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Bykanov AE, Pitskhelauri D, Batalov AI, Trube M, Danilov G, Golbin D. Anatomical and Technical Preparations of the Human Brain for White Matter Fibers Dissection with Electromagnetic Neuronavigation Assistance Technical Nuances for Application. World Neurosurg 2022; 168:173-178. [DOI: 10.1016/j.wneu.2022.09.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
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Buklina SB, Zhukov VY, Goryainov SA, Batalov AI, Afandiev RM, Maryashev SA, Vologdina YO, Bykanov AE. [Conduction aphasia in patients with glioma in the left hemisphere]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:29-40. [PMID: 34463448 DOI: 10.17116/neiro20218504129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background. According to Wernicke-Geschwind model, conduction aphasia following arcuate tract lesion was canonized as primary disorder of repetition in relatively intact speech. OBJECTIVE Syndromic analysis of speech and writing disorders in patients with arcuate tract lesion using the method by A.R. Luria and their comparison with well-known types of aphasia. MATERIAL AND METHODS Clinical and neuropsychological survey was performed in 14 patients with gliomas who underwent surgical treatment at the Burdenko Neurosurgical Center (10 gliomas of the frontal lobe and 4 tumors of the temporal lobe). All patients underwent MRI, HARDI MRI tractography and A.R. Luria's neuropsychological examination prior to surgery and after 5-6 postoperative days. Thirteen patients underwent awake craniotomy, 3 of them were examined one year after surgery. RESULTS In all patients, the tumor was localized near arcuate tract and its infiltration was noted. No intraoperative damage to the tract was ever noted according to speech monitoring data. However, postoperative edema followed by infiltration and dislocation of the tract (in all patients), as well as local ischemia in 4 patients were observed. After resection of prefrontal and premotor gliomas, aphasia included frontal (perseveration) and temporal components (disorders of naming, auditory-speech memory). Unusual verbal paraphrases were noted. We also observed severe violation of writing (temporal type) even if spontaneous speech and repetition were preserved. In case of resection of deep posterior temporal gliomas, speech disorders included signs of frontal lobe lesion (perseveration) and writing disorders. Similar motor abnormalities were identified in writing. CONCLUSION Arcuate tract lesion can result speech and writing disorders as signs of damage to certain cortical speech zones (frontal and temporal lobe). Violations of repetition were not predominant in any case. At the same time, interruption of connection between motor and auditory image of the word could be revealed in writing.
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Affiliation(s)
- S B Buklina
- Burdenko Neurosurgical Center, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - V Yu Zhukov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - A I Batalov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | | | - A E Bykanov
- Burdenko Neurosurgical Center, Moscow, Russia
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Pitskhelauri D, Bykanov A, Konovalov A, Danilov G, Buklina S, Sanikidze A, Sufianov R. Transsylvian Insular Glioma Surgery: New Classification System, Clinical Outcome in a Consecutive Series of 79 Cases. Oper Neurosurg (Hagerstown) 2021; 20:541-548. [PMID: 33677610 DOI: 10.1093/ons/opab051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 12/11/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surgery of insular glial tumors remains a challenge because of high incidence of postoperative neurological deterioration and the complex anatomy of the insular region. OBJECTIVE To explore the prognostic role of our and Berger-Sanai classifications on the extent of resection (EOR) and clinical outcome. METHODS From 2012 to 2017, a transsylvian removal of insular glial tumors was performed in 79 patients. The EOR was assessed depending on magnetic resonance imaging scans performed in the first 48 h after surgery. RESULTS The EOR ≥90% was achieved in 30 (38%) cases and <90% in 49 (62.0%) cases. In the early postoperative period, the new neurological deficit was observed in 31 (39.2%) patients, and in 5 patients (6.3%), it persisted up to 3 mo.We proposed a classification of insular gliomas based on its volumetric and anatomical characteristics. A statistically significant differences were found between proposed classes in tumor volume before and after surgery (P < .001), EOR (P = .02), rate of epileptic seizures before the surgical treatment (P = .04), and the incidence of persistent postoperative complications (P = .03).In the logistic regression model, tumor location in zone II (Berger-Sanai classification) was the predictor significantly related to less likely EOR of ≥90% and the maximum rate of residual tumor detection (P = .02). CONCLUSION The proposed classification of the insular gliomas was an independent predictor of the EOR and persistent postoperative neurological deficit. According to Berger-Sanai classification, zone II was a predictor of less EOR through the transsylvian approach.
