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Yu L, Dugan P, Doyle W, Devinsky O, Friedman D, Flinker A. A left-lateralized dorsolateral prefrontal network for naming. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.15.594403. [PMID: 38798614 PMCID: PMC11118423 DOI: 10.1101/2024.05.15.594403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
The ability to connect the form and meaning of a concept, known as word retrieval, is fundamental to human communication. While various input modalities could lead to identical word retrieval, the exact neural dynamics supporting this convergence relevant to daily auditory discourse remain poorly understood. Here, we leveraged neurosurgical electrocorticographic (ECoG) recordings from 48 patients and dissociated two key language networks that highly overlap in time and space integral to word retrieval. Using unsupervised temporal clustering techniques, we found a semantic processing network located in the middle and inferior frontal gyri. This network was distinct from an articulatory planning network in the inferior frontal and precentral gyri, which was agnostic to input modalities. Functionally, we confirmed that the semantic processing network encodes word surprisal during sentence perception. Our findings characterize how humans integrate ongoing auditory semantic information over time, a critical linguistic function from passive comprehension to daily discourse.
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Affiliation(s)
- Leyao Yu
- Department of Biomedical Engineering, New York University, New York, 10016, New York, the United States
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Patricia Dugan
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Werner Doyle
- Department of Neurosurgery, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Orrin Devinsky
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Daniel Friedman
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
| | - Adeen Flinker
- Department of Biomedical Engineering, New York University, New York, 10016, New York, the United States
- Department of Neurology, School of Medicine, New York University, New York, 10016, New York, the United States
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2
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Kram L, Schroeder A, Meyer B, Krieg SM, Ille S. Function-guided differences of arcuate fascicle and inferior fronto-occipital fascicle tractography as diagnostic indicators for surgical risk stratification. Brain Struct Funct 2024:10.1007/s00429-024-02787-3. [PMID: 38597941 DOI: 10.1007/s00429-024-02787-3] [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: 09/17/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Several patients with language-eloquent gliomas face language deterioration postoperatively. Persistent aphasia is frequently associated with damage to subcortical language pathways. Underlying mechanisms still need to be better understood, complicating preoperative risk assessment. This study compared qualitative and quantitative functionally relevant subcortical differences pre- and directly postoperatively in glioma patients with and without aphasia. METHODS Language-relevant cortical sites were defined using navigated transcranial magnetic stimulation (nTMS) language mapping in 74 patients between 07/2016 and 07/2019. Post-hoc nTMS-based diffusion tensor imaging tractography was used to compare a tract's pre- and postoperative visualization, volume and fractional anisotropy (FA), and the preoperative distance between tract and lesion and postoperative overlap with the resection cavity between the following groups: no aphasia (NoA), tumor- or previous resection induced aphasia persistent pre- and postoperatively (TIA_P), and surgery-induced transient or permanent aphasia (SIA_T or SIA_P). RESULTS Patients with NoA, TIA_P, SIA_T, and SIA_P showed distinct fasciculus arcuatus (AF) and inferior-fronto-occipital fasciculus (IFOF) properties. The AF was more frequently reconstructable, and the FA of IFOF was higher in NoA than TIA_P cases (all p ≤ 0.03). Simultaneously, SIA_T cases showed higher IFOF fractional anisotropy than TIA_P cases (p < 0.001) and the most considerable AF volume loss overall. While not statistically significant, the four SIA_P cases showed complete loss of ventral language streams postoperatively, the highest resection-cavity-AF-overlap, and the shortest AF to tumor distance. CONCLUSION Functionally relevant qualitative and quantitative differences in AF and IFOF provide a pre- and postoperative pathophysiological and clinically relevant diagnostic indicator that supports surgical risk stratification.
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Affiliation(s)
- Leonie Kram
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University, Heidelberg, Germany
| | - Axel Schroeder
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University, Heidelberg, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.
- Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University, Heidelberg, Germany.
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3
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van Ierschot FC, Veenstra W, Miozzo A, Santini B, Jeltema HR, Spena G, Miceli G. Written language preservation in glioma patients undergoing awake surgery: The value of tailored intra-operative assessment. J Neuropsychol 2024; 18 Suppl 1:205-229. [PMID: 37840529 DOI: 10.1111/jnp.12349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023]
Abstract
Written language is increasingly important, as contemporary society strongly relies on text-based communication. Nonetheless, in neurosurgical practice, language preservation has classically focused on spoken language. The current study aimed to evaluate the potential role of intra-operative assessments in the preservation of written language skills in glioma patients undergoing awake surgery. It is the first feasibility study to use a standardized and detailed Written language battery in glioma patients undergoing awakening surgery. Reading and spelling were assessed pre- and post-operatively in eleven patients. Intra-operatively, 7 cases underwent written language assessment in addition to spoken object naming. Results show that reading and spelling deficits may arise before and after glioma surgery and that written language may be differently affected than spoken language. In our case series, task-specific preservation of function was obtained in all cases when a specific written language skill was monitored intra-operatively. However, the benefits of intra-operative testing did not always generalize, and non-monitored written language tasks may not be preserved. Hence, when a specific written language skill needs to be preserved, to facilitate return to work and maintain quality of life, results indicate that intra-operative assessment of that skill is advised. An illustrative case report demonstrates how profile analyses can be used pre-operatively to identify cognitive components at risk and intra-operatively to preserve written language abilities in clinical practice.
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Affiliation(s)
- Fleur Céline van Ierschot
- Center for Mind/Brain Sciences (CiMeC), University of Trento, Rovereto, Italy
- International Doctorate for Experimental Approaches to Language and Brain (IDEALAB), Universities of Trento, Groningen, Newcastle, Potsdam and Macquarie University, Trento, Groningen, Newcastle, Potsdam, Sydney, Italy, Netherlands, Australia, Germany, Australia
| | - Wencke Veenstra
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands
| | - Antonio Miozzo
- Centre for Aging Brain and Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Barbara Santini
- Department of Neuroscience, Neurosurgery Clinic, University of Verona, Verona, Italy
| | - Hanne-Rinck Jeltema
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Giannantonio Spena
- Centre for Aging Brain and Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Gabriele Miceli
- Center for Mind/Brain Sciences (CiMeC), University of Trento, Rovereto, Italy
- International Doctorate for Experimental Approaches to Language and Brain (IDEALAB), Universities of Trento, Groningen, Newcastle, Potsdam and Macquarie University, Trento, Groningen, Newcastle, Potsdam, Sydney, Italy, Netherlands, Australia, Germany, Australia
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4
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Deng D, Liang L. Talking about speaking: what do we know about language reorganization in brain tumors before surgery. Eur Radiol 2023; 33:6066-6068. [PMID: 37405506 DOI: 10.1007/s00330-023-09900-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Demao Deng
- Department of Radiology, Guangxi Academy of Medical Science, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China.
| | - Lingyan Liang
- Department of Radiology, Guangxi Academy of Medical Science, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
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Sahrizan NSA, Manan HA, Abdul Hamid H, Abdullah JM, Yahya N. Functional Alteration in the Brain Due to Tumour Invasion in Paediatric Patients: A Systematic Review. Cancers (Basel) 2023; 15:cancers15072168. [PMID: 37046828 PMCID: PMC10093754 DOI: 10.3390/cancers15072168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
Working memory, language and speech abilities, motor skills, and visual abilities are often impaired in children with brain tumours. This is because tumours can invade the brain's functional areas and cause alterations to the neuronal networks. However, it is unclear what the mechanism of tumour invasion is and how various treatments can cause cognitive impairment. Therefore, this study aims to systematically evaluate the effects of tumour invasion on the cognitive, language, motor, and visual abilities of paediatric patients, as well as discuss the alterations and modifications in neuronal networks and anatomy. The electronic database, PubMed, was used to find relevant studies. The studies were systematically reviewed based on the type and location of brain tumours, cognitive assessment, and pre- and post-operative deficits experienced by patients. Sixteen studies were selected based on the inclusion and exclusion criteria following the guidelines from PRISMA. Most studies agree that tumour invasion in the brain causes cognitive dysfunction and alteration in patients. The effects of a tumour on cognition, language, motor, and visual abilities depend on the type of tumour and its location in the brain. The alteration to the neuronal networks is also dependent on the type and location of the tumour. However, the default mode network (DMN) is the most affected network, regardless of the tumour type and location.Furthermore, our findings suggest that different treatment types can also contribute to patients' cognitive function to improve or deteriorate. Deficits that persisted or were acquired after surgery could result from surgical manipulation or the progression of the tumour's growth. Meanwhile, recovery from the deficits indicated that the brain has the ability to recover and reorganise itself.
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Affiliation(s)
- Nur Shaheera Aidilla Sahrizan
- Department of Radiology, Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), University Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Hanani Abdul Manan
- Department of Radiology, Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), University Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Hamzaini Abdul Hamid
- Department of Radiology, Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), University Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Jafri Malin Abdullah
- Jabatan Neurosains, Pusat Pengajian Sains Perubatan, Jalan Hospital USM, Kampus Kesihatan, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Brain and Behaviour Cluster, Pusat Pengajian Sains Perubatan, Kampus Kesihatan, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Department of Neurosciences & Brain Behaviour Cluster, Hospital Universiti Sains Malaysia, Kampus Kesihatan, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Program, School of Diagnostic & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
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Nieberlein L, Rampp S, Gussew A, Prell J, Hartwigsen G. Reorganization and Plasticity of the Language Network in Patients with Cerebral Gliomas. Neuroimage Clin 2023; 37:103326. [PMID: 36736198 PMCID: PMC9926312 DOI: 10.1016/j.nicl.2023.103326] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/15/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
Language is organized in large-scale networks in the human brain that show a strong potential for flexible interactions and adaptation. Neuroplasticity is the central mechanism that allows such dynamic modulation to changing conditions across the life span and is particularly important for network reorganization after brain lesions. Most studies on language reorganization focused on language recovery after stroke. Yet, a strong degree of adaptive neuroplasticity can also be observed in patients with brain tumors in language-eloquent brain areas. This review discusses key mechanisms for neural reorganization in patients with brain tumors. Our main aim is to elucidate the underlying mechanisms for intra- and interhemispheric plasticity in the language network in these patients. The following reorganization patterns are discussed: 1) Persisting function within the tumor; 2) Reorganization in perilesional regions; 3) Reorganization in a distributed network of the affected hemisphere; 4) Reorganization to the contralesional hemisphere. In this context, we shed light on language-related reorganization patterns in frontal and temporo-parietal areas and discuss their functional relevance. We also address tumor-related changes in structural and functional connectivity between eloquent brain regions. Thereby, we aim to expand the general understanding of the plastic potential of the neural language network and facilitate clinical decision-making processes for effective, function-preserving tumor treatment.
