(s)
- Kirill Elin
- Center for Language and Brain, HSE University, Moscow, Russia
| | - Svetlana Malyutina
- Center for Language and Brain, HSE University, Moscow, Russia
- *Correspondence: Svetlana Malyutina,
| | - Oleg Bronov
- Department of Radiology, National Medical and Surgical Center Named After N.I. Pirogov, Moscow, Russia
| | | | - Aleksei Marinets
- Department of Radiology, National Medical and Surgical Center Named After N.I. Pirogov, Moscow, Russia
| | - Anna Zhuravleva
- Center for Language and Brain, HSE University, Moscow, Russia
| | - Olga Dragoy
- Center for Language and Brain, HSE University, Moscow, Russia
- Institute of Linguistics, Russian Academy of Sciences, Moscow, Russia
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15
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Sahu A, Kurki V, Vijan A, Janu A, Shetty P, Moiyadi A. Case Series of Applications of Resting State Functional MRI in Brain Tumor Surgery: A Novel Technique. Indian J Radiol Imaging 2022; 31:990-997. [PMID: 35136514 PMCID: PMC8817797 DOI: 10.1055/s-0041-1741046] [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] [Indexed: 11/01/2022] Open
Abstract
Abstract
Background The extent of resection for brain tumors is a critical factor in determining the oncologic outcome for a patient. However, a balance between preservation of neurological function and maximal resection is essential for true benefit.Functional magnetic resonance imaging (fMRI) is one of the approaches that augments the neurosurgeon's ability to attain maximal safe resection by providing preoperative mapping. It may not be possible to perform awake craniotomy with intraoperative localization by direct cortical stimulation in all patients, such as children and those with neurocognitive impairment. Task-based fMRI may have limited value in these cases due to low patient cooperability.
Methods In this article we present in a case-based format, the various clinical scenarios where resting state fMRI (rs-fMRI) can be helpful in guiding neurosurgical resection. rs-fMRI of the patients has been acquired on Philips 1.5 T system. Seed voxel method has been used for processing and analysis.
Conclusion rs-fMRI does not require active patient cooperation to generate useful information and thus can be a promising tool in patients unable to cooperate for task-based studies.
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Affiliation(s)
- Arpita Sahu
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai, Maharashtra, India
| | - Vineeth Kurki
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai, Maharashtra, India
| | - Antariksh Vijan
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai, Maharashtra, India
| | - Amit Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai, Maharashtra, India
| | - Prakash Shetty
- Department of Neurosurgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Aliasgar Moiyadi
- Department of Neurosurgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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16
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Zyryanov A, Stupina E, Gordeyeva E, Buivolova O, Novozhilova E, Akinina Y, Bronov O, Gronskaya N, Gunenko G, Iskra E, Ivanova E, Kalinovskiy A, Kliuev E, Kopachev D, Kremneva E, Kryuchkova O, Medyanik I, Pedyash N, Pozdniakova V, Pronin I, Rainich K, Reutov A, Samoukina A, Shlyakhova A, Sitnikov A, Soloukhina O, Yashin K, Zelenkova V, Zuev A, Ivanova MV, Dragoy O. 'Moderate global aphasia': A generalized decline of language processing caused by glioma surgery but not stroke. BRAIN AND LANGUAGE 2022; 224:105057. [PMID: 34883333 PMCID: PMC8743859 DOI: 10.1016/j.bandl.2021.105057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 10/15/2021] [Accepted: 11/24/2021] [Indexed: 06/13/2023]
Abstract
Unlike stroke, neurosurgical removal of left-hemisphere gliomas acts upon a reorganized language network and involves brain areas rarely damaged by stroke. We addressed whether this causes the profiles of neurosurgery- and stroke-induced language impairments to be distinct. K-means clustering of language assessment data (neurosurgery cohort: N = 88, stroke cohort: N = 95) identified similar profiles in both cohorts. But critically, a cluster of individuals with specific phonological deficits was only evident in the stroke but not in the neurosurgery cohort. Thus, phonological deficits are less clearly distinguished from other language deficits after glioma surgery compared to stroke. Furthermore, the correlations between language production and comprehension scores at different linguistic levels were more extensive in the neurosurgery than in the stroke cohort. Our findings suggest that neurosurgery-induced language impairments do not correspond to those caused by stroke, but rather manifest as a 'moderate global aphasia' - a generalized decline of language processing abilities.
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Affiliation(s)
- Andrey Zyryanov
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia.
| | - Ekaterina Stupina
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Elizaveta Gordeyeva
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Olga Buivolova
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia; Federal Center for Brain and Neurotechnologies, 1 Building 10 Ostrovityanova Ulitsa, Moscow 117997, Russia
| | - Evdokiia Novozhilova
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Yulia Akinina
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Oleg Bronov
- Department of Radiology, National Medical and Surgical Center Named after N.I. Pirogov, 70 Nizhnyaya Pervomayskaya Ulitsa, Moscow 105203, Russia
| | - Natalia Gronskaya
- Center for Language and Brain, HSE University, 25/12 Bolshaya Pecherskaya Ulitsa, Nizhny Novgorod 603155, Russia
| | - Galina Gunenko
- Department of Neurooncology, Federal Center of Neurosurgery Novosibirsk, 132/1 Nemirovicha-Danchenko Ulitsa, Novosibirsk 630048, Russia
| | - Ekaterina Iskra
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia; Center for Speech Pathology and Neurorehabilitation, 20/1 Nikoloyamskaya Ulitsa, Moscow 109240, Russia
| | - Elena Ivanova
- Federal Center for Brain and Neurotechnologies, 1 Building 10 Ostrovityanova Ulitsa, Moscow 117997, Russia; Pirogov Russian National Research Medical University, 1 Ostrovityanova Ulitsa, Moscow 117198, Russia
| | - Anton Kalinovskiy
- Department of Neurooncology, Federal Center of Neurosurgery Novosibirsk, 132/1 Nemirovicha-Danchenko Ulitsa, Novosibirsk 630048, Russia
| | - Evgenii Kliuev
- Department of Radiology, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005, Russia
| | - Dmitry Kopachev
- Research Center of Neurology, 80 Volokolamskoye Shosse, Moscow 125367, Russia
| | - Elena Kremneva
- Research Center of Neurology, 80 Volokolamskoye Shosse, Moscow 125367, Russia
| | - Oksana Kryuchkova
- Department of Radiology, Central Clinical Hospital with Outpatient Health Center of the Business Administration for the President of the Russian Federation, 15 Marshala Timoshenko Ulitsa, Moscow 121359, Russia
| | - Igor Medyanik
- Department of Neurosurgery, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005, Russia
| | - Nikita Pedyash
- Department of Neurosurgery, National Medical and Surgical Center named after N.I. Pirogov, 70 Nizhnyaya Pervomayskaya Ulitsa, Moscow 105203, Russia
| | - Viktoria Pozdniakova
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Igor Pronin
- Department of Neuroradiology, National Medical Research Center for Neurosurgery named after N. N. Burdenko, 16 4-ya Tverskaya-Yamskaya Ulitsa, Moscow 125047, Russia
| | - Kristina Rainich
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Andrey Reutov
- Department of Neurosurgery, Central Clinical Hospital with Outpatient Health Center of the Business Administration for the President of the Russian Federation, 15 Marshala Timoshenko Ulitsa, Moscow 121359, Russia
| | - Anastasia Samoukina
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Anastasia Shlyakhova
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Andrey Sitnikov
- Department of Neurosurgery, Federal Centre of Treatment and Rehabilitation of the Ministry of Healthcare of the Russian Federation, 3 Ivan'kovskoye Shosse, Moscow 125367, Russia
| | - Olga Soloukhina
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Konstantin Yashin
- Department of Neurosurgery, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005, Russia
| | - Valeriya Zelenkova
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia
| | - Andrey Zuev
- Department of Neurosurgery, National Medical and Surgical Center named after N.I. Pirogov, 70 Nizhnyaya Pervomayskaya Ulitsa, Moscow 105203, Russia
| | - Maria V Ivanova
- Aphasia Recovery Lab, Department of Psychology, University of California, Berkley, 210 Barker Hall, CA 94720, USA
| | - Olga Dragoy
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, Moscow 101000, Russia; Institute of Linguistics, Russian Academy of Sciences, 1 bld. 1 Bolshoy Kislovsky lane, Moscow 125009, Russia
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17
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Viganò L, Howells H, Rossi M, Rabuffetti M, Puglisi G, Leonetti A, Bellacicca A, Conti Nibali M, Gay L, Sciortino T, Cerri G, Bello L, Fornia L. Stimulation of frontal pathways disrupts hand muscle control during object manipulation. Brain 2021; 145:1535-1550. [PMID: 34623420 PMCID: PMC9128819 DOI: 10.1093/brain/awab379] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/20/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
The activity of frontal motor areas during hand-object interaction is coordinated by dense communication along specific white matter pathways. This architecture allows the continuous shaping of voluntary motor output and, despite extensively investigated in non-human primate studies, remains poorly understood in humans. Disclosure of this system is crucial for predicting and treatment of motor deficits after brain lesions. For this purpose, we investigated the effect of direct electrical stimulation on white matter pathways within the frontal lobe on hand-object manipulation. This was tested in thirty-four patients (15 left hemisphere, mean age 42 years, 17 male, 15 with tractography) undergoing awake neurosurgery for frontal lobe tumour removal with the aid of the brain mapping technique. The stimulation outcome was quantified based on hand-muscle activity required by task execution. The white matter pathways responsive to stimulation with an interference on muscles were identified by means of probabilistic density estimation of stimulated sites, tract-based lesion-symptom (disconnectome) analysis and diffusion tractography on the single patient level. Finally, we assessed the effect of permanent tracts disconnection on motor outcome in the immediate postoperative period using a multivariate lesion-symptom mapping approach. The analysis showed that stimulation disrupted hand-muscle activity during task execution in 66 sites within the white matter below dorsal and ventral premotor regions. Two different EMG interference patterns associated with different structural architectures emerged: 1) an arrest pattern, characterised by complete impairment of muscle activity associated with an abrupt task interruption, occurred when stimulating a white matter area below the dorsal premotor region. Local mid-U-shaped fibres, superior fronto-striatal, corticospinal and dorsal fronto-parietal fibres intersected with this region. 2) a clumsy pattern, characterised by partial disruption of muscle activity associated with movement slowdown and/or uncoordinated finger movements, occurred when stimulating a white matter area below the ventral premotor region. Ventral fronto-parietal and inferior fronto-striatal tracts intersected with this region. Finally, only resections partially including the dorsal white matter region surrounding the supplementary motor area were associated with transient upper-limb deficit (p = 0.05; 5000 permutations). Overall, the results identify two distinct frontal white matter regions possibly mediating different aspects of hand-object interaction via distinct sets of structural connectivity. We suggest the dorsal region, associated with arrest pattern and post-operative immediate motor deficits, to be functionally proximal to motor output implementation, while the ventral region may be involved in sensorimotor integration required for task execution.