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Affiliation(s)
- David Pitskhelauri
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Andrey Bykanov
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Alexander Konovalov
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Gleb Danilov
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Svetlana Buklina
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Alexander Sanikidze
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Rinat Sufianov
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
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Pitskhelauri DI, Ishkinin RE, Bykanov AE, Sanikidze AZ, Buklina SB, Abramyan AA, Pronin IN. [Anterior transperiinsular approach to the head of the caudate nucleus and mediobasal frontal lobe]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2021; 85:54-60. [PMID: 34951760 DOI: 10.17116/neiro20218506154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The head of the caudate nucleus and adjacent mediobasal frontal lobe are deeply localized and have complex anatomical and topographic relationships with surrounding functionally significant cerebral structures. These aspects determine difficult surgical treatment of pathology in this zone. OBJECTIVE To propose a new anterior transperiinsular approach for optimizing surgical access to the head of the caudate nucleus and mediobasal frontal lobe. MATERIAL AND METHODS Two patients with cavernoma of the head of the caudate nucleus and oligodendroglioma of the head of the caudate nucleus and mediobasal frontal lobe underwent resection via transsylvian anterior transperiinsular approach in 2018. In both cases, tumors were localized in dominant hemisphere. Standard MRI was performed before and after surgery. Luria's neurological and neuropsychological examination was carried out before surgery, in 7 days after surgery and then every 3 months. RESULTS Surgical access was performed via stage-by-stage proximal dissection of Sylvian fissure with visualization of anterior and superior periinsular grooves. After that, periinsular groove was dissected at the base of anterior short gyrus. Then, we moved apart white matter using microinstruments and approached the area of interest. In case of this trajectory, surgical approach was performed at the level of the upper parts of inferior frontooccipital fascicle under the arcuate fascicle. Both patients underwent total resection of tumors that was confirmed by MRI. No pre- and postoperative neurological or neuropsychological abnormalities were observed. CONCLUSION Anterior transperiinsular approach provides minimally invasive access to the head of the caudate nucleus and mediobasal frontal lobe. It can be used on dominant hemisphere without significant risk of speech or other cognitive impairments. The advantages of this approach are minimal damage to associative pathways and small distance between periinsular groove and zone of interest. Dissection of commissural fibers of the corpus callosum is not required compared to conventional transcallosal approach.
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Affiliation(s)
| | | | - A E Bykanov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - S B Buklina
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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Bykanov AE, Pitskhelauri DI, Titov OY, Lin MC, Gulaev EV, Ogurtsova AA, Maryashev SA, Zhukov VY, Buklina SB, Lubnin AY, Beshplav ST, Konakova TA, Pronin IN. [Broca's area intraoperative mapping with cortico-cortical evoked potentials]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:49-58. [PMID: 33306299 DOI: 10.17116/neiro20208406149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Mapping of effective speech connections between the frontal and temporal lobes with cortico-cortical evoked potentials. MATERIAL AND METHODS There were 3 patients with brain tumors in the left frontoparietal region. The neoplasms were localized in the dominant hemisphere near cortical speech centers and pathways. Cortico-cortical evoked potentials were intraoperatively recorded in response to bipolar stimulation with a direct current delivered through the subdural electrodes (single rectangular biphasic impulses with duration of 300 μs and frequency of 1 Hz). Stimulation intensity was gradually increased from 2 mA within 3-4 mA. Registration was carried out by averaging ECoG (30-50 stimuli in each session) in the 300-ms epoch after stimulus. Direct cortical stimulation was used to validate the results of cortico-cortical speech mapping with cortico-cortical evoked potentials. RESULTS In our cases, we obtained cortico-cortical evoked potentials from inferior frontal gyrus after stimulation of superior temporal gyrus. In one case, this effective relationship was unidirectional, in the other two patients reciprocal. Mean latency of N1 peak was 65 ms (range 49.6-90 ms), mean amplitude 71 µV (range 50-100 µV). Cortico-cortical mapping data were confirmed by detection of Broca's area in 2 out of 3 cases out during direct cortical stimulation with maximum amplitude of N1 wave. «Awake craniotomy» protocol was applied. In one case, Broca's area was not detected during direct stimulation. No postoperative speech impairment was noted. CONCLUSION Initial results of cortical mapping with cortico-cortical evoked potentials in a small sample confirmed its practical significance for analysis of cortical projections of effective speech communications between the frontal and temporal lobes. Further study of this method in large samples is required.