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Affiliation(s)
- Laura Nieberlein
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Halle (Saale), Germany; Department of Neurosurgery, University Hospital Erlangen, Germany
| | - Alexander Gussew
- Department of Medical Physics, University Hospital Halle (Saale), Germany
| | - Julian Prell
- Department of Neurosurgery, University Hospital Halle (Saale), Germany
| | - Gesa Hartwigsen
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Wilhelm Wundt Institute for Psychology, Leipzig University, Germany
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7
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Collée E, Vincent A, Dirven C, Satoer D. Speech and Language Errors during Awake Brain Surgery and Postoperative Language Outcome in Glioma Patients: A Systematic Review. Cancers (Basel) 2022; 14:cancers14215466. [PMID: 36358884 PMCID: PMC9658495 DOI: 10.3390/cancers14215466] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
Awake craniotomy with direct electrical stimulation (DES) is the standard treatment for patients with gliomas in eloquent areas. Even though language is monitored carefully during surgery, many patients suffer from postoperative aphasia, with negative effects on their quality of life. Some perioperative factors are reported to influence postoperative language outcome. However, the influence of different intraoperative speech and language errors on language outcome is not clear. Therefore, we investigate this relation. A systematic search was performed in which 81 studies were included, reporting speech and language errors during awake craniotomy with DES and postoperative language outcomes in adult glioma patients up until 6 July 2020. The frequencies of intraoperative errors and language status were calculated. Binary logistic regressions were performed. Preoperative language deficits were a significant predictor for postoperative acute (OR = 3.42, p < 0.001) and short-term (OR = 1.95, p = 0.007) language deficits. Intraoperative anomia (OR = 2.09, p = 0.015) and intraoperative production errors (e.g., dysarthria or stuttering; OR = 2.06, p = 0.016) were significant predictors for postoperative acute language deficits. Postoperatively, the language deficits that occurred most often were production deficits and spontaneous speech deficits. To conclude, during surgery, intraoperative anomia and production errors should carry particular weight during decision-making concerning the optimal onco-functional balance for a given patient, and spontaneous speech should be monitored. Further prognostic research could facilitate intraoperative decision-making, leading to fewer or less severe postoperative language deficits and improvement of quality of life.
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Schiavolin S, Mariniello A, Broggi M, DiMeco F, Ferroli P, Leonardi M. Preoperative nonmedical predictors of functional impairment after brain tumor surgery. Support Care Cancer 2022; 30:3441-3450. [PMID: 34999949 DOI: 10.1007/s00520-021-06732-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify the preoperative nonmedical predictors of functional impairment after brain tumor surgery. METHODS Patients were evaluated before brain tumor surgery and after 3 months. The cognitive evaluation included MOCA for the general cognitive status, TMT for attention and executive functions, ROWL-IR and ROWL-DR for memory, and the F-A-S for verbal fluency. Anxiety, depression, social support, resilience, personality, disability, and quality of life were evaluated with the following patient-reported outcome measures (PROMs): HADS, OSS-3, RS-14, TIPI, WHODAS-12, and EORTC-QLQ C30. Functional status was measured with KPS. Regression analyses were performed to identify preoperative nonmedical predictors of functional impairment; PROMs and cognitive tests were compared with the normative values. RESULTS A total of 149 patients were enrolled (64 glioma; 85 meningioma). Increasing age, lower education, higher disability, and lower ROWL-DR scores were predictors of functional impairment in glioma patients while higher TMT scores and disability were predictors in meningioma patients. In multiple regression, only a worse performance in TMT remains a predictor in meningioma patients. Cognitive tests were not significantly worse than normative values, while psychosocial functioning was impaired. CONCLUSION TMT could be used in the preoperative evaluation and as a potential predictor in the research field on outcome predictors. Psychosocial functioning should be studied further and considered in a clinical context to identify who need major support and to plan tailored interventions.
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Affiliation(s)
- Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Arianna Mariniello
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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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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Ekert JO, Kirkman MA, Seghier ML, Green DW, Price CJ. A Data-Based Approach for Selecting Pre- and Intra-Operative Language Mapping Tasks. Front Neurosci 2021; 15:743402. [PMID: 34899156 PMCID: PMC8656425 DOI: 10.3389/fnins.2021.743402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pre- and intra-operative language mapping in neurosurgery patients frequently involves an object naming task. The choice of the optimal object naming paradigm remains challenging due to lack of normative data and standardization in mapping practices. The aim of this study was to identify object naming paradigms that robustly and consistently activate classical language regions and could therefore be used to improve the sensitivity of language mapping in brain tumor and epilepsy patients. Methods: Functional magnetic resonance imaging (fMRI) data from two independent groups of healthy controls (total = 79) were used to generate threshold-weighted voxel-based consistency maps. This novel approach allowed us to compare inter-subject consistency of activation for naming single objects in the visual and auditory modality and naming two objects in a phrase or a sentence. Results: We found that the consistency of activation in language regions was greater for naming two objects per picture than one object per picture, even when controlling for the number of names produced in 5 s. Conclusion: More consistent activation in language areas for naming two objects compared to one object suggests that two-object naming tasks may be more suitable for delimiting language eloquent regions with pre- and intra-operative language testing. More broadly, we propose that the functional specificity of brain mapping paradigms for a whole range of different linguistic and non-linguistic functions could be enhanced by referring to databased models of inter-subject consistency and variability in typical and atypical brain responses.
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Affiliation(s)
- Justyna O. Ekert
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Matthew A. Kirkman
- Department of Neurosurgery, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Mohamed L. Seghier
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - David W. Green
- Department of Experimental Psychology, University College London, London, United Kingdom
| | - Cathy J. Price
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, United Kingdom
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11
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Intraoperative brain mapping during awake surgery in symptomatic supratentorial cavernomas. ACTA ACUST UNITED AC 2021; 32:217-223. [PMID: 34493402 DOI: 10.1016/j.neucie.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Complete resection of symptomatic supratentorial cavernoma (SCA) and removal of the surrounding gliotic area is recommended to minimize the risk of persistent seizures or (re)bleeding. Surgery of SCA located in an eloquent area, can carry out severe postoperative neurological morbidity. We report a study aimed to assess feasibility, extent of resection and outcome after surgical removal of CA by cortico-subcortical intraoperative brain stimulation (ioBS) in the awake patient. METHODS Six patients diagnosed of symptomatic SCA located on an eloquent area and operated on while awake under local anaesthesia ioBS, were included. Preoperative planning included neuropsychologic assessment of language-related functions, sociocognitive functions and executive functions. Intraoperatively, we recorded the results achieved in the planned neuropsychological tasks when stimulation was applied (cortical and subcortical). Postoperative control 3D MRI was scheduled at 1 month after surgery to calculate extent of resection. Neuropsychological assessment at 6 months after surgery was performed in all cases. RESULTS Six patients (5 females, 1 male) aged 24-48 years were included in our study. Locations of the lesions were right insular (n=1), left insular (n=1), left temporo-insular (n=1), left temporal (n=2) and left frontal (n=1). In all patients, positive findings were obtained during ioBS. In 5 patients, complete surgical resection was achieved. Two patients had postoperative transient neurological deficits, one case of hemiparesis, one case of dysnomia, both cleared over a 6-month period. Clinical follow-up revealed that all patients experienced complete recovery from preoperative symptoms within a year and five patients with seizures showed marked improvement and eventually quit antiepileptic drugs. Neuropsychological assessment at 6 months provided normal results compared to preoperative baseline in all domains. CONCLUSIONS Our study suggests that ioBS in the awake surgery of symptomatic SCA located in eloquent areas, allows to increase the rate of complete resection, minimizing postoperative neurological and neuropsychological deficit, and improving postoperative seizures control.
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12
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van der Linden SD, Rutten GJM, Dirven L, Taphoorn MJB, Satoer DD, Dirven CMF, Sitskoorn MM, Gehring K. eHealth cognitive rehabilitation for brain tumor patients: results of a randomized controlled trial. J Neurooncol 2021; 154:315-326. [PMID: 34487313 PMCID: PMC8484142 DOI: 10.1007/s11060-021-03828-1] [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: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence-based cognitive rehabilitation programs for brain tumor patients are not widely available, despite the high need. We aimed to evaluate the effects of a tablet-based cognitive rehabilitation program on cognitive performance, cognitive complaints, fatigue, and psychological distress in primary brain tumor patients following neurosurgery. Also, attrition, adherence and patient satisfaction with the program were evaluated. METHODS Adults with presumed low-grade glioma and meningioma were recruited before surgery. Three months thereafter, participants were allocated to the intervention group or waiting-list control group using minimization. The 10-week eHealth app ReMind, based on the effective face-to-face intervention, consisted of psychoeducation, strategy-training and attention retraining. Performance-based cognitive outcomes and patient-reported outcomes were assessed before surgery and 3, 6 and 12 months thereafter. Mean scores, percentages of cognitively impaired individuals and reliable change indices (RCIs) were compared between groups. RESULTS Sixty-two out of 183 eligible patients were randomized. Of the people who declined, 56% reported that participation would to be too burdensome. All participants found a tablet-app suitable for delivery of cognitive rehabilitation and 90% rated the program as "good" or "excellent". Performance-based cognitive outcomes and patient-reported outcomes did not significantly differ in group means over time nor RCIs between the intervention (final n = 20) and control group (final n = 25). CONCLUSIONS Recruitment at this early stage was difficult, resulting in limited statistical power. No significant effects were demonstrated, while adherence and satisfaction with the eHealth program were good. In clinical practice, ReMind may be helpful, if timing would be adapted to patients' needs.
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Affiliation(s)
- Sophie D van der Linden
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.,Department of Cognitive Neuropsychology, Tilburg University, Room S219, P.O. Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Geert-Jan M Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Djaina D Satoer
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Margriet M Sitskoorn
- Department of Cognitive Neuropsychology, Tilburg University, Room S219, P.O. Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Karin Gehring
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands. .,Department of Cognitive Neuropsychology, Tilburg University, Room S219, P.O. Box 90153, 5000 LE, Tilburg, the Netherlands.
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13
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Abstract
Picture naming tasks are currently the gold standard for identifying and preserving language-related areas during awake brain surgery. With multilingual populations increasing worldwide, patients frequently need to be tested in more than one language. There is still no reliable testing instrument, as the available batteries have been developed for specific languages. Heterogeneity in the selection criteria for stimuli leads to differences, for example, in the size, color, image quality, and even names associated with pictures, making direct cross-linguistic comparisons difficult. Here we present MULTIMAP, a new multilingual picture naming test for mapping eloquent areas during awake brain surgery. Recognizing that the distinction between nouns and verbs is necessary for detailed and precise language mapping, MULTIMAP consists of a database of 218 standardized color pictures representing both objects and actions. These images have been tested for name agreement with speakers of Spanish, Basque, Catalan, Italian, French, English, German, Mandarin Chinese, and Arabic, and have been controlled for relevant linguistic features in cross-language combinations. The MULTIMAP test for objects and verbs represents an alternative to the Oral Denomination 80 (DO 80) monolingual pictorial set currently used in language mapping, providing an open-source, standardized set of up-to-date pictures, where relevant linguistic variables across several languages have been taken into account in picture creation and selection.