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Affiliation(s)
- Luca Viganò
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Henrietta Howells
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
| | - Marco Rossi
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Marco Rabuffetti
- Biomedical Technology Department, IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milano, Italy
| | - Guglielmo Puglisi
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano.,MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
| | - Antonella Leonetti
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Andrea Bellacicca
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
| | - Marco Conti Nibali
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Lorenzo Gay
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Tommaso Sciortino
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Gabriella Cerri
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Luca Fornia
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
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18
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Perturbation of cortical activity elicits regional and age-dependent effects on unconstrained reaching behavior: a pilot study. Exp Brain Res 2021; 239:3585-3600. [PMID: 34591126 DOI: 10.1007/s00221-021-06228-z] [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: 01/26/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
Contributions from premotor and supplementary motor areas to reaching behavior in aging humans are not well understood. The objective of these experiments was to examine effects of perturbations to specific cortical areas on the control of unconstrained reaches against gravity by younger and older adults. Double-pulse transcranial magnetic stimulation (TMS) was applied to scalp locations targeting primary motor cortex (M1), dorsal premotor area (PMA), supplementary motor area (SMA), or dorsolateral prefrontal cortex (DLPFC). Stimulation was intended to perturb ongoing activity in the targeted cortical region before or after a visual cue to initiate moderately paced reaches to one of three vertical target locations. Regional effects were observed in movement amplitude both early and late in the reach. Perturbation of PMA increased reach distance before the time of peak velocity to a greater extent than all other regions. Reaches showed greater deviation from a straight-line path around the time of peak velocity and greater overall curvature with perturbation of PMA and M1 relative to SMA and DLPFC. The perturbation increased positional variability of the reach path at the time of peak velocity and the time elapsing after peak velocity. Although perturbations had stronger effects on reaches by younger subjects, this group exhibited less reach path variability at the time of peak velocity and required less time to adjust the movement trajectory thereafter. These findings support the role of PMA in visually guided reaching and suggest an age-related change in sensorimotor processing, possibly due to a loss of cortical inhibitory control.
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Higashiyama Y, Hamada T, Saito A, Morihara K, Okamoto M, Kimura K, Joki H, Kishida H, Doi H, Ueda N, Takeuchi H, Tanaka F. Neural mechanisms of foreign accent syndrome: Lesion and network analysis. NEUROIMAGE-CLINICAL 2021; 31:102760. [PMID: 34274725 PMCID: PMC8319358 DOI: 10.1016/j.nicl.2021.102760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Foreign accent syndrome (FAS) is a rare acquired speech disorder wherein an individual's spoken accent is perceived as "foreign." Most reported cases involve left frontal brain lesions, but it is known that various other lesions can also cause FAS. To determine whether heterogeneous FAS-causing lesions are localized to a common functional speech network rather than to a single anatomical site, we employed a recently validated image analysis technique known as "lesion network mapping." METHODS We identified 25 published cases of acquired neurogenic FAS without aphasia, and mapped each lesion volume onto a reference brain. We next identified the network of brain regions functionally connected to each FAS lesion using a connectome dataset from normative participants. Network maps were then overlapped to identify common network sites across the lesions. RESULTS Classical lesion overlap analysis showed heterogeneity in lesion anatomical location, consistent with prior reports. However, at least 80% of lesions showed network overlap in the bilateral lower and middle portions of the precentral gyrus and in the medial frontal cortex. The left lower portion of the precentral gyrus is suggested to be the location of lesions causing apraxia of speech (AOS), and the middle portion is considered to be a larynx-specific motor area associated with the production of vowels and stop/nasal consonants and with the determination of pitch accent. CONCLUSIONS The lesions that cause FAS are anatomically heterogeneous, but they share a common functional network located in the bilateral posterior region of the frontal lobe. This network specifically includes not only the lower portion of the central gyrus, but also its middle region, which is referred to as the larynx motor cortex and is known to be associated with phonation. Our findings suggest that disrupted networks in FAS might be anatomically different from those in AOS.
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Affiliation(s)
- Yuichi Higashiyama
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Tomoya Hamada
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan; Department of Speech-Language-Hearing Therapy, Japan Welfare Education College, 2-16-3 Takadanobaba, Shinjuku-ku, Tokyo 169-0073, Japan
| | - Asami Saito
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Keisuke Morihara
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Mitsuo Okamoto
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Katsuo Kimura
- Department of Neurology, Yokohama City University Medical Center Hospital, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
| | - Hideto Joki
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Hitaru Kishida
- Department of Neurology, Yokohama City University Medical Center Hospital, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
| | - Hiroshi Doi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Naohisa Ueda
- Department of Neurology, Yokohama City University Medical Center Hospital, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
| | - Hideyuki Takeuchi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
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20
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Maldonado IL. Letter to the Editor Regarding "Clinical Application of Brain Plasticity in Neurosurgery". World Neurosurg 2021; 146:399. [PMID: 33607735 DOI: 10.1016/j.wneu.2020.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Igor Lima Maldonado
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Department of Interventional Neuroradiology, CHRU de Tours, Tours, France.
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21
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Luna LP, Sherbaf FG, Sair HI, Mukherjee D, Oliveira IB, Köhler CA. Can Preoperative Mapping with Functional MRI Reduce Morbidity in Brain Tumor Resection? A Systematic Review and Meta-Analysis of 68 Observational Studies. Radiology 2021; 300:338-349. [PMID: 34060940 DOI: 10.1148/radiol.2021204723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Preoperative functional MRI (fMRI) is one of several techniques developed to localize critical brain structures and brain tumors. However, the usefulness of fMRI for preoperative surgical planning and its potential effect on neurologic outcomes remain unclear. Purpose To assess the overall postoperative morbidity among patients with brain tumors by using preoperative fMRI versus surgery without this tool or with use of standard (nonfunctional) neuronavigation. Materials and Methods A systematic review and meta-analysis of studies across major databases from 1946 to June 20, 2020, were conducted. Inclusion criteria were original studies that (a) included patients with brain tumors, (b) performed preoperative neuroimaging workup with fMRI, (c) investigated the usefulness of a preoperative or intraoperative functional neuroimaging technique and used that technique to resect cerebral tumors, and (d) reported postoperative clinical measures. Pooled estimates for adverse event rate (ER) effect size (log ER, log odds ratio, or Hedges g) with 95% CIs were computed by using a random-effects model. Results Sixty-eight studies met eligibility criteria (3280 participants; 58.9% men [1555 of 2641]; mean age, 46 years ± 8 [standard deviation]). Functional deterioration after surgical procedure was less likely to occur when fMRI mapping was performed before the operation (odds ratio, 0.25; 95% CI: 0.12, 0.53; P < .001]), and postsurgical Karnofsky performance status scores were higher in patients who underwent fMRI mapping (Hedges g, 0.66; 95% CI: 0.21, 1.11; P = .004]). Craniotomies for tumor resection performed with preoperative fMRI were associated with a pooled adverse ER of 11% (95% CI: 8.4, 13.1), compared with a 21.0% ER (95% CI: 12.2, 33.5) in patients who did not undergo fMRI mapping. Conclusion From the currently available data, the benefit of preoperative functional MRI planning for the resection of brain tumors appears to reduce postsurgical morbidity, especially when used with other advanced imaging techniques, such as diffusion-tensor imaging, intraoperative MRI, or cortical stimulation. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Licia P Luna
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe St, Phipps B100F, Baltimore, MD 21287 (L.P.L., F.G.S., H.I.S.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Md (D.M.); Department of Radiology, Hospital Geral de Fortaleza, Fortaleza, Brazil (I.B.O.); and Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil (C.A.K.)
| | - Farzaneh Ghazi Sherbaf
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe St, Phipps B100F, Baltimore, MD 21287 (L.P.L., F.G.S., H.I.S.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Md (D.M.); Department of Radiology, Hospital Geral de Fortaleza, Fortaleza, Brazil (I.B.O.); and Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil (C.A.K.)
| | - Haris I Sair
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe St, Phipps B100F, Baltimore, MD 21287 (L.P.L., F.G.S., H.I.S.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Md (D.M.); Department of Radiology, Hospital Geral de Fortaleza, Fortaleza, Brazil (I.B.O.); and Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil (C.A.K.)
| | - Debraj Mukherjee
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe St, Phipps B100F, Baltimore, MD 21287 (L.P.L., F.G.S., H.I.S.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Md (D.M.); Department of Radiology, Hospital Geral de Fortaleza, Fortaleza, Brazil (I.B.O.); and Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil (C.A.K.)
| | - Isabella Bezerra Oliveira
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe St, Phipps B100F, Baltimore, MD 21287 (L.P.L., F.G.S., H.I.S.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Md (D.M.); Department of Radiology, Hospital Geral de Fortaleza, Fortaleza, Brazil (I.B.O.); and Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil (C.A.K.)
| | - Cristiano André Köhler
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe St, Phipps B100F, Baltimore, MD 21287 (L.P.L., F.G.S., H.I.S.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Md (D.M.); Department of Radiology, Hospital Geral de Fortaleza, Fortaleza, Brazil (I.B.O.); and Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil (C.A.K.)