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Affiliation(s)
- A E Bykanov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - O Yu Titov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - E V Gulaev
- Ivanovo Regional Hospital, Ivanovo, Russia
| | | | | | - V Yu Zhukov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - S B Buklina
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A Yu Lubnin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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Buklina SB, Bykanov AE, Pitskhelauri DI. [Clinical and neuropsychological studies of patients before and after insular glioma resection]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:43-54. [PMID: 32207742 DOI: 10.17116/neiro20208401143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The study was aimed to investigate the insula function based on analysis and comparison of epileptic seizures (irritation symptoms) and cognitive impairment (memory loss) in patients with insular gliomas. MATERIAL AND METHODS Epileptic seizures and cognitive impairment were analyzed in 51 patients with insular gliomas before and after surgery. The tumor was located on the left in 21 patients and on the right - in 30. Patients were aged 9 to 67 years; most patients were diagnosed with grade II and grade III gliomas. Patients were examined before surgery and 4-6 days after tumor resection. Neuropsychological examination was carried out according to the A.R. Luria method, which enabled establishing a correlation between detected impairments and the topography of injury to different brain areas. To identify the seizure features, the study presents data from two additional groups of patients: with temporal and frontal lobe tumors, 50 patients each. RESULTS Epileptic seizures were detected in 45 (88.2%) of 51 patients in the main group and were similar to paroxysms associated with medial temporal lobe tumors, but quantitatively differed from them. Seizures in patients with frontal lobe tumors significantly differed from those with insular and temporal lobe tumors. Compared to temporal lobe epilepsy, symptomatic epilepsy in the setting of insular tumors was characterized by significantly less frequent losses of consciousness (84% versus 35.2%) but more frequent olfactory and taste hallucinations (16% versus 51%). Fear and anxiety attacks associated with these tumor localizations occurred at the same rate (in 17.6% of patients with insular tumors and in 14% patients with temporal tumors). The vegetative component of seizures did not differ in tumors of both localizations and different lateralization. Olfactory and taste hallucinations were qualitatively similar in tumors of the insula and temporal lobe: smell and taste were always unpleasant or corresponded to danger. Pleasant taste or smell was not developed in any case. Cognitive impairment before and after surgery directly depended on the tumor spread to the adjacent temporal or frontal lobes. Memory impairments were most frequent, and speech disorders were most frequent in the case left-sided lesions. Eight patients with total removal of the insula and without postoperative complications had no deterioration in speech and memory. CONCLUSION Epileptic seizures associated with insular tumors are characterized by both similarities and differences with medial-temporal seizures, which is due to the close relationships between the insula and the limbic system. The nature of taste and olfactory hallucinations associated with insular tumors reflects a significant role of the insula in the formation of 'protective behavior'. The absence of clear cognitive impairment in focal lesions of the insula restricts extended interpretation of the insula role in implementation of cognitive functions. This issue needs further investigation.