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14
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Połczyńska MM. Organizing Variables Affecting fMRI Estimates of Language Dominance in Patients with Brain Tumors. Brain Sci 2021; 11:brainsci11060694. [PMID: 34070413 PMCID: PMC8226970 DOI: 10.3390/brainsci11060694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 11/16/2022] Open
Abstract
Numerous variables can affect the assessment of language dominance using presurgical functional magnetic resonance (fMRI) in patients with brain tumors. This work organizes the variables into confounding and modulating factors. Confounding factors give the appearance of changed language dominance. Most confounding factors are fMRI-specific and they can substantially disrupt the evaluation of language dominance. Confounding factors can be divided into two categories: tumor-related and fMRI analysis. The tumor-related confounds further subdivide into tumor characteristics (e.g., tumor grade) and tumor-induced conditions (aphasia). The fMRI analysis confounds represent technical aspects of fMRI methods (e.g., a fixed versus an individual threshold). Modulating factors can modify language dominance without confounding it. They are not fMRI-specific, and they can impact language dominance both in healthy individuals and neurosurgical patients. The effect of most modulating factors on fMRI language dominance is smaller than that of confounding factors. Modulating factors include demographics (e.g., age) and linguistic variables (e.g., early bilingualism). Three cases of brain tumors in the left hemisphere are presented to illustrate how modulating confounding and modulating factors can impact fMRI estimates of language dominance. Distinguishing between confounding and modulating factors can help interpret the results of presurgical language mapping with fMRI.
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Affiliation(s)
- Monika M Połczyńska
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA 90025, USA
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15
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Papatzalas C, Fountas K, Brotis A, Kapsalaki E, Papathanasiou I. The Greek linguistic assessment for awake brain surgery: development process and normative data. CLINICAL LINGUISTICS & PHONETICS 2021; 35:458-488. [PMID: 32666837 DOI: 10.1080/02699206.2020.1792997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 06/11/2023]
Abstract
Language mapping with direct electrical stimulation is considered the gold standard in surgical treatment of brain tumors. Assessing a variety of language functions intraoperatively can affect the extent of the tumor resection as well as the patient's postoperative quality of life. Although most tests include preoperative sessions where tasks are personalised to each patient, normative data are essential since they can ensure that the presented stimuli can be responded appropriately. In this study, we describe the development and standardisation procedures of the first linguistic test in Greek, designed specifically for brain mapping during awake craniotomies. The tasks are developed to comply with the special conditions and restrictions of language assessment inside the operating room. Each task is controlled for various psycholinguistic and lexical variables and it is associated with specific neuroanatomical areas and linguistic processes. Our population consists of 80 right-handed, healthy, Greek-speaking individuals aged 20-60 years. We found only a few main effects and interactions of demographic variables on our test scores. Most differences were found between age groups, since older participants tend to perform slightly worse than younger ones. Therefore, percentiles and cut-off scores were calculated separately for each demographic group. Regarding the clinical application of GLAABS, we describe the procedures we followed to administer it to brain tumor patients from our department and also discuss how sensitivity and specificity can affect patients' postoperative course.
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Affiliation(s)
- Christos Papatzalas
- Faculty of Medicine, University of Thessaly, Larisa, Greece
- Department of Neurosurgery, General University Hospital of Larisa, Larisa, Greece
| | - Kostas Fountas
- Faculty of Medicine, University of Thessaly, Larisa, Greece
- Department of Neurosurgery, General University Hospital of Larisa, Larisa, Greece
| | - Alexandros Brotis
- Department of Neurosurgery, General University Hospital of Larisa, Larisa, Greece
| | - Eftychia Kapsalaki
- Faculty of Medicine, University of Thessaly, Larisa, Greece
- Department of Radiology, General University Hospital of Larisa, Larisa, Greece
| | - Ilias Papathanasiou
- Department of Speech & Language Therapy, University of Patras, Pátrai, Greece
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16
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Papatzalas C, Fountas K, Kapsalaki E, Papathanasiou I. The Use of Standardized Intraoperative Language Tests in Awake Craniotomies: A Scoping Review. Neuropsychol Rev 2021; 32:20-50. [PMID: 33786797 DOI: 10.1007/s11065-021-09492-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/22/2021] [Indexed: 12/12/2022]
Abstract
Assessment of speech and language functions is an essential part of awake craniotomies. Although standardized and validated tests have several advantages compared to homemade (or mixed) batteries, in the literature it is unclear how such tests are used or whether they are used at all. In this study, we performed a scoping review in order to locate standardized and validated intraoperative language tests. Our inquiry included two databases (PubMED and MEDLINE), gray literature, and snowball referencing. We discovered 87 studies reporting use of mixed batteries, which consist of homemade tasks and tests borrowed from other settings. The tests we found to meet the validation and standardization criteria we set were ultimately three (n = 3) and each one has its own advantages and disadvantages. We argue that tests with high sensitivity and specificity not only can lead to better outcomes postoperatively, but they can also help us to gain a better understanding of the neuroanatomy of language.
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Affiliation(s)
- Christos Papatzalas
- Department of Medicine, University of Thessaly, Larisa, Greece.
- Department of Neurosurgery, University Hospital of Larisa, Larisa, Greece.
| | - Kostas Fountas
- Department of Medicine, University of Thessaly, Larisa, Greece
- Department of Neurosurgery, University Hospital of Larisa, Larisa, Greece
| | - Eftychia Kapsalaki
- Department of Medicine, University of Thessaly, Larisa, Greece
- Department of Radiology, University Hospital of Larisa, Larisa, Greece
| | - Ilias Papathanasiou
- Department of Speech & Language Therapy, University of Patras, Patras, Greece
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Intraoperative brain mapping of language, cognitive functions, and social cognition in awake surgery of low-grade gliomas located in the right non-dominant hemisphere. Clin Neurol Neurosurg 2020; 200:106363. [PMID: 33203593 DOI: 10.1016/j.clineuro.2020.106363] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/24/2020] [Accepted: 11/07/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of our study was to evaluate the usefulness of cortical-subcortical intraoperative brain mapping (ioBM) in resective awake surgery of low-grade gliomas (LGG) of the right non-dominant hemisphere (RndH). It was estimated how ioBM may affect both the extent of resection and postoperative outcome of language, spatial cognition, social cognition, and executive functions including attention and working memory. PATIENTS AND METHODS Fifteen patients that underwent ioBM in resective awake surgery of LGG located on the RndH, were included. A cohort of 15 patients with the same tumour location operated under general anaesthesia without brain mapping was used as control. Specific intraoperative tasks for each location were carried out and results registered. Neuropsychological assessment was performed preoperatively and at 6 months after surgery. RESULTS In the group of patients operated by using ioBM in awake surgery, an 86.66 % mean of resection was obtained compared to 60.33 % in the control group. Speech arrest and incorrect naming responses were elicited in higher proportion in frontal and insular locations. Parietal stimulation associated higher number of incorrect responses in social cognition task. Parietal and temporal stimulation were more frequently associated with incorrect performance of spatial cognition task. Parietal stimulation associated with higher frequency incorrect execution of attention and working memory tasks. After comparing clinical and neuropsychological results in both cohorts, worst outcome at 6 months was observed in the group of patients operated under general anaesthesia without brain mapping, especially in parietal and insular locations. CONCLUSIONS Intraoperative identification of language, cognitive functions, and social cognition of RndH by means of ioBM, can be of paramount importance in improving the extent of resection of low-grade gliomas and positively affects clinical and neuropsychological outcome at six months.
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18
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Prat-Acín R, Galeano-Senabre I, López-Ruiz P, García-Sánchez D, Ayuso-Sacido A, Espert-Tortajada R. Intraoperative brain mapping during awake surgery in symptomatic supratentorial cavernomas. Neurocirugia (Astur) 2020; 32:S1130-1473(20)30105-6. [PMID: 33060022 DOI: 10.1016/j.neucir.2020.07.004] [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: 05/20/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Complete resection of symptomatic supratentorial cavernoma (SCA) and removal of the surrounding gliotic area is recommended to minimize the risk of persistent seizures or (re)bleeding. Surgery of SCA located in an eloquent area, can carry out severe postoperative neurological morbidity. We report a study aimed to assess feasibility, extent of resection and outcome after surgical removal of CA by cortico-subcortical intraoperative brain stimulation (ioBS) in the awake patient. METHODS Six patients diagnosed of symptomatic SCA located on an eloquent area and operated on while awake under local anaesthesia ioBS, were included. Preoperative planning included neuropsychologic assessment of language-related functions, sociocognitive functions and executive functions. Intraoperatively, we recorded the results achieved in the planned neuropsychological tasks when stimulation was applied (cortical and subcortical). Postoperative control 3D MRI was scheduled at 1 month after surgery to calculate extent of resection. Neuropsychological assessment at 6 months after surgery was performed in all cases. RESULTS Six patients (5 females, 1 male) aged 24-48 years were included in our study. Locations of the lesions were right insular (n=1), left insular (n=1), left temporo-insular (n=1), left temporal (n=2) and left frontal (n=1). In all patients, positive findings were obtained during ioBS. In 5 patients, complete surgical resection was achieved. Two patients had postoperative transient neurological deficits, one case of hemiparesis, one case of dysnomia, both cleared over a 6-month period. Clinical follow-up revealed that all patients experienced complete recovery from preoperative symptoms within a year and five patients with seizures showed marked improvement and eventually quit antiepileptic drugs. Neuropsychological assessment at 6 months provided normal results compared to preoperative baseline in all domains. CONCLUSIONS Our study suggests that ioBS in the awake surgery of symptomatic SCA located in eloquent areas, allows to increase the rate of complete resection, minimizing postoperative neurological and neuropsychological deficit, and improving postoperative seizures control.