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22
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Pinson H, Van Lerbeirghe J, Vanhauwaert D, Van Damme O, Hallaert G, Kalala JP. The supplementary motor area syndrome: a neurosurgical review. Neurosurg Rev 2021; 45:81-90. [PMID: 33993354 DOI: 10.1007/s10143-021-01566-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/19/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
The supplementary motor area (SMA) syndrome is a frequently encountered clinical phenomenon associated with surgery of the dorsomedial prefrontal lobe. The region has a known motor sequencing function and the dominant pre-SMA specifically is associated with more complex language functions; the SMA is furthermore incorporated in the negative motor network. The SMA has a rich interconnectivity with other cortical regions and subcortical structures using the frontal aslant tract (FAT) and the frontostriatal tract (FST). The development of the SMA syndrome is positively correlated with the extent of resection of the SMA region, especially its medial side. This may be due to interruption of the nearby callosal association fibres as the contralateral SMA has a particular important function in brain plasticity after SMA surgery. The syndrome is characterized by a profound decrease in interhemispheric connectivity of the motor network hubs. Clinical improvement is related to increasing connectivity between the contralateral SMA region and the ipsilateral motor hubs. Overall, most patients know a full recovery of the SMA syndrome, however a minority of patients might continue to suffer from mild motor and speech dysfunction. Rarely, no recovery of neurological function after SMA region resection is reported.
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Affiliation(s)
- Harry Pinson
- Department of Neurosurgery, AZ Delta, Roeselare, Belgium. .,Department of Neurosurgery, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | | | | | | | - Giorgio Hallaert
- Department of Neurosurgery, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Jean-Pierre Kalala
- Department of Neurosurgery, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
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23
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Sjöberg RL. Free will and neurosurgical resections of the supplementary motor area: a critical review. Acta Neurochir (Wien) 2021; 163:1229-1237. [PMID: 33566193 PMCID: PMC8053652 DOI: 10.1007/s00701-021-04748-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/31/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Research suggests that unconscious activity in the supplementary motor area (SMA) precedes not only certain simple motor actions but also the point at which we become aware of our intention to perform such actions. The extent to which these findings have implications for our understanding of the concepts of free will and personal responsibility has been subject of intense debate during the latest four decades. METHODS This research is discussed in relation to effects of neurosurgical removal of the SMA in a narrative review. RESULTS Removal of the SMA typically causes a transient inability to perform non-stimulus-driven, voluntary actions. This condition, known as the SMA syndrome, does not appear to be associated with a loss of sense of volition but with a profound disruption of executive function/cognitive control. CONCLUSIONS The role of the SMA may be to serve as a gateway between the corticospinal tract and systems for executive function. Such systems are typically seen as tools for conscious decisions. What is known about effects of SMA resections would thus seem to suggest a view that is compatible with concepts of personal responsibility. However, the philosophical question whether free will exists cannot be definitely resolved on the basis of these observations.
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Affiliation(s)
- Rickard L Sjöberg
- Department of Clinical Science, Umeå University, Umeå, Sweden.
- Department of Clinical Science, Neurosciences, Umeå University, S901 85, Umeå, Sweden.
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24
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Tatekawa H, Uetani H, Hagiwara A, Yao J, Oughourlian TC, Ueda I, Raymond C, Lai A, Cloughesy TF, Nghiemphu PL, Liau LM, Bahri S, Pope WB, Salamon N, Ellingson BM. Preferential tumor localization in relation to 18F-FDOPA uptake for lower-grade gliomas. J Neurooncol 2021; 152:573-582. [PMID: 33704629 DOI: 10.1007/s11060-021-03730-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Although tumor localization and 3,4-dihydroxy-6-18F-fluoro-L-phenylalanine (FDOPA) uptake may have an association, preferential tumor localization in relation to FDOPA uptake is yet to be investigated in lower-grade gliomas (LGGs). This study aimed to identify differences in the frequency of tumor localization between FDOPA hypometabolic and hypermetabolic LGGs using a probabilistic radiographic atlas. METHODS Fifty-one patients with newly diagnosed LGG (WHO grade II, 29; III, 22; isocitrate dehydrogenase wild-type, 21; mutant 1p19q non-codeleted,16; mutant codeleted, 14) who underwent FDOPA positron emission tomography (PET) were retrospectively selected. Semiautomated tumor segmentation on FLAIR was performed. Patients with LGGs were separated into two groups (FDOPA hypometabolic and hypermetabolic LGGs) according to the normalized maximum standardized uptake value of FDOPA PET (a threshold of the uptake in the striatum) within the segmented regions. Spatial normalization procedures to build a 3D MRI-based atlas using each segmented region were validated by an analysis of differential involvement statistical mapping. RESULTS Superimposition of regions of interest showed a high number of hypometabolic LGGs localized in the frontal lobe, while a high number of hypermetabolic LGGs was localized in the insula, putamen, and temporal lobe. The statistical mapping revealed that hypometabolic LGGs occurred more frequently in the superior frontal gyrus (close to the supplementary motor area), while hypermetabolic LGGs occurred more frequently in the insula. CONCLUSION Radiographic atlases revealed preferential frontal lobe localization for FDOPA hypometabolic LGGs, which may be associated with relatively early detection.
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Affiliation(s)
- Hiroyuki Tatekawa
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Uetani
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Akifumi Hagiwara
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Jingwen Yao
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Bioengineering, Henry Samueli School of Engineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Talia C Oughourlian
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Neuroscience Interdepartmental Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Issei Ueda
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Albert Lai
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Phioanh L Nghiemphu
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Linda M Liau
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Shadfar Bahri
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Whitney B Pope
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Noriko Salamon
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA. .,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. .,Department of Bioengineering, Henry Samueli School of Engineering, University of California Los Angeles, Los Angeles, CA, USA. .,Neuroscience Interdepartmental Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. .,UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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25
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Briggs RG, Allan PG, Poologaindran A, Dadario NB, Young IM, Ahsan SA, Teo C, Sughrue ME. The Frontal Aslant Tract and Supplementary Motor Area Syndrome: Moving towards a Connectomic Initiation Axis. Cancers (Basel) 2021; 13:cancers13051116. [PMID: 33807749 PMCID: PMC7961364 DOI: 10.3390/cancers13051116] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Connectomics enables us to map whole brain networks that can be applied to operative neurosurgery to improve neuro-oncological outcomes. Damage to the superior frontal gyrus during frontal lobe surgery is thought to induce supplementary motor area (SMA) syndrome in patients. However, network-based modeling may provide a more accurate cortical model of SMA syndrome, including the Frontal Aslant Tract (FAT). The aim of our study was to retrospectively assess if surgical tractography with diffusion tensor imaging (DTI) decreases the likelihood of SMA syndrome. Compared to patients who underwent surgery preserving the SFG (n = 23), patients who had their FAT and SMA networks mapped through DTI and subsequently preserved were less likely to experience transient SMA syndrome. Preserving the FAT and SMA improves functional outcomes in patients following medial frontal glioma surgery and demonstrates how network-based approaches can improve surgical outcomes. Abstract Connectomics is the use of big data to map the brain’s neural infrastructure; employing such technology to improve surgical planning may improve neuro-oncological outcomes. Supplementary motor area (SMA) syndrome is a well-known complication of medial frontal lobe surgery. The ‘localizationist’ view posits that damage to the posteromedial bank of the superior frontal gyrus (SFG) is the basis of SMA syndrome. However, surgical experience within the frontal lobe suggests that this is not entirely true. In a study on n = 45 patients undergoing frontal lobe glioma surgery, we sought to determine if a ‘connectomic’ or network-based approach can decrease the likelihood of SMA syndrome. The control group (n = 23) underwent surgery avoiding the posterior bank of the SFG while the treatment group (n = 22) underwent mapping of the SMA network and Frontal Aslant Tract (FAT) using network analysis and DTI tractography. Patient outcomes were assessed post operatively and in subsequent follow-ups. Fewer patients (8.3%) in the treatment group experienced transient SMA syndrome compared to the control group (47%) (p = 0.003). There was no statistically significant difference found between the occurrence of permanent SMA syndrome between control and treatment groups. We demonstrate how utilizing tractography and a network-based approach decreases the likelihood of transient SMA syndrome during medial frontal glioma surgery. We found that not transecting the FAT and the SMA system improved outcomes which may be important for functional outcomes and patient quality of life.
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Affiliation(s)
- Robert G. Briggs
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (R.G.B.); (P.G.A.)
| | - Parker G. Allan
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (R.G.B.); (P.G.A.)
| | - Anujan Poologaindran
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge CB2 1TN, UK;
- Doctoral Program, The Alan Turing Institute, British Library, London NW1 2DB, UK
| | - Nicholas B. Dadario
- Department of Neurosurgery, Prince of Wales Private Hospital, Sydney 2031, Australia; (N.B.D.); (I.M.Y.); (S.A.A.); (C.T.)
