1
|
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.
Collapse
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
| |
Collapse
|
2
|
Krishna S, Hervey-Jumper SL. Neural Regulation of Cancer: Cancer-Induced Remodeling of the Central Nervous System. Adv Biol (Weinh) 2022; 6:e2200047. [PMID: 35802914 PMCID: PMC10182823 DOI: 10.1002/adbi.202200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/01/2022] [Indexed: 01/28/2023]
Abstract
In recent years, there have been significant advances in understanding the neuronal influence on the biology of solid tumors such as prostate, pancreatic, gastric, and brain cancers. An increasing amount of experimental evidence across multiple tumor types strongly suggests the existence of bidirectional crosstalk between cancer cells and the neural microenvironment. However, unlike cancers affecting many solid organs, brain tumors, namely gliomas, can synaptically integrate into neural circuits and thus can exert a greater potential to induce dynamic remodeling of functional circuits resulting in long-lasting behavioral changes. The first part of the review describes dynamic changes in language, sensory, and motor networks following glioma development and presents evidence focused on how different patterns of glioma-induced cortical reorganization may predict the degree and time course of functional recovery in brain tumor patients. The second part focuses on the network and cellular-level mechanisms underlying glioma-induced cerebral reorganization. Finally, oncological and clinical factors influencing glioma-induced network remodeling in glioma patients are reviewed.
Collapse
Affiliation(s)
- Saritha Krishna
- Department of Neurological Surgery, University of California, San Francisco, CA, 94143, USA
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, CA, 94143, USA.,Weill Neurosciences Institute, University of California, San Francisco, CA, 94143, USA.,Helen Diller Comprehensive Cancer Center, University of California, San Francisco, CA, 94143, USA
| |
Collapse
|
3
|
You H, Qiao H. Intraoperative Neuromonitoring During Resection of Gliomas Involving Eloquent Areas. Front Neurol 2021; 12:658680. [PMID: 34248818 PMCID: PMC8260928 DOI: 10.3389/fneur.2021.658680] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
In the case of resection of gliomas involving eloquent areas, equal consideration should be given to maintain maximal extent of resection (EOR) and neurological protection, for which the intraoperative neuromonitoring (IONM) proves an effective and admirable approach. IONM techniques applied in clinical practice currently consist of somatosensory evoked potential (SSEP), direct electrical stimulation (DES), motor evoked potential (MEP), electromyography (EMG), and electrocorticography (ECoG). The combined use of DES and ECoG has been adopted widely. With the development of technology, more effective IONM tactics and programs would be proposed. The ultimate goal would be strengthening the localization of eloquent areas and epilepsy foci, reducing the incidence of postoperative dysfunction and epilepsy improving the life quality of patients.
Collapse
Affiliation(s)
- Hao You
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hui Qiao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| |
Collapse
|
4
|
Aabedi AA, Kakaizada S, Young JS, Ahn E, Weissman DH, Berger MS, Brang D, Hervey-Jumper SL. Balancing task sensitivity with reliability for multimodal language assessments. J Neurosurg 2021; 135:1817-1824. [PMID: 34049284 PMCID: PMC10404475 DOI: 10.3171/2020.10.jns202947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative tasks for awake language mapping are typically selected based on the language tracts that will likely be encountered during tumor resection. However, diminished attention and arousal secondary to perioperative sedatives may reduce a task's usefulness for identifying eloquent cortex. For instance, accuracy in performing select language tasks may be high preoperatively but decline in the operating room. In the present study, the authors sought to identify language tasks that can be performed with high accuracy in both situational contexts so the neurosurgical team can be confident that speech errors committed during awake language mapping result from direct cortical stimulation to eloquent cortex, rather than from poor performance in general. METHODS We administered five language tasks to 44 patients: picture naming (PN), text reading (TR), auditory object naming (AN), repetition of 4-syllable words (4SYL), and production of syntactically intact sentences (SYNTAX). Performance was assessed using the 4-point scale of the quick aphasia battery 24 hours preoperatively and intraoperatively. We next determined whether or not accuracy on each task was higher preoperatively than intraoperatively. We also determined whether 1) intraoperative accuracy on a given task predicted intraoperative performance on the other tasks and 2) low preoperative accuracy on a task predicted a decrease in accuracy intraoperatively. RESULTS Relative to preoperative accuracy, intraoperative accuracy declined on PN (3.90 vs 3.82, p = 0.0001), 4SYL (3.96 vs 3.91, p = 0.0006), and SYNTAX (3.85 vs 3.67, p = 0.0001) but not on TR (3.96 vs 3.94, p = 0.13) or AN (3.70 vs 3.58, p = 0.058). Intraoperative accuracy on PN and AN independently predicted intraoperative accuracy on the remaining language tasks (p < 0.001 and p < 0.01, respectively). Finally, low preoperative accuracy on SYNTAX predicted a decrease in accuracy on this task intraoperatively (R2 = 0.36, p = 0.00002). CONCLUSIONS While TR lacks sensitivity in identifying language deficits at baseline, accuracy on TR is stable across testing settings. Baseline accuracy on the other four of our five language tasks was not predictive of intraoperative performance, signifying the need to repeat language tests prior to stimulation mapping to confirm reliability.