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Affiliation(s)
- Ricardo Prat-Acín
- Servicio de Neurocirugía. Hospital Universitario I Politècnic La Fe, Valencia, Spain; Unidad Mixta Nanomedicina y Sensores: Fundación Hospital La Fe, Universidad Politécnica de Valencia, Spain.
| | - Inma Galeano-Senabre
- Servicio de Neurocirugía. Hospital Universitario I Politècnic La Fe, Valencia, Spain; Unidad Mixta Nanomedicina y Sensores: Fundación Hospital La Fe, Universidad Politécnica de Valencia, Spain
| | | | - Daniel García-Sánchez
- Servicio de Neurocirugía. Hospital Universitario I Politècnic La Fe, Valencia, Spain
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19
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Norrelgen F, Jensdottir M, Östberg P. High-level language outcomes three and twelve months after awake surgery in low grade glioma and cavernoma patients. Clin Neurol Neurosurg 2020; 195:105946. [PMID: 32480197 DOI: 10.1016/j.clineuro.2020.105946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Knowledge about the long-term outcome of high-level language ability in awake surgery patients with low-grade gliomas or cavernomas in language eloquent regions is limited, particularly regarding subtle changes in high-level language abilities. PATIENTS AND METHODS The study group consisted of 27 patients with LGG or cavernoma which involved language eloquent regions in the left hemisphere. A comprehensive assessment battery was used to target subtle changes in overall high-level language ability as well as in language sub skills. Assessments were made preoperatively and at 3 and 12 months postoperatively. RESULTS The results showed that overall high-level language ability had not decreased significantly at group level at 3 or 12 months postoperatively. The proportion of patients with a decline of 5 percent or more at follow up 3 and 12 months were 13% and 9% respectively. There was a marked decline in semantic fluency (animals and verbs) at 3 and 12 months postoperatively. Phonemic fluency, while not significantly reduced at three months, improved markedly in the interval between 3 and 12 months. At 12 months, the only significant decline relative to preoperative scores were seen in semantic fluency for animals and verbs. Verbal cognitive speed did not decline significantly postoperatively but approximately 40% of the patients had a decline of 5% or more at 12 months. CONCLUSIONS Overall high-level language ability was not significantly affected postoperatively at 3 and 12 months in LGG and cavernoma awake surgery patients. Semantic word fluency had deteriorated postoperatively at 3 and 12 months follow-up. Taken together our results indicate a decline in processing speed of verbal material postoperatively in the patient group.
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Affiliation(s)
- Fritjof Norrelgen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden.
| | - Margret Jensdottir
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Per Östberg
- Department of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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20
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Schiavolin S, Raggi A, Scaratti C, Toppo C, Silvaggi F, Sattin D, Broggi M, Ferroli P, Leonardi M. Outcome prediction in brain tumor surgery: a literature review on the influence of nonmedical factors. Neurosurg Rev 2020; 44:807-819. [PMID: 32377881 DOI: 10.1007/s10143-020-01289-0] [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] [Received: 01/28/2020] [Revised: 03/05/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
The purpose of the present study was to review the existing data on preoperative nonmedical factors that are predictive of outcome in brain tumor surgery. Our hypothesis was that also the individual characteristics (e.g., emotional state, cognitive status, social relationships) could influence the postoperative course in addition to clinical factors usually investigated in brain tumor surgery. PubMed, Embase, and Scopus were searched from 2008 to 2018 using terms relating to brain tumors, craniotomy, and predictors. All types of outcome were considered: clinical, cognitive, and psychological. Out of 6.288 records identified, 16 articles were selected for analysis and a qualitative synthesis of the prognostic factors was performed. The following nonmedical factors were found to be predictive of surgical outcomes: socio-demographic (age, marital status, type of insurance, gender, socio-economic status, type of hospital), cognitive (preoperative language and cognitive deficits, performance at TMT-B test), and psychological (preoperative depressive symptoms, personality traits, autonomy for daily activities, altered mental status). This review showed that nonmedical predictors of outcome exist in brain tumor surgery. Consequently, individual characteristics (e.g., emotional state, cognitive status, social relationships) can influence the postoperative course in addition to clinical factors.
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Affiliation(s)
- Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Chiara Scaratti
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Claudia Toppo
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Fabiola Silvaggi
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Davide Sattin
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Morgan Broggi
- Division of Neurosurgery II, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Paolo Ferroli
- Division of Neurosurgery II, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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The verb and noun test for peri-operative testing (VAN-POP): standardized language tests for navigated transcranial magnetic stimulation and direct electrical stimulation. Acta Neurochir (Wien) 2020; 162:397-406. [PMID: 31823119 PMCID: PMC6982630 DOI: 10.1007/s00701-019-04159-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/25/2019] [Indexed: 11/21/2022]
Abstract
Background Protocols for intraoperative language mapping with direct electrical stimulation (DES) often include various language tasks triggering both nouns and verbs in sentences. Such protocols are not readily available for navigated transcranial magnetic stimulation (nTMS), where only single word object naming is generally used. Here, we present the development, norming, and standardization of the verb and noun test for peri-operative testing (VAN-POP) that measures language skills more extensively. Methods The VAN-POP tests noun and verb retrieval in sentence context. Items are marked and balanced for several linguistic factors known to influence word retrieval. The VAN-POP was administered in English, German, and Dutch under conditions that are used for nTMS and DES paradigms. For each language, 30 speakers were tested. Results At least 50 items per task per language were named fluently and reached a high naming agreement. Conclusion The protocol proved to be suitable for pre- and intraoperative language mapping with nTMS and DES.
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Kreidenhuber R, De Tiège X, Rampp S. Presurgical Functional Cortical Mapping Using Electromagnetic Source Imaging. Front Neurol 2019; 10:628. [PMID: 31249552 PMCID: PMC6584755 DOI: 10.3389/fneur.2019.00628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/28/2019] [Indexed: 02/03/2023] Open
Abstract
Preoperative localization of functionally eloquent cortex (functional cortical mapping) is common clinical practice in order to avoid or reduce postoperative morbidity. This review aims at providing a general overview of magnetoencephalography (MEG) and high-density electroencephalography (hdEEG) based methods and their clinical role as compared to common alternatives for functional cortical mapping of (1) verbal language function, (2) sensorimotor cortex, (3) memory, (4) visual, and (5) auditory cortex. We highlight strengths, weaknesses and limitations of these functional cortical mapping modalities based on findings in the recent literature. We also compare their performance relative to other non-invasive functional cortical mapping methods, such as functional Magnetic Resonance Imaging (fMRI), Transcranial Magnetic Stimulation (TMS), and to invasive methods like the intracarotid Amobarbital Test (WADA-Test) or intracranial investigations.
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Affiliation(s)
- Rudolf Kreidenhuber
- Department of Neurology, Christian-Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Xavier De Tiège
- Laboratoire de Cartographie Fonctionelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium.,Department of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefan Rampp
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany.,Department of Neurosurgery, University Hospital Halle, Halle, Germany
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23
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Anterior insular cortex stimulation and its effects on emotion recognition. Brain Struct Funct 2019; 224:2167-2181. [DOI: 10.1007/s00429-019-01895-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/24/2019] [Indexed: 12/20/2022]
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24
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De Witte E, Piai V, Kurteff G, Cai R, Mariën P, Dronkers N, Chang E, Berger M. A valid alternative for in-person language assessments in brain tumor patients: feasibility and validity measures of the new TeleLanguage test. Neurooncol Pract 2019; 6:93-102. [PMID: 31386040 PMCID: PMC6656337 DOI: 10.1093/nop/npy020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although language deficits after awake brain surgery are usually milder than post-stroke, postoperative language assessments are needed to identify these. Follow-up of brain tumor patients in certain geographical regions can be difficult when most patients are not local and come from afar. We developed a short telephone-based test for pre- and postoperative language assessments. METHODS The development of the TeleLanguage Test was based on the Dutch Linguistic Intraoperative Protocol and existing standardized English batteries. Two parallel versions were composed and tested in healthy native English speakers. Subsequently, the TeleLanguage Test was administered in a group of 14 tumor patients before surgery and at 1 week, 1 month, and 3 months after surgery. The test includes auditory comprehension, repetition, semantic selection, sentence or story completion, verbal naming, and fluency tests. It takes less than 20 minutes to administer. RESULTS Healthy participants had no difficulty performing any of the language tests via the phone, attesting to the feasibility of a phone assessment. In the patient group, all TeleLanguage test scores significantly declined shortly after surgery with a recovery to preoperative levels at 3 months postsurgery for naming and fluency tasks and a recovery to normal levels for the other language tasks. Analysis of the in-person language assessments (until 1 month) revealed a similar profile. CONCLUSION The use of the TeleLanguage battery to conduct language assessments from afar can provide convenience, might optimize patient care, and enables longitudinal clinical research. The TeleLanguage is a valid tool for various clinical and scientific purposes.
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Affiliation(s)
- Elke De Witte
- University of California San Francisco Medical Center, Department of Neurological Surgery, San Francisco, California, USA
- Vrije Universiteit Brussel, Department of Clinical and Experimental Neurolinguistics, Center of Linguistics and Literary Studies, Brussels, Belgium
| | - Vitória Piai
- Radboud University Medical Center, Department of Medical Psychology, Nijmegen, the Netherlands
- Radboud University, Donders Centre for Cognition, Nijmegen, the Netherlands
| | - Garret Kurteff
- University of California San Francisco Medical Center, Department of Neurological Surgery, San Francisco, California, USA
| | - Ruofan Cai
- University of California San Francisco Medical Center, Department of Neurological Surgery, San Francisco, California, USA
| | - Peter Mariën
- Vrije Universiteit Brussel, Department of Clinical and Experimental Neurolinguistics, Center of Linguistics and Literary Studies, Brussels, Belgium
- ZNA Middelheim, Department of Neurology & Memory Clinic, Antwerp, Belgium
| | - Nina Dronkers
- VA Northern California Health Care System, Center for Aphasia and Related Disorders, Martinez, California, USA
| | - Edward Chang
- University of California San Francisco Medical Center, Department of Neurological Surgery, San Francisco, California, USA
| | - Mitchel Berger
- University of California San Francisco Medical Center, Department of Neurological Surgery, San Francisco, California, USA
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van Ierschot F, Bastiaanse R, Miceli G. Evaluating Spelling in Glioma Patients Undergoing Awake Surgery: a Systematic Review. Neuropsychol Rev 2018; 28:470-495. [DOI: 10.1007/s11065-018-9391-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/07/2018] [Indexed: 01/20/2023]
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26
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ACEVEDO-PÉREZ JL. Revisión sobre el tratamiento de las secuelas lingüísticas en pacientes intervenidos con mapeo de lenguaje intraoperatorio. REVISTA ORL 2018. [DOI: 10.14201/orl.19433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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27
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Ruis C. Monitoring cognition during awake brain surgery in adults: A systematic review. J Clin Exp Neuropsychol 2018; 40:1081-1104. [DOI: 10.1080/13803395.2018.1469602] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Carla Ruis
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Psychology, Utrecht University, Utrecht, The Netherlands
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28
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Rofes A, Mandonnet E, de Aguiar V, Rapp B, Tsapkini K, Miceli G. Language processing from the perspective of electrical stimulation mapping. Cogn Neuropsychol 2018; 36:117-139. [PMID: 29996708 DOI: 10.1080/02643294.2018.1485636] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Electrical Stimulation (ES) is a neurostimulation technique that is used to localize language functions in the brain of people with intractable epilepsy and/or brain tumors. We reviewed 25 ES articles published between 1984 and 2018 and interpreted them from a cognitive neuropsychological perspective. Our aim was to highlight ES as a tool to further our understanding of cognitive models of language. We focused on associations and dissociations between cognitive functions within the framework of two non-neuroanatomically specified models of language. Also, we discussed parallels between the ES and the stroke literatures and showed how ES data can help us to generate hypotheses regarding how language is processed. A good understanding of cognitive models of language is essential to motivate task selection and to tailor surgical procedures, for example, by avoiding testing the same cognitive functions and understanding which functions may be more or less relevant to be tested during surgery.