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Isabella M. Young
- Department of Neurosurgery, Prince of Wales Private Hospital, Sydney 2031, Australia; (N.B.D.); (I.M.Y.); (S.A.A.); (C.T.)
| | - Syed A. Ahsan
- Department of Neurosurgery, Prince of Wales Private Hospital, Sydney 2031, Australia; (N.B.D.); (I.M.Y.); (S.A.A.); (C.T.)
| | - Charles Teo
- Department of Neurosurgery, Prince of Wales Private Hospital, Sydney 2031, Australia; (N.B.D.); (I.M.Y.); (S.A.A.); (C.T.)
| | - Michael E. Sughrue
- Department of Neurosurgery, Prince of Wales Private Hospital, Sydney 2031, Australia; (N.B.D.); (I.M.Y.); (S.A.A.); (C.T.)
- Correspondence:
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26
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Lammers F, Zacharias N, Borchers F, Mörgeli R, Spies CD, Winterer G. Functional Connectivity of the Supplementary Motor Network Is Associated with Fried's Modified Frailty Score in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 75:2239-2248. [PMID: 31900470 DOI: 10.1093/gerona/glz297] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Indexed: 01/22/2023] Open
Abstract
Frailty is a geriatric syndrome defined by coexistence of unintentional weight loss, low physical reserve, or activity and is associated with adverse health events. Neuroimaging studies reported structural white matter changes in frail patients. In the current study, we hypothesized that clinical frailty is associated also with functional changes in motion-related cortical areas, that is, (pre-)supplementary motor areas (SMA, pre-SMA). We expected that observed functional changes are related to motor-cognitive test performance. We studied a clinical sample of 143 cognitively healthy patients ≥65 years presenting for elective surgery, enrolled in the BioCog prospective multicentric cohort study on postoperative cognitive disorders. Participants underwent preoperative resting-state functional magnetic resonance imaging, motor-cognitive testing, and assessment of Fried's modified frailty criteria. We analyzed functional connectivity associations with frailty and motor-cognitive test performance. Clinically robust patients (N = 60) showed higher connectivity in the SMA network compared to frail (N = 13) and prefrail (N = 70) patients. No changes were found in the pre-SMA network. SMA connectivity correlated with motor speed (Trail-Making-Test A) and manual dexterity (Grooved Pegboard Test). Our results suggest that diminished functional connectivity of the SMA is an early correlate of functional decline in the older adults . The SMA may serve as a potential treatment target in frailty.
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Affiliation(s)
- Florian Lammers
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Norman Zacharias
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany.,Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
| | - Friedrich Borchers
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Rudolf Mörgeli
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Claudia Doris Spies
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Georg Winterer
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany.,Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
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Yamao Y, Matsumoto R, Kikuchi T, Yoshida K, Kunieda T, Miyamoto S. Intraoperative Brain Mapping by Cortico-Cortical Evoked Potential. Front Hum Neurosci 2021; 15:635453. [PMID: 33679353 PMCID: PMC7930065 DOI: 10.3389/fnhum.2021.635453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 12/04/2022] Open
Abstract
To preserve postoperative brain function, it is important for neurosurgeons to fully understand the brain's structure, vasculature, and function. Intraoperative high-frequency electrical stimulation during awake craniotomy is the gold standard for mapping the function of the cortices and white matter; however, this method can only map the "focal" functions and cannot monitor large-scale cortical networks in real-time. Recently, an in vivo electrophysiological method using cortico-cortical evoked potentials (CCEPs) induced by single-pulse electrical cortical stimulation has been developed in an extraoperative setting. By using the CCEP connectivity pattern intraoperatively, mapping and real-time monitoring of the dorsal language pathway is available. This intraoperative CCEP method also allows for mapping of the frontal aslant tract, another language pathway, and detection of connectivity between the primary and supplementary motor areas in the frontal lobe network. Intraoperative CCEP mapping has also demonstrated connectivity between the frontal and temporal lobes, likely via the ventral language pathway. Establishing intraoperative electrophysiological monitoring is clinically useful for preserving brain function, even under general anesthesia. This CCEP technique demonstrates potential clinical applications for mapping and monitoring large-scale cortical networks.
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Affiliation(s)
- Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayuki Kikuchi
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Correia MS, Neville IS, Almeida CCD, Hayashi CY, Ferreira LTD, Quadros DG, Gomes Dos Santos A, Solla DJF, Marta GN, Teixeira MJ, Paiva WS. Clinical outcome assessments of motor status in patients undergoing brain tumor surgery. Clin Neurol Neurosurg 2020; 201:106420. [PMID: 33388662 DOI: 10.1016/j.clineuro.2020.106420] [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: 09/17/2020] [Revised: 11/21/2020] [Accepted: 12/04/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Clinical outcome assessment (COA) is an important instrument for testing the effectiveness of treatments and for supporting healthcare professionals on decision-making. This review aims to assess the use of COAs, and the evaluation time points of motor status in patients with brain tumor (BT) undergoing surgery. METHODS We performed a scoping review through MEDLINE, EMBASE, and LILACS databases, looking for original studies in primary or secondary BT, having motor function status as the primary outcome. EXCLUSION CRITERIA mixed sample, BT recurrence, and an unspecific description of motor deficits evaluation. RESULTS Nine studies met the eligibility criteria. There were 449 patients assessed. A total of 18 scales evaluated these BT patients, 12 performance outcomes measures (PerfO) tested motor function. Four scales were the clinician-reported outcome measures (ClinRO) found in this review, two assessed performance status, and two rated ambulation. Two patient-reported outcome measures (PRO) appraised functionality. CONCLUSIONS A variety of instruments were used to assess BT patients. Rehabilitation studies are more likely to associate the use of PerfO and PRO concerning motor and functional status. The use of specific validated scales to the BT population was rare. The lack of a standardized approach hampers the quality of BT patient's assessment.
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Affiliation(s)
- Mayla Santana Correia
- Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, 01246-000, Brazil.
| | - Iuri Santana Neville
- Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, 01246-000, Brazil; Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil
| | - Cesar Cimonari de Almeida
- Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil
| | - Cintya Yukie Hayashi
- Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil
| | - Luana Talita Diniz Ferreira
- Hospital Samaritano Paulista, Sao Paulo, 01333-030, Brazil; School of Public Health, University of Sao Paulo, Sao Paulo, 01246-904, Brazil
| | - Danilo Gomes Quadros
- Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil
| | | | - Davi Jorge Fontoura Solla
- Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil
| | - Gustavo Nader Marta
- Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, 01246-000, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, 01308-050, Brazil
| | - Manoel Jacobsen Teixeira
- Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil; Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, 01246-903, Brazil
| | - Wellingson Silva Paiva
- Division of Neurosurgery, LIM-62, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, 01246-903, Brazil; Hospital Samaritano Paulista, Sao Paulo, 01333-030, Brazil
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de la Peña MJ, Gil-Robles S, de Vega VM, Aracil C, Acevedo A, Rodríguez MR. A Practical Approach to Imaging of the Supplementary Motor Area and Its Subcortical Connections. Curr Neurol Neurosci Rep 2020; 20:50. [PMID: 32930895 DOI: 10.1007/s11910-020-01070-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW First, an anatomical and functional review of these cortical areas and subcortical connections with T-fMRI and tractography techniques; second, to demonstrate the value of this approach in neurosurgical planning in a series of patients with tumors close to the SMA. RECENT FINDINGS Implications in language and cognitive networks with a clear hemispheric lateralization of these SMA/pre-SMA. The recommendation of the use of the advanced neuroimaging studies for surgical planning and preservation of these areas. The SMA/pre-SMA and their subcortical connections are functional areas to be taken into consideration in neurosurgical planning. These areas would be involved in the control/inhibition of movement, in verbal expression and fluency and in tasks of cognitive control capacity. Its preservation is key to the patient's postsurgical cognitive and functional evolution.
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Affiliation(s)
- Mar Jiménez de la Peña
- Department of Radiology, Hospital Universitario QuironSalud Madrid, C/ Diego de Velázquez 1, Pozuelo de Alarcón, 28223, Madrid, Spain.
| | - Santiago Gil-Robles
- Department of Neurosurgery, Hospital Universitario QuironSalud Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Vicente Martínez de Vega
- Department of Radiology, Hospital Universitario QuironSalud Madrid, C/ Diego de Velázquez 1, Pozuelo de Alarcón, 28223, Madrid, Spain
| | - Cristina Aracil
- Department of Neurosurgery, Hospital Universitario QuironSalud Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Agustín Acevedo
- Department of Pathology, Hospital Universitario QuironSalud Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Manuel Recio Rodríguez
- Department of Radiology, Hospital Universitario QuironSalud Madrid, C/ Diego de Velázquez 1, Pozuelo de Alarcón, 28223, Madrid, Spain
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30
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Cargnelutti E, Ius T, Skrap M, Tomasino B. What do we know about pre- and postoperative plasticity in patients with glioma? A review of neuroimaging and intraoperative mapping studies. NEUROIMAGE-CLINICAL 2020; 28:102435. [PMID: 32980599 PMCID: PMC7522801 DOI: 10.1016/j.nicl.2020.102435] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023]
Abstract
Brain reorganization can take place before and after surgery of low- and high-grade gliomas. Plasticity is observed for low-grade but also for high-grade gliomas. The contralesional hemisphere can be vital for successful compensation. There is evidence of plasticity for both the language system and the sensorimotor system. Partial compensation can also occur at the white-matter level. Subcortical connectivity is crucial for brain reorganization.