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Affiliation(s)
- S B Buklina
- Burdenko Neurosurgical Center, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - A E Bykanov
- Burdenko Neurosurgical Center, Moscow, Russia
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Zhukov VY, Goryaynov SA, Buklina SB, Vologdina YO, Batalov AI, Ogurtsova AA, Kulikov AS, Kobyakov GL, Sitnikov AR, Chernyshov KA, Chelushkin DM, Zakharova NE, Potapov AA. [Intraoperative mapping of long association fibers in surgery of gliomas of the speech-dominant frontal lobe]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 82:5-20. [PMID: 30412152 DOI: 10.17116/neiro2018820515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgery of intracerebral tumors involving long association fibers is a challenge. In this study, we analyze the results of intraoperative mapping of the superior longitudinal, arcuate, and frontal aslant tracts in surgery of brain gliomas. PURPOSE The study purpose was to compare the results of intraoperative mapping and the postoperative speech function in patients with gliomas of the premotor area of the speech-dominant frontal lobe, which involved the superior longitudinal, arcuate, and frontal aslant tracts, who were operated on using awake craniotomy. MATERIAL AND METHODS Twelve patients with left frontal lobe gliomas were operated on: 11 patients were right-handed, and one patient was a left-hander retrained at an early age. Histological types of tumors were represented by Grade II diffuse astrocytomas (6 patients), Grade III anaplastic astrocytomas (1 patient), Grade IV glioblastoma (1 patient), Grade II oligodendroglioma (1 patient), and Grade III anaplastic oligodendrogliomas (3 patients). The mean age of patients was 45 (29-67) years; there were 6 males and 6 females. All patients underwent preoperative and postoperative MRI with reconstruction of the long association fibers and determination of the topographic anatomical relationships between the fibers and the tumor. Surgery was performed using the asleep-awake-asleep protocol with intraoperative awakening of patients. All patients underwent cortical and subcortical electrophysiological stimulation to control the localization of eloquent structures and to clarify the safe limits of resection. For intraoperative speech monitoring, a computerized naming test was used with naming of nouns or verbs, and automatic speech was evaluated (counting from 1 to 10, enumeration of months and days of the week), which was complemented by a talk with the patient. Speech disorders before, during, and after surgery were evaluated by a neuropsychologist. The mean current strength during direct electrical stimulation was 3 (1.9-6.5) mA. RESULTS The association fibers were intraoperatively identified in all patients (SLF/AF in 11 patients; FAT in one patient). In 4 patients, the cortical motor speech area was intraoperatively mapped; in three cases, tumor resection was accompanied by speech disturbances outside the stimulation. During direct electrical stimulation, speech disturbances developed in 7 of 12 cases. All patients underwent control MRI within the first 48-72 h: total resection (more than 90% of the tumor) was performed in 7 cases; subtotal resection was achieved in two patients; partial resection was performed in two cases. According to postoperative MR tractography, the resected tumor bed was adjacent to the SLF/AF complex in 7 cases, located near the SLF/AF complex in three cases, and adjacent to the FAT in two cases. Postoperatively, 11 out of 12 patients had worsening of neurological symptoms in the form of various speech disturbances. In one patient, speech disturbances developed 2 days after surgery, which was associated with an increase in edema. On examination 3 months after surgery, severe speech disturbances remained in 1 patient. CONCLUSION Resection of frontal lobe tumors in the speech-dominant hemisphere using early postoperative awakening is associated with a high rate of complex speech disorders due to injury to the SLF/AF complex and FAT. In these cases, intraoperative speech mapping with allowance for the course of long association fibers is an essential procedure. Preoperative tractography in combination with intraoperative speech mapping enables identification of association fibers of the SLF/AF complex and FAT, which may help to avoid severe conduction aphasia with poor speech recovery after tumor resection.
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Affiliation(s)
- V Yu Zhukov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - S B Buklina
- Burdenko Neurosurgical Institute, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - A I Batalov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A S Kulikov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - G L Kobyakov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A R Sitnikov
- Treatment and Rehabilitation Center of the Russian Ministry of Health, Moscow, Russia
| | - K A Chernyshov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | | | | | - A A Potapov
- Burdenko Neurosurgical Institute, Moscow, Russia
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