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Affiliation(s)
- Adrià Rofes
- Global Brain Health Institute, Trinity College Dublin , Dublin , Ireland.,Department of Cognitive Science, Johns Hopkins University , Baltimore , MD , USA
| | - Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital , Paris , France.,University Diderot Paris 7 , Paris , France.,Frontlab, INSERM, ICM , Paris , France
| | - Vânia de Aguiar
- Department of Neurology, Johns Hopkins University , Baltimore , MD , USA
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University , Baltimore , MD , USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins University , Baltimore , MD , USA
| | - Gabriele Miceli
- Center for Mind and Brain Sciences, University of Trento , Trento , Italy
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29
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Antonsson M, Jakola A, Longoni F, Carstam L, Hartelius L, Thordstein M, Tisell M. Post-surgical effects on language in patients with presumed low-grade glioma. Acta Neurol Scand 2018; 137:469-480. [PMID: 29265169 DOI: 10.1111/ane.12887] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Low-grade glioma (LGG) is a slow-growing brain tumour often situated in or near areas involved in language and/or cognitive functions. Thus, language impairments due to tumour growth or surgical resection are obvious risks. We aimed to investigate language outcome following surgery in patients with presumed LGG, using a comprehensive and sensitive language assessment. MATERIALS AND METHODS Thirty-two consecutive patients with presumed LGG were assessed preoperative, early post-operative, and 3 months post-operative using sensitive tests including lexical retrieval, language comprehension and high-level language. The patients' preoperative language ability was compared with a reference group, but also with performance at post-operative controls. Further, the association between tumour location and language performance pre- and post-operatively was explored. RESULTS Before surgery, the patients with presumed LGG performed worse on tests of lexical retrieval when compared to a reference group (BNT: LGG-group median 52, Reference-group median 54, P = .002; Animals: LGG-group mean 21.0, Reference-group mean 25, P = 001; Verbs: LGG-group mean 17.3, Reference-group mean 21.4, P = .001). At early post-operative assessment, we observed a decline in all language tests, whereas at 3 months there was only a decline on a single test of lexical retrieval (Animals: preoperative. median 20, post-op median 14, P = .001). The highest proportion of language impairment was found in the group with a tumour in language-eloquent areas at all time-points. CONCLUSIONS Although many patients with a tumour in the left hemisphere deteriorated in their language function directly after surgery, their prognosis for recovery was good.
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Affiliation(s)
- M. Antonsson
- Speech and Language Pathology Unit; Institute of Neuroscience and Physiology; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
| | - A. Jakola
- Department of Neurosurgery; Sahlgrenska University Hospital; Gothenburg Sweden
- Institute of Neuroscience and Physiology; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
| | - F. Longoni
- Speech and Language Pathology Unit; Institute of Neuroscience and Physiology; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
| | - L. Carstam
- Department of Neurosurgery; Sahlgrenska University Hospital; Gothenburg Sweden
| | - L. Hartelius
- Speech and Language Pathology Unit; Institute of Neuroscience and Physiology; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
| | - M. Thordstein
- Institute of Neuroscience and Physiology; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
| | - M. Tisell
- Department of Neurosurgery; Sahlgrenska University Hospital; Gothenburg Sweden
- Institute of Neuroscience and Physiology; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
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Intraoperative linguistic performance during awake brain surgery predicts postoperative linguistic deficits. J Neurooncol 2018; 139:215-223. [PMID: 29637508 PMCID: PMC6061224 DOI: 10.1007/s11060-018-2863-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/04/2018] [Indexed: 11/20/2022]
Abstract
Introduction Awake craniotomy pursues a balance between extensive tumor resection and preservation of postoperative language function. A dilemma exists in patients whose tumor resection is restricted due to signs of language impairment observed during awake craniotomy. In order to determine the degree to which recovery of language function caused by tumor resection can be achieved by spontaneous neuroplasticity, the change in postoperative language function was compared to quantified intraoperative linguistic performance. Methods The modified, short-form Boston Diagnostic Aphasia Examination (sfBDAE) was used to assess pre- and postoperative language functions; visual object naming (DO 80) and semantic-association (Pyramid and Palm Tree Test, PPTT) tests assessed intraoperative linguistic performance. DO 80 and PPTT were performed alternatively during subcortical functional monitoring while performing tumor resection and sfBDAE was assessed 1-week postoperatively. Results Most patients with observed language impairment during awake surgery showed improved language function postoperatively. Both intraoperative DO 80 and PPTT showed significant correlation to postoperative sfBDAE domain scores (p < 0.05), with a higher correlation observed with PPTT. A linear regression model showed that only PPTT predicted the postoperative sfBDAE domain scores with the adjusted R2 ranging from 0.51 to 0.89 (all p < 0.01). Receiver operating characteristic analysis showed a cutoff value of PPTT that yielded a sensitivity of 80% and specificity of 100%. Conclusion PPTT may be a feasible tool for intraoperative linguistic evaluation that can predict postoperative language outcomes. Further studies are needed to determine the extent of tumor resection that optimizes the postoperative language following neuroplasticity.
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31
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Lehtinen H, Mäkelä JP, Mäkelä T, Lioumis P, Metsähonkala L, Hokkanen L, Wilenius J, Gaily E. Language mapping with navigated transcranial magnetic stimulation in pediatric and adult patients undergoing epilepsy surgery: Comparison with extraoperative direct cortical stimulation. Epilepsia Open 2018; 3:224-235. [PMID: 29881801 PMCID: PMC5983150 DOI: 10.1002/epi4.12110] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2018] [Indexed: 12/04/2022] Open
Abstract
Objective Navigated transcranial magnetic stimulation (nTMS) is becoming increasingly popular in noninvasive preoperative language mapping, as its results correlate well enough with those obtained by direct cortical stimulation (DCS) during awake surgery in adult patients with tumor. Reports in the context of epilepsy surgery or extraoperative DCS in adults are, however, sparse, and validation of nTMS with DCS in children is lacking. Furthermore, little is known about the risk of inducing epileptic seizures with nTMS in pediatric epilepsy patients. We provide the largest validation study to date in an epilepsy surgery population. Methods We compared language mapping with nTMS and extraoperative DCS in 20 epilepsy surgery patients (age range 9‐32 years; 14 children and adolescents). Results In comparison with DCS, sensitivity of nTMS was 68%, specificity 76%, positive predictive value 27%, and negative predictive value 95%. Age, location of ictal‐onset zone near or within DCS‐mapped language areas or severity of cognitive deficits had no significant effect on these values. None of our patients had seizures during nTMS. Significance Our study suggests that nTMS language mapping is clinically useful and safe in epilepsy surgery patients, including school‐aged children and patients with extensive cognitive dysfunction. Similar to in tumor surgery, mapping results in the frontal region are most reliable. False negative findings may be slightly more likely in epilepsy than in tumor surgery patients. Mapping results should always be verified by other methods in individual patients.
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Affiliation(s)
- Henri Lehtinen
- Epilepsy UnitDepartment of Pediatric NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Department of Psychology and LogopedicsFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Jyrki P. Mäkelä
- BioMag LaboratoryHUS Medical Imaging CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Teemu Mäkelä
- HUS Medical Imaging CenterRadiologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - Pantelis Lioumis
- Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental HealthTorontoOntarioCanada
| | - Liisa Metsähonkala
- Epilepsy UnitDepartment of Pediatric NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Laura Hokkanen
- Department of Psychology and LogopedicsFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Juha Wilenius
- Clinical NeurosciencesDepartment of Clinical NeurophysiologyHUS Medical Imaging CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Eija Gaily
- Epilepsy UnitDepartment of Pediatric NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
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32
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Satoer D, Vincent A, Ruhaak L, Smits M, Dirven C, Visch-Brink E. Spontaneous speech in patients with gliomas in eloquent areas: Evaluation until 1 year after surgery. Clin Neurol Neurosurg 2018; 167:112-116. [PMID: 29475027 DOI: 10.1016/j.clineuro.2018.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/08/2018] [Accepted: 02/11/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Glioma patients often complain about problems in daily conversation with a negative impact on quality of life. Disorders in standardized language tests (e.g. naming and fluency), are frequently observed. Most studies claim recovery of language functions within 3 months. However, long-term effects of surgery on spontaneous speech remain unknown. PATIENTS AND METHODS Eighteen glioma patients were compared to healthy controls in spontaneous speech variables: Type Token Ratio (TTR), Mean Length of Utterance words (MLUw), Incomplete Sentences, Self-corrections and Repetitions. Boston Naming Test (BNT) and Category Fluency (CF) were also assessed. We compared: pre- and 3 months postoperatively (T1-T2), 3 months and 1 year postoperatively (T2-T3), pre- and 1 year postoperatively (T1-T3). Correlations were computed between deviating variables and BNT/CF, tumor localization, and tumor grade. RESULTS Patients had deficits in Incomplete sentences (T1, T2, T3), TTR (T2,T3), MLUw (T3) and Self-corrections (T2). Between T1-T2 no decline was present. Between T2-T3 and T1-T3, there was a decrease of MLUw, Self-corrections and Repetitions and an increase of Incomplete Sentences, BNT and CF were impaired (T1, T2, T3) without differences between test-moments. Most spontaneous speech variables did not correlate with standardized tests. Tumor localization and grade had no influence on spontaneous speech. CONCLUSION Glioma patients showed impaired spontaneous speech combined with naming and fluency deficits. Surgery appeared to have deteriorated the quality of spontaneous speech until long-term but not the performance at test-level. Hence, spontaneous speech has an added value to standardized tests for diagnosis of language impairments.
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Affiliation(s)
- Djaina Satoer
- Departments of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Arnaud Vincent
- Departments of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Leonie Ruhaak
- Departments of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marion Smits
- Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Clemens Dirven
- Departments of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Evy Visch-Brink
- Departments of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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Antonsson M, Longoni F, Jakola A, Tisell M, Thordstein M, Hartelius L. Pre-operative language ability in patients with presumed low-grade glioma. J Neurooncol 2017; 137:93-102. [PMID: 29196925 PMCID: PMC5846960 DOI: 10.1007/s11060-017-2699-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 11/24/2017] [Indexed: 11/29/2022]
Abstract
In patients with low-grade glioma (LGG), language deficits are usually only found and investigated after surgery. Deficits may be present before surgery but to date, studies have yielded varying results regarding the extent of this problem and in what language domains deficits may occur. This study therefore aims to explore the language ability of patients who have recently received a presumptive diagnosis of low-grade glioma, and also to see whether they reported any changes in their language ability before receiving treatment. Twenty-three patients were tested using a comprehensive test battery that consisted of standard aphasia tests and tests of lexical retrieval and high-level language functions. The patients were also asked whether they had noticed any change in their use of language or ability to communicate. The test scores were compared to a matched reference group and to clinical norms. The presumed LGG group performed significantly worse than the reference group on two tests of lexical retrieval. Since five patients after surgery were discovered to have a high-grade glioma, a separate analysis excluding them were performed. These analyses revealed comparable results; however one test of word fluency was no longer significant. Individually, the majority exhibited normal or nearly normal language ability and only a few reported subjective changes in language or ability to communicate. This study shows that patients who have been diagnosed with LGG generally show mild or no language deficits on either objective or subjective assessment.