Brain plasticity potential is a central theme in neuro-oncology and is currently receiving increased attention. Advances in treatment have prolonged life expectancy in neuro-oncological patients and the long-term preservation of their quality of life is, therefore, a new challenge. To this end, a better understanding of brain plasticity mechanisms is vital as it can help prevent permanent deficits following neurosurgery. Indeed, reorganization processes can be fundamental to prevent or recover neurological and cognitive deficits by reallocating brain functions outside the lesioned areas. According to more recent studies in the literature, brain reorganization taking place following neurosurgery is associated with good neurofunctioning at follow-up. Interestingly, in the last few years, the number of reports on plasticity has notably increased. Aim of the current review was to provide a comprehensive overview of pre- and postoperative neuroplasticity patterns. Within this framework, we aimed to shed light on some tricky issues, including i) involvement of the contralateral healthy hemisphere, ii) role and potential changes of white matter and connectivity patterns, and iii) reorganization in low- versus high-grade gliomas. We finally discussed the practical implications of these aspects and role of additional potentially relevant factors to be explored. Final purpose was to provide a guideline helpful in promoting increase in the extent of tumor resection while preserving the patients’ neurological and cognitive functioning.
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Affiliation(s)
- Elisa Cargnelutti
- Scientific Institute, IRCCS E. Medea, Dipartimento/Unità Operativa Pasian di Prato, Udine, Italy
| | - Tamara Ius
- SOC Neurochirurgia, Azienda Sanitaria Universitaria Friuli Centrale ASU FC, Italy
| | - Miran Skrap
- SOC Neurochirurgia, Azienda Sanitaria Universitaria Friuli Centrale ASU FC, Italy
| | - Barbara Tomasino
- Scientific Institute, IRCCS E. Medea, Dipartimento/Unità Operativa Pasian di Prato, Udine, Italy.
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Duffau H. Functional Mapping before and after Low-Grade Glioma Surgery: A New Way to Decipher Various Spatiotemporal Patterns of Individual Neuroplastic Potential in Brain Tumor Patients. Cancers (Basel) 2020; 12:E2611. [PMID: 32933174 PMCID: PMC7565450 DOI: 10.3390/cancers12092611] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022] Open
Abstract
Intraoperative direct electrostimulation mapping (DEM) is currently the gold-standard for glioma surgery, since functional-based resection allows an optimization of the onco-functional balance (increased resection with preserved quality of life). Besides intrasurgical awake mapping of conation, cognition, and behavior, preoperative mapping by means of functional neuroimaging (FNI) and transcranial magnetic stimulation (TMS) has increasingly been utilized for surgical selection and planning. However, because these techniques suffer from several limitations, particularly for direct functional mapping of subcortical white matter pathways, DEM remains crucial to map neural connectivity. On the other hand, non-invasive FNI and TMS can be repeated before and after surgical resection(s), enabling longitudinal investigation of brain reorganization, especially in slow-growing tumors like low-grade gliomas. Indeed, these neoplasms generate neuroplastic phenomena in patients with usually no or only slight neurological deficits at diagnosis, despite gliomas involving the so-called "eloquent" structures. Here, data gained from perioperative FNI/TMS mapping methods are reviewed, in order to decipher mechanisms underpinning functional cerebral reshaping induced by the tumor and its possible relapse, (re)operation(s), and postoperative rehabilitation. Heterogeneous spatiotemporal patterns of rearrangement across patients and in a single patient over time have been evidenced, with structural changes as well as modifications of intra-hemispheric (in the ipsi-lesional and/or contra-lesional hemisphere) and inter-hemispheric functional connectivity. Such various fingerprints of neural reconfiguration were correlated to different levels of cognitive compensation. Serial multimodal studies exploring neuroplasticity might lead to new management strategies based upon multistage therapeutic approaches adapted to the individual profile of functional reallocation.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Montpellier University Medical Center, 34295 Montpellier, France; ; Tel.: +33-4-67-33-66-12; Fax: +33-4-67-33-69-12
- Institute of Functional Genomics, INSERM U-1191, University of Montpellier, 34298 Montpellier, France
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Russo AA, Khajeh R, Bittner SR, Perkins SM, Cunningham JP, Abbott LF, Churchland MM. Neural Trajectories in the Supplementary Motor Area and Motor Cortex Exhibit Distinct Geometries, Compatible with Different Classes of Computation. Neuron 2020; 107:745-758.e6. [PMID: 32516573 DOI: 10.1016/j.neuron.2020.05.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/25/2019] [Accepted: 05/11/2020] [Indexed: 12/21/2022]
Abstract
The supplementary motor area (SMA) is believed to contribute to higher order aspects of motor control. We considered a key higher order role: tracking progress throughout an action. We propose that doing so requires population activity to display low "trajectory divergence": situations with different future motor outputs should be distinct, even when present motor output is identical. We examined neural activity in SMA and primary motor cortex (M1) as monkeys cycled various distances through a virtual environment. SMA exhibited multiple response features that were absent in M1. At the single-neuron level, these included ramping firing rates and cycle-specific responses. At the population level, they included a helical population-trajectory geometry with shifts in the occupied subspace as movement unfolded. These diverse features all served to reduce trajectory divergence, which was much lower in SMA versus M1. Analogous population-trajectory geometry, also with low divergence, naturally arose in networks trained to internally guide multi-cycle movement.
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Affiliation(s)
- Abigail A Russo
- Department of Neuroscience, Columbia University, New York, NY 10027, USA; Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY 10027, USA
| | - Ramin Khajeh
- Department of Neuroscience, Columbia University, New York, NY 10027, USA; Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY 10027, USA; Center for Theoretical Neuroscience, Columbia University, New York, NY 10027, USA
| | - Sean R Bittner
- Department of Neuroscience, Columbia University, New York, NY 10027, USA; Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY 10027, USA; Center for Theoretical Neuroscience, Columbia University, New York, NY 10027, USA
| | - Sean M Perkins
- Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY 10027, USA; Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - John P Cunningham
- Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY 10027, USA; Grossman Center for the Statistics of Mind, Columbia University, New York, NY 10027, USA; Center for Theoretical Neuroscience, Columbia University, New York, NY 10027, USA; Department of Statistics, Columbia University, New York, NY 10027, USA
| | - L F Abbott
- Department of Neuroscience, Columbia University, New York, NY 10027, USA; Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY 10027, USA; Grossman Center for the Statistics of Mind, Columbia University, New York, NY 10027, USA; Center for Theoretical Neuroscience, Columbia University, New York, NY 10027, USA; Department of Physiology and Cellular Biophysics, Columbia University Medical Center, New York, NY 10032, USA; Kavli Institute for Brain Science, Columbia University, New York, NY 10027, USA
| | - Mark M Churchland
- Department of Neuroscience, Columbia University, New York, NY 10027, USA; Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY 10027, USA; Grossman Center for the Statistics of Mind, Columbia University, New York, NY 10027, USA; Kavli Institute for Brain Science, Columbia University, New York, NY 10027, USA.
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Intraoperative Electrophysiologic Mapping of Medial Frontal Motor Areas and Functional Outcomes. World Neurosurg 2020; 138:e389-e404. [DOI: 10.1016/j.wneu.2020.02.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 11/19/2022]
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Monticelli M, Zeppa P, Altieri R, Veneziani Santonio F, Cofano F, Melcarne A, Junemann CV, Zenga F, Sabatino G, La Rocca G, Della Pepa GM, Ducati A, Garbossa D. Exploring the anatomy of negative motor areas (NMAs): Findings in awake surgery. J Clin Neurosci 2020; 73:219-223. [PMID: 32001111 DOI: 10.1016/j.jocn.2020.01.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/05/2020] [Accepted: 01/11/2020] [Indexed: 11/28/2022]
Abstract
Positive motor responses have been used in neurosurgery for the identification of motor structures. With the term "negative motor responses" (NMRs) a complete inhibition of movement without loss of muscle tone or consciousness is meant. Papers already exist in the literature regarding cortical areas in which such NMRs are evoked, the so-called "negative motor areas" (NMAs), but their location and functional meaning are still poorly understood. This paper discusses the anatomy of the NMAs of the human brain, in light of our brain mapping experience. 21 patients underwent awake surgery and direct electrical stimulation (DES) was performed using bipolar electrodes. Excision was interrupted when functional responses were intraoperatively identified through DES. The labeled mapping sites were recorded by photography prior to and following tumor resection. Results depicting a probabilistic map of negative motor network anatomy were retrospectively analyzed. Our findings strongly support the fact that the precentral gyrus, classical site of the of the Primary Motor Areas, is also strongly involved in generating NMRs. The distribution of NMAs was noted not to be as rigid as previously described, ranging in different brain areas with a somatotopic arrangement. Presented anatomical results are consistent with the literature, but the exact functional meaning of NMAs and their subcortical connectivity is still far from being completely understood.