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Affiliation(s)
- Malin Antonsson
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy at the University of Gothenburg, Box 452, 405 30, Gothenburg, Sweden.
| | - Francesca Longoni
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy at the University of Gothenburg, Box 452, 405 30, Gothenburg, Sweden
| | - Asgeir Jakola
- Department of Neurosurgery, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Magnus Tisell
- Department of Neurosurgery, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Magnus Thordstein
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Lena Hartelius
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy at the University of Gothenburg, Box 452, 405 30, Gothenburg, Sweden
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Differential Effects of Awake Glioma Surgery in "Critical" Language Areas on Cognition: 4 Case Studies. Case Rep Neurol Med 2017; 2017:6038641. [PMID: 28717525 PMCID: PMC5498926 DOI: 10.1155/2017/6038641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/21/2017] [Indexed: 11/18/2022] Open
Abstract
Awake surgery with electrocorticosubcortical stimulation is the golden standard treatment for gliomas in eloquent areas. Preoperatively, mostly mild cognitive disturbances are observed with postoperative deterioration. We describe pre- and postoperative profiles of 4 patients (P1–P4) with gliomas in “critical” language areas (“Broca,” “Wernicke,” and the arcuate fasciculus) undergoing awake surgery to get insight into the underlying mechanism of neuroplasticity. Neuropsychological examination was carried out preoperatively (at T1) and postoperatively (at T2, T3). At T1, cognition of P1 was intact and remained stable. P2 had impairments in all cognitive domains at T1 with further deterioration at T2 and T3. At T1, P3 had impairments in memory and executive functions followed by stable recovery. P4 was intact at T1, followed by a decline in a language test at T2 and recovery at T3. Intraoperatively, in all patients language positive sites were identified. Patients with gliomas in “critical” language areas do not necessarily present cognitive disturbances. Surgery can either improve or deteriorate (existing) cognitive impairments. Several factors may underlie the plastic potential of the brain, for example, corticosubcortical networks and tumor histopathology. Our findings illustrate the complexity of the underlying mechanism of neural plasticity and provide further support for a “hodotopical” viewpoint.
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Noll KR, Weinberg JS, Ziu M, Benveniste RJ, Suki D, Wefel JS. Neurocognitive Changes Associated With Surgical Resection of Left and Right Temporal Lobe Glioma. Neurosurgery 2016; 77:777-85. [PMID: 26317672 DOI: 10.1227/neu.0000000000000987] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known regarding the neurocognitive impact of temporal lobe tumor resection. OBJECTIVE To clarify subacute surgery-related changes in neurocognitive functioning (NCF) in patients with left (LTL) and right (RTL) temporal lobe glioma. METHODS Patients with glioma in the LTL (n = 45) or RTL (n = 19) completed comprehensive pre- and postsurgical neuropsychological assessments. NCF was analyzed with 2-way mixed design repeated-measures analysis of variance, with hemisphere (LTL or RTL) as an independent between-subjects factor and pre- and postoperative NCF as a within-subjects factor. RESULTS About 60% of patients with LTL glioma and 40% with RTL lesions exhibited significant worsening on at least 1 NCF test. Domains most commonly impacted included verbal memory and executive functioning. Patients with LTL tumor showed greater decline than patients with RTL tumor on verbal memory and confrontation naming tests. Nonetheless, over one-third of patients with RTL lesions also showed verbal memory decline. CONCLUSION In patients with temporal lobe glioma, NCF decline in the subacute postoperative period is common. As expected, patients with LTL tumor show more frequent and severe decline than patients with RTL tumor, particularly on verbally mediated measures. However, a considerable proportion of patients with RTL tumor also exhibit decline across various domains, even those typically associated with left hemisphere structures, such as verbal memory. While patients with RTL lesions may show even greater decline in visuospatial memory, this domain was not assessed. Nonetheless, neuropsychological assessment can identify acquired deficits and help facilitate early intervention in patients with temporal lobe glioma.
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Affiliation(s)
- Kyle R Noll
- Departments of *Neuro-Oncology and ‡Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; §Brain and Spine Institute, Seton Hospital, Austin, Texas; ¶Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Kobyakov GL, Lubnin AY, Kulikov AS, Gavrilov AG, Goryaynov SA, Poddubskiy AA, Lodygina KS. [Awake craniotomy]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2016; 80:107-116. [PMID: 27186613 DOI: 10.17116/neiro2016801107-116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Awake craniotomy is a neurosurgical intervention aimed at identifying and preserving the eloquent functional brain areas during resection of tumors located near the cortical and subcortical language centers. This article provides a review of the modern literature devoted to the issue. The anatomical rationale and data of preoperative functional neuroimaging, intraoperative electrophysiological monitoring, and neuropsychological tests as well as the strategy of active surgical intervention are presented. Awake craniotomy is a rapidly developing technique aimed at both preserving speech and motor functions and improving our knowledge in the field of speech psychophysiology.
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Affiliation(s)
- G L Kobyakov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A Yu Lubnin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A S Kulikov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A G Gavrilov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - K S Lodygina
- Burdenko Neurosurgical Institute, Moscow, Russia
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Stevanovic A, Rossaint R, Veldeman M, Bilotta F, Coburn M. Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0156448. [PMID: 27228013 PMCID: PMC4882028 DOI: 10.1371/journal.pone.0156448] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 05/13/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Awake craniotomy (AC) renders an expanded role in functional neurosurgery. Yet, evidence for optimal anaesthesia management remains limited. We aimed to summarise the latest clinical evidence of AC anaesthesia management and explore the relationship of AC failures on the used anaesthesia techniques. METHODS Two authors performed independently a systematic search of English articles in PubMed and EMBASE database 1/2007-12/2015. Search included randomised controlled trials (RCTs), observational trials, and case reports (n>4 cases), which reported anaesthetic approach for AC and at least one of our pre-specified outcomes: intraoperative seizures, hypoxia, arterial hypertension, nausea and vomiting, neurological dysfunction, conversion into general anaesthesia and failure of AC. Random effects meta-analysis was used to estimate event rates for four outcomes. Relationship with anaesthesia technique was explored using logistic meta-regression, calculating the odds ratios (OR) and 95% confidence intervals [95%CI]. RESULTS We have included forty-seven studies. Eighteen reported asleep-awake-asleep technique (SAS), twenty-seven monitored anaesthesia care (MAC), one reported both and one used the awake-awake-awake technique (AAA). Proportions of AC failures, intraoperative seizures, new neurological dysfunction and conversion into general anaesthesia (GA) were 2% [95%CI:1-3], 8% [95%CI:6-11], 17% [95%CI:12-23] and 2% [95%CI:2-3], respectively. Meta-regression of SAS and MAC technique did not reveal any relevant differences between outcomes explained by the technique, except for conversion into GA. Estimated OR comparing SAS to MAC for AC failures was 0.98 [95%CI:0.36-2.69], 1.01 [95%CI:0.52-1.88] for seizures, 1.66 [95%CI:1.35-3.70] for new neurological dysfunction and 2.17 [95%CI:1.22-3.85] for conversion into GA. The latter result has to be interpreted cautiously. It is based on one retrospective high-risk of bias study and significance was abolished in a sensitivity analysis of only prospectively conducted studies. CONCLUSION SAS and MAC techniques were feasible and safe, whereas data for AAA technique are limited. Large RCTs are required to prove superiority of one anaesthetic regime for AC.
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Affiliation(s)
- Ana Stevanovic
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Veldeman
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Federico Bilotta
- Department of Anaesthesiology, Critical Care and Pain Medicine, University of Rome “La Sapienza”, Rome, Italy
| | - Mark Coburn
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
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Skrap M, Marin D, Ius T, Fabbro F, Tomasino B. Brain mapping: a novel intraoperative neuropsychological approach. J Neurosurg 2016; 125:877-887. [PMID: 26848912 DOI: 10.3171/2015.10.jns15740] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Awake surgery and mapping are performed in patients with low-grade tumors infiltrating functional brain areas for which the greater the resection, the longer the patient survival. However, the extent of resection is subject to preservation of cognitive functions, and in the absence of proper feedback during mapping, the surgeon may be less prone to perform an extensive resection. The object of this study was to perform real-time continuous assessment of cognitive function during the resection of tumor tissue that could infiltrate eloquent tissue. METHODS The authors evaluated the use of new, complex real-time neuropsychological testing (RTNT) in a series of 92 patients. They reported normal scoring and decrements in patient performance as well as reversible intraoperative neuropsychological dysfunctions in tasks (for example, naming) associated with different cognitive abilities. RESULTS RTNT allowed one to obtain a more defined neuropsychological picture of the impact of surgery. The influence of this monitoring on surgical strategy was expressed as the mean extent of resection: 95% (range 73%-100%). At 1 week postsurgery, the neuropsychological scores were very similar to those detected with RTNT, revealing the validity of the RTNT technique as a predictive tool. At the follow-up, the majority of neuropsychological scores were still > 70%, indicating a decrease of < 30%. CONCLUSIONS RTNT enables continuous enriched intraoperative feedback, allowing the surgeon to increase the extent of resection. In sharp contrast to classic mapping techniques, RTNT allows testing of several cognitive functions for one brain area under surgery.
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Affiliation(s)
- Miran Skrap
- Unità Operativa di Neurochirurgia, A.O.S. Maria della Misericordia, Udine; and
| | - Dario Marin
- IRCCS "E. Medea," San Vito al Tagliamento (PN), Italy
| | - Tamara Ius
- Unità Operativa di Neurochirurgia, A.O.S. Maria della Misericordia, Udine; and
| | - Franco Fabbro
- IRCCS "E. Medea," San Vito al Tagliamento (PN), Italy
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Satoer D, Visch-Brink E, Dirven C, Vincent A. Glioma surgery in eloquent areas: can we preserve cognition? Acta Neurochir (Wien) 2016; 158:35-50. [PMID: 26566782 PMCID: PMC4684586 DOI: 10.1007/s00701-015-2601-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive preservation is crucial in glioma surgery, as it is an important aspect of daily life functioning. Several studies claimed that surgery in eloquent areas is possible without causing severe cognitive damage. However, this conclusion was relatively ungrounded due to the lack of extensive neuropsychological testing in homogenous patient groups. In this study, we aimed to elucidate the short-term and long-term effects of glioma surgery on cognition by identifying all studies who conducted neuropsychological tests preoperatively and postoperatively in glioma patients. METHODS We systematically searched the electronical databases Embase, Medline OvidSP, Web of Science, PsychINFO OvidSP, PubMed, Cochrane, Google Scholar, Scirius and Proquest aimed at cognitive performance in glioma patients preoperatively and postoperatively. RESULTS We included 17 studies with tests assessing the cognitive domains: language, memory, attention, executive functions and/or visuospatial abilities. Language was the domain most frequently examined. Immediately postoperatively, all studies except one, found deterioration in one or more cognitive domains. In the longer term (3-6/6-12 months postoperatively), the following tests showed both recovery and deterioration compared with the preoperative level: naming and verbal fluency (language), verbal word learning (memory) and Trailmaking B (executive functions). CONCLUSIONS Cognitive recovery to the preoperative level after surgery is possible to a certain extent; however, the results are too arbitrary to draw definite conclusions and not all studies investigated all cognitive domains. More studies with longer postoperative follow-up with tests for cognitive change are necessary for a better understanding of the conclusive effects of glioma surgery on cognition.
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Affiliation(s)
- Djaina Satoer
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Wytemaweg 80, Room EE220, 3015 GE, Rotterdam, The Netherlands.
- Centre for Language and Cognition Groningen (CLCG), University of Groningen, Groningen, The Netherlands.
| | - Evy Visch-Brink
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Wytemaweg 80, Room EE220, 3015 GE, Rotterdam, The Netherlands
| | - Clemens Dirven
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Wytemaweg 80, Room EE220, 3015 GE, Rotterdam, The Netherlands
| | - Arnaud Vincent
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Wytemaweg 80, Room EE220, 3015 GE, Rotterdam, The Netherlands
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Wolfson R, Soni N, Shah AH, Hosein K, Sastry A, Bregy A, Komotar RJ. The role of awake craniotomy in reducing intraoperative visual field deficits during tumor surgery. Asian J Neurosurg 2015; 10:139-44. [PMID: 26396597 PMCID: PMC4553722 DOI: 10.4103/1793-5482.161189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Homonymous hemianopia due to damage to the optic radiations or visual cortex is a possible consequence of tumor resection involving the temporal or occipital lobes. The purpose of this review is to present and analyze a series of studies regarding the use of awake craniotomy (AC) to decrease visual field deficits following neurosurgery. Materials and Methods: A literature search was performed using the Medline and PubMed databases from 1970 and 2014 that compared various uses of AC other than intraoperative motor/somatosensory/language mapping with a focus on visual field mapping. Results: For the 17 patients analyzed in this study, 14 surgeries resulted in quadrantanopia, 1 in hemianopia, and 2 without visual deficits. Overall, patient satisfaction with AC was high, and AC was a means to reduce surgery-related complications and cost related with the procedure. Conclusion AC is a safe and tolerable procedure that can be used effectively to map optic radiations and the visual cortices in order to preserve visual function during resection of tumors infiltrating the temporal and occipital lobes. In the majority of cases, a homonymous hemianopia was prevented and patients were left with a quadrantanopia that did not interfere with daily function.
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Affiliation(s)
- Racheal Wolfson
- Department of Neurological Surgery, University of Miami, Florida, USA
| | - Neil Soni
- Department of Neurological Surgery, University of Miami, Florida, USA
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami, Florida, USA
| | - Khadil Hosein
- Department of Neurological Surgery, University of Miami, Florida, USA
| | - Ananth Sastry
- Department of Neurological Surgery, University of Miami, Florida, USA
| | - Amade Bregy
- Department of Neurological Surgery, University of Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Florida, USA
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Villalba G, Pacreu S, Fernández-Candil JL, León A, Serrano L, Conesa G. [Incidence and causes of early end in awake surgery for language mapping not directly related to eloquence]. Neurocirugia (Astur) 2015; 27:10-4. [PMID: 26260205 DOI: 10.1016/j.neucir.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/20/2015] [Accepted: 06/02/2015] [Indexed: 11/29/2022]
Abstract
The incidence and causes that may lead to an early end (unfinished cortical/subcortical mapping) of awake surgery for language mapping are little known. A study was conducted on 41 patients with brain glioma located in the language area that had awake surgery under conscious sedation. Surgery was ended early in 6 patients. The causes were: tonic-clonic seizure (1), lack of cooperation due to fatigue/sleep (4), whether or not word articulation was involved, a decreased level of consciousness for ammonia encephalopathy that required endotracheal intubation (1). There are causes that could be expected and in some cases avoided. Tumour size, preoperative aphasia, valproate treatment, and type of anaesthesia used are variables to consider to avoid failure in awake surgery for language mapping. With these results, the following measures are proposed: l) If the tumour is large, perform surgery in two times to avoid fatigue, 2) if patient has a preoperative aphasia, do not use sedation during surgery to ensure that sleepiness does not cause worse word articulation, 3) if the patient is on valproate treatment, it is necessary to rule out the pre-operative symptoms that are not due to ammonia encephalopathy.
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Affiliation(s)
- Gloria Villalba
- Servicio de Neurocirugía, Hospital del Mar, Barcelona, España.
| | - Susana Pacreu
- Servicio de Anestesia y Reanimación, Hospital del Mar, Barcelona, España
| | | | - Alba León
- Servicio de Neurología, Hospital del Mar, Barcelona, España
| | - Laura Serrano
- Servicio de Neurocirugía, Hospital del Mar, Barcelona, España
| | - Gerardo Conesa
- Servicio de Neurocirugía, Hospital del Mar, Barcelona, España
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42
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Ibrahim GM, Bernstein M. Awake craniotomy for supratentorial gliomas: why, when and how? CNS Oncol 2015; 1:71-83. [PMID: 25054301 DOI: 10.2217/cns.12.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Awake craniotomy has become an increasingly utilized procedure in the treatment of supratentorial intra-axial tumors. The popularity of this procedure is partially attributable to improvements in intraoperative technology and anesthetic techniques. The application of awake craniotomy to the field of neuro-oncology has decreased iatrogenic postoperative neurological deficits, allowed for safe maximal tumor resection and improved healthcare resource stewardship by permitting early patient discharge. In this article, we review recent evidence for the utility of awake craniotomy in the resection of gliomas and describe the senior author's experience in performing this procedure. Furthermore, we explore innovative applications of awake craniotomy to outpatient tumor resections and the conduct of neurosurgery in resource-poor settings. We conclude that awake craniotomy is an effective and versatile neurosurgical procedure with expanding applications in neuro-oncology.
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Affiliation(s)
- George M Ibrahim
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, 4th Floor West Wing Rm 4WW448, 399 Bathurst St., Toronto, Ontario, M5T 2S8, Canada
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43
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Li T, Bai H, Wang G, Wang W, Lin J, Gao H, Wang L, Xia L, Xie X. Glioma localization and excision using direct electrical stimulation for language mapping during awake surgery. Exp Ther Med 2015; 9:1962-1966. [PMID: 26136923 DOI: 10.3892/etm.2015.2359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 02/04/2015] [Indexed: 01/14/2023] Open
Abstract
The aim of this study was to investigate the method and significance of the application of direct electrical stimulation (DES) to the brain mapping of language functions during glioma surgery. A retrospective analysis of clinical data was performed for 91 cases of brain functional area glioma surgery under DES from January 2003 until January 2012. Following cortical electrical stimulation, 88 patients exhibited seizures involving facial or hand movements and 91 cases experienced language disorders such as counting interruption, naming errors or anomia. The most commonly observed areas of counting interruption were distributed on the posterior part of the left anterior central gyrus (47.7%), the operculum of the left inferior frontal gyrus (24.4%) and the triangular part of the left inferior frontal gyrus (12.8%). Postoperative magnetic resonance imaging demonstrated that overall excision was achieved in 53 cases and sub-overall excision was performed in 31 cases. A total of 42 cases (46.2%) exhibited no postoperative neurological dysfunction, 39 cases (42.9%) exhibited brief language dysfunction, 27 cases (29.7%) experienced brief limb movement disorder, and one case appeared to have permanent neurological dysfunction. DES was indicated to be a reliable and noninvasive method for the intraoperative positioning of language areas, and was able to resect gliomas in the language area with maximal safety.
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Affiliation(s)
- Tiandong Li
- Department of Neurosurgery, Liuhuaqiao Hospital, Guangzhou, Guangdong 510010, P.R. China
| | - Hongmin Bai
- Department of Neurosurgery, Liuhuaqiao Hospital, Guangzhou, Guangdong 510010, P.R. China
| | - Guoliang Wang
- Department of Neurosurgery, Liuhuaqiao Hospital, Guangzhou, Guangdong 510010, P.R. China
| | - Weimin Wang
- Department of Neurosurgery, Liuhuaqiao Hospital, Guangzhou, Guangdong 510010, P.R. China
| | - Jian Lin
- Department of Neurosurgery, Liuhuaqiao Hospital, Guangzhou, Guangdong 510010, P.R. China
| | - Han Gao
- Department of Neurosurgery, Liuhuaqiao Hospital, Guangzhou, Guangdong 510010, P.R. China
| | - Limin Wang
- Department of Neurosurgery, Liuhuaqiao Hospital, Guangzhou, Guangdong 510010, P.R. China
| | - Lihui Xia
- Department of Neurosurgery, Liuhuaqiao Hospital, Guangzhou, Guangdong 510010, P.R. China
| | - Xuemin Xie
- Department of Neurosurgery, Liuhuaqiao Hospital, Guangzhou, Guangdong 510010, P.R. China
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44
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De Witte E, Satoer D, Robert E, Colle H, Verheyen S, Visch-Brink E, Mariën P. The Dutch Linguistic Intraoperative Protocol: a valid linguistic approach to awake brain surgery. BRAIN AND LANGUAGE 2015; 140:35-48. [PMID: 25526520 DOI: 10.1016/j.bandl.2014.10.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/03/2014] [Accepted: 10/25/2014] [Indexed: 05/10/2023]
Abstract
Intraoperative direct electrical stimulation (DES) is increasingly used in patients operated on for tumours in eloquent areas. Although a positive impact of DES on postoperative linguistic outcome is generally advocated, information about the neurolinguistic methods applied in awake surgery is scarce. We developed for the first time a standardised Dutch linguistic test battery (measuring phonology, semantics, syntax) to reliably identify the critical language zones in detail. A normative study was carried out in a control group of 250 native Dutch-speaking healthy adults. In addition, the clinical application of the Dutch Linguistic Intraoperative Protocol (DuLIP) was demonstrated by means of anatomo-functional models and five case studies. A set of DuLIP tests was selected for each patient depending on the tumour location and degree of linguistic impairment. DuLIP is a valid test battery for pre-, intraoperative and postoperative language testing and facilitates intraoperative mapping of eloquent language regions that are variably located.