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Affiliation(s)
- Matteo Monticelli
- Department of Neuroscience "Rita Levi Montalcini"; Neurosurgery Unit, University of Turin, Turin, Italy.
| | - Pietro Zeppa
- Department of Neuroscience "Rita Levi Montalcini"; Neurosurgery Unit, University of Turin, Turin, Italy
| | - Roberto Altieri
- Department of Neuroscience "Rita Levi Montalcini"; Neurosurgery Unit, University of Turin, Turin, Italy; Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy; PhD program at Department of Neuroscience "Rita Levi Montalcini"; University of Turin, Turin, Italy
| | | | - Fabio Cofano
- Department of Neuroscience "Rita Levi Montalcini"; Neurosurgery Unit, University of Turin, Turin, Italy
| | - Antonio Melcarne
- Department of Neuroscience "Rita Levi Montalcini"; Neurosurgery Unit, University of Turin, Turin, Italy
| | - Carola Vera Junemann
- Department of Neuroscience "Rita Levi Montalcini"; Neurosurgery Unit, University of Turin, Turin, Italy
| | - Francesco Zenga
- Department of Neuroscience "Rita Levi Montalcini"; Neurosurgery Unit, University of Turin, Turin, Italy
| | | | - Giuseppe La Rocca
- Mater Olbia Hospital, Neurosurgery Unit, Italy; "Agostino Gemelli" Policlinic Hospital, Neurosurgery Unit, Italy
| | | | - Alessandro Ducati
- Department of Neuroscience "Rita Levi Montalcini"; Neurosurgery Unit, University of Turin, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini"; Neurosurgery Unit, University of Turin, Turin, Italy
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Postoperative isolated lower extremity supplementary motor area syndrome: case report and review of the literature. Childs Nerv Syst 2020; 36:189-195. [PMID: 31705188 DOI: 10.1007/s00381-019-04362-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
The supplementary motor area (SMA) syndrome is characterized by transient weakness and akinesia contralateral to the side of the affected hemisphere. The underlying pathology of the syndrome is not fully understood but is thought to be related to lesions in the SMA, residing principally in the mesial superior frontal gyrus (Broadmann's area 6c). Although the SMA syndrome a well-characterized clinical entity, we report herein, to our knowledge, the first case of isolated lower extremity SMA syndrome in the literature. This case highlights the importance of considering this rare clinical entity in the context of new or worsening postoperative neurologic deficits. Moreover, early studies did not support somatotopic organization of the SMA as in the primary motor cortex; emerging evidence suggests that delicate somatotopic representation may underlie distinct presentations like that reported in the present case.
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36
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Oda K, Yamaguchi F, Enomoto H, Higuchi T, Morita A. Prediction of recovery from supplementary motor area syndrome after brain tumor surgery: preoperative diffusion tensor tractography analysis and postoperative neurological clinical course. Neurosurg Focus 2019; 44:E3. [PMID: 29852764 DOI: 10.3171/2017.12.focus17564] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous studies have suggested a correlation between interhemispheric sensorimotor networks and recovery from supplementary motor area (SMA) syndrome. In the present study, the authors examined the hypothesis that interhemispheric connectivity of the primary motor cortex in one hemisphere with the contralateral SMA may be important in the recovery from SMA syndrome. Further, they posited that motor cortical fiber connectivity with the SMA is related to the severity of SMA syndrome. METHODS Patients referred to the authors' neurological surgery department were retrospectively analyzed for this study. All patients with tumors involving the unilateral SMA region, without involvement of the primary motor area, and diagnosed with SMA syndrome in the postoperative period were eligible for inclusion. Preoperative diffusion tensor imaging tractography (DTT) was used to examine the number of fiber tracts (NFidx) connecting the contralateral SMA to the ipsilateral primary motor area via the corpus callosum. Complete neurological examination had been performed in all patients in the pre- and postoperative periods. All patients were divided into two groups: those who recovered from SMA syndrome in ≤ 7 days (early recovery group) and those who recovered in ≥ 8 days (late recovery group). Differences between the two groups were assessed using the Student t-test and the chi-square test. RESULTS Eleven patients (10 men, 1 woman) were included in the study. All patients showed transient postoperative motor deficits because of SMA syndrome. Tractography data revealed NFidx from the contralateral SMA to the ipsilateral primary motor area via the corpus callosum. The mean tumor volume (early 27.87 vs late 50.91 cm3, p = 0.028) and mean NFidx (early 8923.16 vs late 4726.4, p = 0.002) were significantly different between the two groups. Fisher exact test showed a significant difference in the days of recovery from SMA syndrome between patients with an NFidx > 8000 and those with an NFidx < 8000. CONCLUSIONS Diffusion tensor imaging tractography may be useful for predicting the speed of recovery from SMA syndrome. To the authors' knowledge, this is the first DTT study to identify interhemispheric connectivity of the SMA in patients with brain tumors.
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Affiliation(s)
| | - Fumio Yamaguchi
- 2Neurosurgery for Community Health, Nippon Medical School, Bunkyo-Ku, Tokyo, Japan
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Bathla G, Gene MN, Peck KK, Jenabi M, Tabar V, Holodny AI. Resting State Functional Connectivity of the Supplementary Motor Area to Motor and Language Networks in Patients with Brain Tumors. J Neuroimaging 2019; 29:521-526. [PMID: 31034698 DOI: 10.1111/jon.12624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE We examined the resting-state functional connectivity (RSFC) of the supplementary motor area (SMA) in brain tumor patients. We compared the SMA subdivisions (pre-SMA, SMA proper, central SMA) in terms of RSFC projected from each region to the motor gyrus and language areas. METHODS We retrospectively identified 14 brain tumor patients who underwent task-based and resting-state fMRI, and who completed motor and language paradigms that activated the SMA proper and pre-SMA, respectively. Regions of interest (ROIs) obtained from task-based fMRI were generated in both areas and the central SMA to produce RSFC maps. Degree of RSFC was measured from each subdivision to the motor gyrus and Broca's area (BA). RESULTS All patients showed RSFC between the pre-SMA and language centers and between the SMA proper and motor gyrus. Thirteen of 14 patients showed RSFC from the central SMA to both motor and language areas. There was no significant difference between subdivisions in degree of RSFC to BA (pre-SMA, r = .801; central SMA, r = .803; SMA proper; r = .760). The pre-SMA showed significantly less RSFC to the motor gyrus (r = .732) compared to the central SMA (r = .842) and SMA proper (r = .883) (P = .016, P = .001, respectively). CONCLUSIONS The region between the pre-SMA and SMA proper produces reliable RSFC to the motor gyrus and language areas in brain tumor patients. This study is the first to examine RSFC of the central SMA in this population. Consequently, our results provide further validation to previous studies, supporting the existence of a central SMA with connectivity to both motor and language networks.
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Affiliation(s)
- Girish Bathla
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Madeleine N Gene
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kyung K Peck
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mehrnaz Jenabi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Neuroscience, Weill Cornell Graduate School of Medical Sciences, New York, NY
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Neuroscience, Weill Cornell Graduate School of Medical Sciences, New York, NY.,Department of Radiology, Weill Medical College of Cornell University, New York, NY
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Sjöberg RL, Stålnacke M, Andersson M, Eriksson J. The supplementary motor area syndrome and cognitive control. Neuropsychologia 2019; 129:141-145. [PMID: 30930302 DOI: 10.1016/j.neuropsychologia.2019.03.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/26/2019] [Accepted: 03/22/2019] [Indexed: 11/26/2022]
Abstract
The Supplementary Motor Area (SMA)-syndrome is a transient disturbance of the ability to initiate voluntary motor and speech actions that will often occur immediately after neurosurgical resections in the dorsal superior frontal gyrus but will typically have disappeared after 3 months. The purpose of the present study was to investigate the extent to which this syndrome is associated with alterations in cognitive control. Five patients who were to different extents affected by the SMA-syndrome after surgery for WHO grade II gliomas in the left hemisphere, were tested with the color word interference (Stroop) test; the Bergen dichotic listening test and for letter and category verbal fluency before surgery, 1-2 days after surgery and approximately 3 months after surgery. Results suggest that the motor symptoms known as the SMA syndrome co-occur with pronounced deficits in cognitive control.
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Affiliation(s)
- Rickard L Sjöberg
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Sweden; University Hospital of Northern Sweden, Department of Neurosurgery, S-901 85, Umeå, Sweden.
| | - Mattias Stålnacke
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Sweden
| | - Micael Andersson
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, S-901 87, Umeå, Sweden; Department of Integrative Medical Biology, Umeå University, S-901 87, Umeå, Sweden
| | - Johan Eriksson
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, S-901 87, Umeå, Sweden; Department of Integrative Medical Biology, Umeå University, S-901 87, Umeå, Sweden
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39
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Perturbation of Macaque Supplementary Motor Area Produces Context-Independent Changes in the Probability of Movement Initiation. J Neurosci 2019; 39:3217-3233. [PMID: 30755488 DOI: 10.1523/jneurosci.2335-18.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/16/2019] [Accepted: 02/04/2019] [Indexed: 01/26/2023] Open
Abstract
The contribution of the supplementary motor area (SMA) to movement initiation remains unclear. SMA exhibits premovement activity across a variety of contexts, including externally cued and self-initiated movements. Yet SMA lesions impair initiation primarily for self-initiated movements. Does SMA influence initiation across contexts or does it play a more specialized role, perhaps contributing only when initiation is less dependent on external cues? To address this question, we perturbed SMA activity via microstimulation at variable times before movement onset. Experiments used two adult male rhesus monkeys trained on a reaching task. We used three contexts that differed regarding how tightly movement initiation was linked to external cues. Movement kinematics were not altered by microstimulation. Instead, microstimulation induced a variety of changes in the timing of movement initiation, with different effects dominating for different contexts. Despite their diversity, these changes could be explained by a simple model where microstimulation has a stereotyped impact on the probability of initiation. Surprisingly, a unified model accounted for effects across all three contexts, regardless of whether initiation was determined more by external cues versus internal considerations. All effects were present for stimulation both contralateral and ipsilateral to the moving arm. Thus, the probability of initiating a pending movement is altered by perturbation of SMA activity. However, changes in initiation probability are independent of the balance of internal and external factors that establish the baseline initiation probability.SIGNIFICANCE STATEMENT The role of the supplementary motor area (SMA) in initiating movement remains unclear. Lesion experiments suggest that SMA makes a critical contribution only for self-initiated movements. Yet SMA is active before movements made under a range of contexts, suggesting a less-specialized role in movement initiation. Here, we use microstimulation to probe the role of SMA across a range of behavioral contexts that vary in the degree to which movement onset is influenced by external cues. We demonstrate that microstimulation produces a temporally stereotyped change in the probability of initiation that is independent of context. These results argue that SMA participates in the computations that lead to movement initiation and does so across a variety of contexts.