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Affiliation(s)
- E De Witte
- Clinical and Experimental Neurolinguistics, Centre for Linguistics, Vrije Universiteit Brussel, Brussels, Belgium
| | - D Satoer
- Department of Neurosurgery, Erasmus University Medical Centre, Rotterdam, The Netherlands; Department of Neurolinguistics, Groningen Center of Expertise for Language and Communication Disorders (GELC), University of Groningen, The Netherlands
| | - E Robert
- Department of Neurosurgery, AZ Sint-Lucas, Ghent, Belgium
| | - H Colle
- Department of Neurosurgery, AZ Sint-Lucas, Ghent, Belgium
| | - S Verheyen
- Department of Psychology, Catholic University Leuven, Belgium
| | - E Visch-Brink
- Department of Neurosurgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - P Mariën
- Clinical and Experimental Neurolinguistics, Centre for Linguistics, Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurology and Memory Clinic, ZNA Middelheim, Antwerp, Belgium.
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Tabatabai G, Hattingen E, Schlegel J, Stummer W, Schlegel U. [Interdisciplinary neuro-oncology: part 1: diagnostics and operative therapy of primary brain tumors]. DER NERVENARZT 2014; 85:965-75. [PMID: 25037493 DOI: 10.1007/s00115-014-4041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
By combining the expertise of clinical neuroscience, the aim of neuro-oncology is to optimize diagnostic planning and therapy of primary brain tumors in an interdisciplinary setting together with radio-oncology and medical oncology. High-end imaging frequently allows brain tumors to be diagnosed preoperatively with respect to tumor entity and even tumor malignancy grade. Moreover, neuroimaging is indispensable for guidance of biopsy resection and monitoring of therapy. Surgical resection of intracranial lesions with preservation of neurological function is increasingly feasible. Tools to achieve this goal are, for example neuronavigation, functional magnetic resonance imaging (fMRI), tractography, intraoperative cortical stimulation and precise intraoperative definition of tumor margins by virtue of various techniques. In addition to classical histopathological diagnosis and tumor classification, modern neuropathology is supplemented by molecular characterization of brain tumors in order to provide clinicians with prognostic and predictive (of therapy) markers, such as codeletion of chromosomes 1p and 19q in anaplastic gliomas and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in glioblastomas. Although this is not yet individualized tumor therapy, the increasingly more detailed analysis of the molecular pathogenesis of an individual glioma will eventually lead to specific pharmacological blockade of disturbed intracellular pathways in individual patients. This article gives an overview of the state of the art of interdisciplinary neuro-oncology whereby part 1 deals with the diagnostics and surgical therapy of primary brain tumors and part 2 describes the medical therapy of primary brain tumors.
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Affiliation(s)
- G Tabatabai
- Interdisziplinäre Sektion für Neuroonkologie, Klinik für Neurochirurgie, Zentrum für Neurologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
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46
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Shinoura N, Midorikawa A, Yamada R, Hana T, Saito A, Hiromitsu K, Itoi C, Saito S, Yagi K. Awake craniotomy for brain lesions within and near the primary motor area: A retrospective analysis of factors associated with worsened paresis in 102 consecutive patients. Surg Neurol Int 2013; 4:149. [PMID: 24381792 PMCID: PMC3872643 DOI: 10.4103/2152-7806.122003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/19/2013] [Indexed: 11/04/2022] Open
Abstract
Background: We analyzed factors associated with worsened paresis in a large series of patients with brain lesions located within or near the primary motor area (M1) to establish protocols for safe, awake craniotomy of eloquent lesions. Methods: We studied patients with brain lesions involving M1, the premotor area (PMA) and the primary sensory area (S1), who underwent awake craniotomy (n = 102). In addition to evaluating paresis before, during, and one month after surgery, the following parameters were analyzed: Intraoperative complications; success or failure of awake surgery; tumor type (A or B), tumor location, tumor histology, tumor size, and completeness of resection. Results: Worsened paresis at one month of follow-up was significantly associated with failure of awake surgery, intraoperative complications and worsened paresis immediately after surgery, which in turn was significantly associated with intraoperative worsening of paresis. Intraoperative worsening of paresis was significantly related to preoperative paresis, type A tumor (motor tract running in close proximity to and compressed by the tumor), tumor location within or including M1 and partial removal (PR) of the tumor. Conclusions: Successful awake surgery and prevention of deterioration of paresis immediately after surgery without intraoperative complications may help prevent worsening of paresis at one month. Factors associated with intraoperative worsening of paresis were preoperative motor deficit, type A and tumor location in M1, possibly leading to PR of the tumor.
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Affiliation(s)
- Nobusada Shinoura
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Akira Midorikawa
- Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan
| | - Ryoji Yamada
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Taijun Hana
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Akira Saito
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Kentaro Hiromitsu
- Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan
| | - Chisato Itoi
- Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan
| | - Syoko Saito
- Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan
| | - Kazuo Yagi
- Department of Radiologic Technology, Tokyo Metropolitan University of Health Sciences, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8553, Japan
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Bilotta F, Stazi E, Titi L, Lalli D, Delfini R, Santoro A, Rosa G. Diagnostic work up for language testing in patients undergoing awake craniotomy for brain lesions in language areas. Br J Neurosurg 2013; 28:363-7. [PMID: 24195669 DOI: 10.3109/02688697.2013.854313] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Awake craniotomy is the technique of choice in patients with brain tumours adjacent to primary and accessory language areas (Broca's and Wernicke's areas). Language testing should be aimed to detect preoperative deficits, to promptly identify the occurrence of new intraoperative impairments and to establish the course of postoperative language status. Aim of this case series is to describe our experience with a dedicated language testing work up to evaluate patients with or at risk for language disturbances undergoing awake craniotomy for brain tumour resection. Pre- and intra operative testing was accomplished with 8 tests. Intraoperative evaluation was accomplished when patients were fully cooperative (Ramsey < 3). Postoperative evaluation was scheduled at early (within 21 days) and long-term follow-up (3-6 months). Twenty consecutive patients were prospectively recruited. Preoperative language testings were normal in 9 patients (45%), showed mild to moderate language deficit in 8 (40%) and severe language deficit or aphasic disorders in 3 (15%). Broca's area was identified in 15 patients, in all cases by counting arrest during stimulation and in 12 cases by naming arrest. In this article we describe our experience using a language testing work up to evaluate - pre, intra and postoperatively - patients undergoing awake craniotomy for brain tumour resection with preoperative language disturbances or at risk for postoperative language deficits. This approach allows a systematic evaluation and recording of language function status and can be accomplished even when a neuropsychologist or speech therapist are not involved in the operation crew.
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Affiliation(s)
- Federico Bilotta
- Department of Anaesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome , Rome , Italy
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Zhang X, Zhang G, Yu T, Ni D, Cai L, Qiao L, Du W, Li Y. Surgical treatment for epilepsy involving language cortices: A combined process of electrical cortical stimulation mapping and intra-operative continuous language assessment. Seizure 2013; 22:780-6. [DOI: 10.1016/j.seizure.2013.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 06/11/2013] [Accepted: 06/12/2013] [Indexed: 11/29/2022] Open
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Satoer D, Visch-Brink E, Smits M, Kloet A, Looman C, Dirven C, Vincent A. Long-term evaluation of cognition after glioma surgery in eloquent areas. J Neurooncol 2013; 116:153-60. [PMID: 24173681 DOI: 10.1007/s11060-013-1275-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/09/2013] [Indexed: 11/24/2022]
Abstract
Preservation of cognition is an important outcome measure in eloquent area glioma surgery. Glioma patients may have pre-operative deficits in one or more cognitive domains which could deteriorate post-operatively. It is assumed that these impairments recover within 3 months; some studies however, still detected cognitive decline. Longer follow-up is necessary to elucidate the conclusive effects of surgery. 45 patients with gliomas (low- and high-grade, but without contrast enhancement at diagnosis) in eloquent areas were assessed pre-operatively, 3 months and 1 year post-operatively with a neuropsychological test-protocol. Patients' performance was compared to normal population and between test-moments. Univariate analyses were performed between cognitive change and tumor-characteristics (localization, grade, volume, extent of resection [EOR]) and treatment-related factors (radio-/chemotherapy). Pre- and post-operatively, impairments were found in all cognitive domains; language, memory, attention and executive functions (p < 0.05). Post-operatively, permanent improvement was observed on a memory test (verbal recall: t = -1.931, p = 0.034), whereas deterioration was found on a language test (category fluency: t = 2.517, p = 0.030). Between 3 months and 1 year, patients improved on 2 language tests (naming: t = -2.781, p = 0.026 and letter fluency: t = -1.975, p = 0.047). There was no influence of tumor- or treatment-related factors on cognitive change. The findings underline the importance of cognitive testing at longer term post-operatively, as cognitive recovery took longer than 3 months, especially within the language domain. However, this longitudinal follow-up study showed that glioma surgery is possible without major long-term damage of cognitive functions. Tumor characteristics and EOR are no additional risk factors for cognitive outcome.
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Affiliation(s)
- Djaina Satoer
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Dr. Molewaterplein 50, Room EE220, 3015 GE, Rotterdam, The Netherlands,
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50
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Satoer D, Vincent A, Smits M, Dirven C, Visch-Brink E. Spontaneous speech of patients with gliomas in eloquent areas before and early after surgery. Acta Neurochir (Wien) 2013; 155:685-92. [PMID: 23440372 DOI: 10.1007/s00701-013-1638-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 02/06/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Glioma patients often complain about problems in daily conversation. A detailed spontaneous speech analysis could provide more insight in these communicative problems; no previous studies are reported. OBJECTIVE To select sensitive parameters in spontaneous speech pre- and post-operatively in patients with gliomas in eloquent areas. METHODS We included 27 patients and 21 healthy controls. In addition to a naming and category fluency test, spontaneous speech was collected 1 month pre-operatively and 3 months post-operatively, and analysed with the variables: Self-corrections, Repetitions, Lexical Diversity, Incomplete Sentences and Mean Length of Utterance (MLUw). A correlation analysis was performed between the linguistic variables and tumour characteristics (grade, localisation and volume), treatment related factors, and between the linguistic variables and the language tasks. RESULTS Pre-operatively, patients produced more Incomplete Sentences than the controls (p < 0.001). Post-operatively, patients' utterance length (MLUw) (p < 0.05) was also deviant. The quality of the spontaneous speech was influenced by tumour grade and localisation. There was no influence of tumour volume or treatment-related factors. Pre- and post-operatively, patients' performance on the naming and the fluency task deviated from normal (p < 0.001). The majority of the linguistic variables did not correlate with the language tasks, pointing to a measurement of distinct linguistic aspects. CONCLUSION Pre- and post-operatively there was a disorder in naming, category fluency and spontaneous speech, partly influenced by tumour characteristics. A spontaneous speech analysis appeared to be a valuable addition to standardised language tasks. Both measurements are important tools to obtain a complete linguistic profile.
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Affiliation(s)
- Djaina Satoer
- Department of Neurosurgery, Erasmus MC-University Medical Center, Dr. Molewaterplein 50-60, PO Box 2040, 3015 GE, Rotterdam, The Netherlands.
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