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40
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Welniarz Q, Gallea C, Lamy JC, Méneret A, Popa T, Valabregue R, Béranger B, Brochard V, Flamand-Roze C, Trouillard O, Bonnet C, Brüggemann N, Bitoun P, Degos B, Hubsch C, Hainque E, Golmard JL, Vidailhet M, Lehéricy S, Dusart I, Meunier S, Roze E. The supplementary motor area modulates interhemispheric interactions during movement preparation. Hum Brain Mapp 2019; 40:2125-2142. [PMID: 30653778 DOI: 10.1002/hbm.24512] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/21/2018] [Accepted: 01/01/2019] [Indexed: 01/25/2023] Open
Abstract
The execution of coordinated hand movements requires complex interactions between premotor and primary motor areas in the two hemispheres. The supplementary motor area (SMA) is involved in movement preparation and bimanual coordination. How the SMA controls bimanual coordination remains unclear, although there is evidence suggesting that the SMA could modulate interhemispheric interactions. With a delayed-response task, we investigated interhemispheric interactions underlying normal movement preparation and the role of the SMA in these interactions during the delay period of unimanual or bimanual hand movements. We used functional MRI and transcranial magnetic stimulation in 22 healthy volunteers (HVs), and then in two models of SMA dysfunction: (a) in the same group of HVs after transient disruption of the right SMA proper by continuous transcranial magnetic theta-burst stimulation; (b) in a group of 22 patients with congenital mirror movements (CMM), whose inability to produce asymmetric hand movements is associated with SMA dysfunction. In HVs, interhemispheric connectivity during the delay period was modulated according to whether or not hand coordination was required for the forthcoming movement. In HVs following SMA disruption and in CMM patients, interhemispheric connectivity was modified during the delay period and the interhemispheric inhibition was decreased. Using two models of SMA dysfunction, we showed that the SMA modulates interhemispheric interactions during movement preparation. This unveils a new role for the SMA and highlights its importance in coordinated movement preparation.
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Affiliation(s)
- Quentin Welniarz
- Faculté de Médecine, INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France.,Faculté des sciences, INSERM, CNRS, Institut de Biologie Paris Seine, Neuroscience Paris Seine, Sorbonne Université, Paris, France
| | - Cécile Gallea
- Faculté de Médecine, INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Jean-Charles Lamy
- Faculté de Médecine, INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Aurélie Méneret
- Faculté de Médecine, INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France.,Département de Neurologie, Assistance Publique - Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Traian Popa
- Faculté de Médecine, INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Romain Valabregue
- Centre de NeuroImagerie de Recherche CENIR, Institut du Cerveau et de la Moelle - ICM, Paris, France
| | - Benoît Béranger
- Centre de NeuroImagerie de Recherche CENIR, Institut du Cerveau et de la Moelle - ICM, Paris, France
| | - Vanessa Brochard
- Centre d'Investigation Clinique 14-22, INSERM/AP-HP, Paris, France
| | - Constance Flamand-Roze
- IFPPC, Centre CAMKeys, 7 rue des Cordelières, Paris, France.,Service de Neurologie, Unité Cardiovasculaire, Centre Hospitalier Sud-Francilien, Université Paris-Sud, Corbeille-Essonne, France
| | - Oriane Trouillard
- Faculté de Médecine, INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Cécilia Bonnet
- Faculté de Médecine, INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France.,Département de Neurologie, Assistance Publique - Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Norbert Brüggemann
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | | | - Bertrand Degos
- Département de Neurologie, Assistance Publique - Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Cécile Hubsch
- Faculté de Médecine, INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France.,Département de Neurologie, Assistance Publique - Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Elodie Hainque
- Faculté de Médecine, INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France.,Département de Neurologie, Assistance Publique - Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Louis Golmard
- Département de biostatistiques, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Marie Vidailhet
- Faculté de Médecine, INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France.,Département de Neurologie, Assistance Publique - Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Stéphane Lehéricy
- Faculté de Médecine, INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France.,Centre de NeuroImagerie de Recherche CENIR, Institut du Cerveau et de la Moelle - ICM, Paris, France
| | - Isabelle Dusart
- Faculté des sciences, INSERM, CNRS, Institut de Biologie Paris Seine, Neuroscience Paris Seine, Sorbonne Université, Paris, France
| | - Sabine Meunier
- Faculté de Médecine, INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Emmanuel Roze
- Faculté de Médecine, INSERM U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France.,Département de Neurologie, Assistance Publique - Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
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41
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Parmigiani S, Cattaneo L. Stimulation of the Dorsal Premotor Cortex, But Not of the Supplementary Motor Area Proper, Impairs the Stop Function in a STOP Signal Task. Neuroscience 2018; 394:14-22. [DOI: 10.1016/j.neuroscience.2018.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 12/17/2022]
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42
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Yoo PE, Hagan MA, John SE, Opie NL, Ordidge RJ, O'Brien TJ, Oxley TJ, Moffat BA, Wong YT. Spatially dynamic recurrent information flow across long-range dorsal motor network encodes selective motor goals. Hum Brain Mapp 2018. [PMID: 29516636 DOI: 10.1002/hbm.24029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Performing voluntary movements involves many regions of the brain, but it is unknown how they work together to plan and execute specific movements. We recorded high-resolution ultra-high-field blood-oxygen-level-dependent signal during a cued ankle-dorsiflexion task. The spatiotemporal dynamics and the patterns of task-relevant information flow across the dorsal motor network were investigated. We show that task-relevant information appears and decays earlier in the higher order areas of the dorsal motor network then in the primary motor cortex. Furthermore, the results show that task-relevant information is encoded in general initially, and then selective goals are subsequently encoded in specifics subregions across the network. Importantly, the patterns of recurrent information flow across the network vary across different subregions depending on the goal. Recurrent information flow was observed across all higher order areas of the dorsal motor network in the subregions encoding for the current goal. In contrast, only the top-down information flow from the supplementary motor cortex to the frontoparietal regions, with weakened recurrent information flow between the frontoparietal regions and bottom-up information flow from the frontoparietal regions to the supplementary cortex were observed in the subregions encoding for the opposing goal. We conclude that selective motor goal encoding and execution rely on goal-dependent differences in subregional recurrent information flow patterns across the long-range dorsal motor network areas that exhibit graded functional specialization.
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Affiliation(s)
- Peter E Yoo
- Department of Medicine and Radiology, Melbourne Medical School, The University of Melbourne, Victoria, Australia.,Vascular Bionics Laboratory, Melbourne Brain Centre, Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Maureen A Hagan
- Neuroscience Program, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Sam E John
- Department of Electrical & Electronic Engineering, The University of Melbourne, Victoria, Australia.,Vascular Bionics Laboratory, Melbourne Brain Centre, Department of Medicine, The University of Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Nicholas L Opie
- Department of Electrical & Electronic Engineering, The University of Melbourne, Victoria, Australia.,Vascular Bionics Laboratory, Melbourne Brain Centre, Department of Medicine, The University of Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Roger J Ordidge
- Department of Medicine and Radiology, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas J Oxley
- Vascular Bionics Laboratory, Melbourne Brain Centre, Department of Medicine, The University of Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,NeuroEngineering Laboratory, Department of Electrical &Electronic Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bradford A Moffat
- Department of Medicine and Radiology, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Yan T Wong
- Department of Electrical and Computer Systems Engineering, Monash University, Victoria, Australia.,Department of Physiology, Monash University, Clayton, Victoria, Australia.,Neuroscience Program, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
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43
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Mandonnet E, Duffau H. An attempt to conceptualize the individual onco-functional balance: Why a standardized treatment is an illusion for diffuse low-grade glioma patients. Crit Rev Oncol Hematol 2017; 122:83-91. [PMID: 29458793 DOI: 10.1016/j.critrevonc.2017.12.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/19/2017] [Accepted: 12/12/2017] [Indexed: 12/15/2022] Open
Abstract
In the era of evidence-based medicine, clinicians aim to establish standards of care from randomized studies. Following, personalized medicine has emerged, as new individualized biomarkers could help to predict sensitivity to specific treatment. In this paper, we show that, for diffuse low-grade glioma, some specificities - dual goal of both survival and functional gain, long duration of the disease with multistep treatments, multiparametric evaluation of the onco-functional balance of each treatment modality - call for a change of paradigm. After summarizing how to weight the benefits and risks of surgery, chemotherapy and radiotherapy, we show that the overall efficacy of a treatment modality cannot be assessed per se, as it depends on its integration in the whole sequence. Then, we revisit the notion of personalized medicine: instead of decision-making based solely on molecular profile, we plead for a recursive algorithm, allowing a dynamic evaluation of the onco-functional balance, integrating many individual characteristics of the patient's tumor and brain function.
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Affiliation(s)
- Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France; University Paris 7, Paris, France; Institut du Cerveau de la Moelle (ICM), Paris, France.
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier Medical University Center, Montpellier, France; Institute of Neuroscience of Montpellier, INSERM U1051, Montpellier, France; University of Montpellier, Montpellier, France
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44
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Bornstein MH, Putnick DL, Rigo P, Esposito G, Swain JE, Suwalsky JTD, Su X, Du X, Zhang K, Cote LR, De Pisapia N, Venuti P. Neurobiology of culturally common maternal responses to infant cry. Proc Natl Acad Sci U S A 2017; 114:E9465-E9473. [PMID: 29078366 PMCID: PMC5692572 DOI: 10.1073/pnas.1712022114] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This report coordinates assessments of five types of behavioral responses in new mothers to their own infants' cries with neurobiological responses in new mothers to their own infants' cries and in experienced mothers and inexperienced nonmothers to infant cries and other emotional and control sounds. We found that 684 new primipara mothers in 11 countries (Argentina, Belgium, Brazil, Cameroon, France, Kenya, Israel, Italy, Japan, South Korea, and the United States) preferentially responded to their infants' vocalizing distress by picking up and holding and by talking to their infants, as opposed to displaying affection, distracting, or nurturing. Complementary functional magnetic resonance imaging (fMRI) analyses of brain responses to their own infants' cries in 43 new primipara US mothers revealed enhanced activity in concordant brain territories linked to the intention to move and to speak, to process auditory stimulation, and to caregive [supplementary motor area (SMA), inferior frontal regions, superior temporal regions, midbrain, and striatum]. Further, fMRI brain responses to infant cries in 50 Chinese and Italian mothers replicated, extended, and, through parcellation, refined the results. Brains of inexperienced nonmothers activated differently. Culturally common responses to own infant cry coupled with corresponding fMRI findings to own infant and to generic infant cries identified specific, common, and automatic caregiving reactions in mothers to infant vocal expressions of distress and point to their putative neurobiological bases. Candidate behaviors embedded in the nervous systems of human caregivers lie at the intersection of evolutionary biology and developmental cultural psychology.
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Affiliation(s)
- Marc H Bornstein
- Child and Family Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892;
| | - Diane L Putnick
- Child and Family Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892
| | - Paola Rigo
- Child and Family Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892
- Department of Psychology and Cognitive Science, University of Trento, I-38068 Trento, Italy
- Division of Psychology, Nanyang Technological University, Singapore 639798
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, I-38068 Trento, Italy
- Division of Psychology, Nanyang Technological University, Singapore 639798
| | - James E Swain
- Stony Brook University Hospital Medical Center, Stony Brook, NY 11794
| | - Joan T D Suwalsky
- Child and Family Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892
| | - Xueyun Su
- East China Normal University, Shanghai 200241, China
| | - Xiaoxia Du
- East China Normal University, Shanghai 200241, China
| | - Kaihua Zhang
- East China Normal University, Shanghai 200241, China
| | - Linda R Cote
- Department of Psychology, Marymount University, Arlington, VA 22207
| | - Nicola De Pisapia
- Department of Psychology and Cognitive Science, University of Trento, I-38068 Trento, Italy
| | - Paola Venuti
- Department of Psychology and Cognitive Science, University of Trento, I-38068 Trento, Italy
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45
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Vilasboas T, Herbet G, Duffau H. Challenging the Myth of Right Nondominant Hemisphere: Lessons from Corticosubcortical Stimulation Mapping in Awake Surgery and Surgical Implications. World Neurosurg 2017; 103:449-456. [DOI: 10.1016/j.wneu.2017.04.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
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46
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Boissonneau S, Duffau H. Identifying clinical risk in low grade gliomas and appropriate treatment strategies, with special emphasis on the role of surgery. Expert Rev Anticancer Ther 2017; 17:703-716. [PMID: 28608763 DOI: 10.1080/14737140.2017.1342537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Diffuse low-grade glioma (DLGG) is a chronic tumoral disease that ineluctably grows, migrates along white matter pathways, and progresses to a higher grade of malignancy. Areas covered: To determine the best individualized treatment attitude for each DLGG patient, and to redefine it over the years, i.e. to optimize the 'onco-functional balance' of serial and multimodal therapies, the understanding of the natural history of this chronic disease is crucial but not sufficient. A paradigmatic shift is to tailor the individual management according to the dynamic relationships between DLGG course and neural remodeling. In this spirit, a better knowledge of brain plasticity in a connectomal account of cerebral processing has enabled a dramatic improvement of both oncological and functional outcomes in DLGG patients, by increasing overall survival while preserving (or even improving) the quality of life. Expert commentary: Here, we propose an individualized and recursive therapeutic strategy in DLGG, leading to the concept of a 'personalized functional neuro-oncology', by emphasizing the role of early and maximal safe surgical resection(s) reliably achieved using intraoperative mapping of cortico-subcortical networks in awake patients.
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Affiliation(s)
| | - Hugues Duffau
- b Department of Neurosurgery , Gui de Chauliac Hospital, Montpellier University Medical Center , Montpellier , France.,c Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," INSERM U1051, Institute for Neurosciences of Montpellier , Montpellier University Medical Center , Montpellier , France
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47
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Xu J, Elazab A, Liang J, Jia F, Zheng H, Wang W, Wang L, Hu Q. Cortical and Subcortical Structural Plasticity Associated with the Glioma Volumes in Patients with Cerebral Gliomas Revealed by Surface-Based Morphometry. Front Neurol 2017. [PMID: 28649229 PMCID: PMC5465275 DOI: 10.3389/fneur.2017.00266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Postlesional plasticity has been identified in patients with cerebral gliomas by inducing a large functional reshaping of brain networks. Although numerous non-invasive functional neuroimaging methods have extensively investigated the mechanisms of this functional redistribution in patients with cerebral gliomas, little effort has been made to investigate the structural plasticity of cortical and subcortical structures associated with the glioma volume. In this study, we aimed to investigate whether the contralateral cortical and subcortical structures are able to actively reorganize by themselves in these patients. The compensation mechanism following contralateral cortical and subcortical structural plasticity is considered. We adopted the surface-based morphometry to investigate the difference of cortical and subcortical gray matter (GM) volumes in a cohort of 14 healthy controls and 13 patients with left-hemisphere cerebral gliomas [including 1 patients with World Health Organization (WHO I), 8 WHO II, and 4 WHO III]. The glioma volume ranges from 5.1633 to 208.165 cm2. Compared to healthy controls, we found significantly increased GM volume of the right cuneus and the left thalamus, as well as a trend toward enlargement in the right globus pallidus in patients with cerebral gliomas. Moreover, the GM volumes of these regions were positively correlated with the glioma volumes of the patients. These results provide evidence of cortical and subcortical enlargement, suggesting the usefulness of surface-based morphometry to investigate the structural plasticity. Moreover, the structural plasticity might be acted as the compensation mechanism to better fulfill its functions in patients with cerebral gliomas as the gliomas get larger.
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Affiliation(s)
- Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Ahmed Elazab
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Misr Higher Institute for Commerce and Computers, Mansoura, Egypt
| | - Jinhua Liang
- Neurosurgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Fucang Jia
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Huimin Zheng
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Weimin Wang
- Neurosurgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Limin Wang
- Psychological Department, Guangzhou First People's Hospital, Guangzhou, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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48
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Rech F, Duffau H, Pinelli C, Masson A, Roublot P, Billy-Jacques A, Brissart H, Civit T. Intraoperative identification of the negative motor network during awake surgery to prevent deficit following brain resection in premotor regions. Neurochirurgie 2017; 63:235-242. [DOI: 10.1016/j.neuchi.2016.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/17/2016] [Accepted: 08/30/2016] [Indexed: 12/01/2022]
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49
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Pallud J, Mandonnet E, Corns R, Dezamis E, Parraga E, Zanello M, Spena G. Technical principles of direct bipolar electrostimulation for cortical and subcortical mapping in awake craniotomy. Neurochirurgie 2017; 63:158-163. [DOI: 10.1016/j.neuchi.2016.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 11/24/2016] [Accepted: 12/04/2016] [Indexed: 12/01/2022]
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50
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Moser T, Bulubas L, Sabih J, Conway N, Wildschutz N, Sollmann N, Meyer B, Ringel F, Krieg SM. Resection of Navigated Transcranial Magnetic Stimulation-Positive Prerolandic Motor Areas Causes Permanent Impairment of Motor Function. Neurosurgery 2017; 81:99-110. [DOI: 10.1093/neuros/nyw169] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 12/23/2016] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Navigated transcranial magnetic stimulation (nTMS) helps to determine the distribution of motor eloquent areas prior to brain surgery. Yet, the eloquence of primary motor areas frontal to the precentral gyrus identified via nTMS is unclear.
OBJECTIVE: To investigate the resection of nTMS-positive prerolandic motor areas and its correlation with postsurgical impairment of motor function.
METHODS: Forty-three patients with rolandic or prerolandic gliomas (WHO grade I-IV) underwent nTMS prior to surgery. Only patients without ischemia within the motor system in postoperative MRI diffusion sequences were enrolled. Based on the 3-dimensional fusion of preoperative nTMS motor mapping data with postsurgical MRI scans, we identified nTMS points that were resected in the infiltration zone of the tumor. We then classified the resected points according to the localization and latency of their motor evoked potentials. Surgery-related paresis was graded as transient (≤6 weeks) or permanent (>6 weeks).
RESULTS: Out of 43, 31 patients (72%) showed nTMS-positive motor points in the prerolandic gyri. In general, 13 out of 43 patients (30%) underwent resection of nTMS points. Ten out of these patients showed postoperative paresis. There were 2 (15%) patients with a transient and 8 (62%) with a permanent surgery-related paresis. In 3 cases (23%), motor function remained unimpaired.
CONCLUSION: After resection of nTMS-positive motor points, 62% of patients suffered from a new permanent paresis. Thus, even though they are located in the superior or middle frontal gyrus, these cortical areas must undergo intraoperative mapping.
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Affiliation(s)
- Tobias Moser
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Lucia Bulubas
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jamil Sabih
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Neal Conway
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Noémie Wildschutz
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sandro M. Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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