Collapse
Affiliation(s)
- Alexander A. Aabedi
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Sofia Kakaizada
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Jacob S. Young
- Department of Neurological Surgery, University of California, San Francisco, California
| | - EunSeon Ahn
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | | | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, California
| | - David Brang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | | |
Collapse
|
5
|
Latini F, Axelson H, Fahlström M, Jemstedt M, Alberius Munkhammar Å, Zetterling M, Ryttlefors M. Role of Preoperative Assessment in Predicting Tumor-Induced Plasticity in Patients with Diffuse Gliomas. J Clin Med 2021; 10:jcm10051108. [PMID: 33799925 PMCID: PMC7961995 DOI: 10.3390/jcm10051108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 01/03/2023] Open
Abstract
When diffuse gliomas (DG) affect the brain’s potential to reorganize functional networks, patients can exhibit seizures and/or language/cognitive impairment. The tumor–brain interaction and the individual connectomic organization cannot be predicted preoperatively. We aimed to, first, investigate the relationship between preoperative assessment and intraoperative findings of eloquent tumors in 36 DG operated with awake surgery. Second, we also studied possible mechanisms of tumor-induced brain reorganization in these patients. FLAIR-MRI sequences were used for tumor volume segmentation and the Brain-Grid system (BG) was used as an overlay for infiltration analysis. Neuropsychological (NPS) and/or language assessments were performed in all patients. The distance between eloquent spots and tumor margins was measured. All variables were used for correlation and logistic regression analyses. Eloquent tumors were detected in 75% of the patients with no single variable able to predict this finding. Impaired NPS functions correlated with invasive tumors, crucial location (A4C2S2/A3C2S2-voxels, left opercular-insular/sub-insular region) and higher risk of eloquent tumors. Epilepsy was correlated with larger tumor volumes and infiltrated A4C2S2/A3C2S2 voxels. Language impairment was correlated with infiltrated A3C2S2 voxel. Peritumoral cortical eloquent spots reflected an early compensative mechanism with age as possible influencing factor. Preoperative NPS impairment is linked with high risk of eloquent tumors. A systematic integration of extensive cognitive assessment and advanced neuroimaging can improve our comprehension of the connectomic brain organization at the individual scale and lead to a better oncological/functional balance.
Collapse
Affiliation(s)
- Francesco Latini
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, 75185 Uppsala, Sweden; (M.Z.); (M.R.)
- Correspondence: ; Tel.: +46-764-244-653
| | - Hans Axelson
- Section of Clinical Neurophysiology, Department of Neuroscience, Uppsala University, 75185 Uppsala, Sweden;
| | - Markus Fahlström
- Section of Radiology, Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden;
| | - Malin Jemstedt
- Department of Neuroscience, Speech-Language Pathology, Uppsala University, 75185 Uppsala, Sweden;
| | | | - Maria Zetterling
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, 75185 Uppsala, Sweden; (M.Z.); (M.R.)
| | - Mats Ryttlefors
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, 75185 Uppsala, Sweden; (M.Z.); (M.R.)
| |
Collapse
|
6
|
Surgical Paradigms in Diffuse Low-grade Glioma: Insular Glioma Case Illustration. Can J Neurol Sci 2021. [DOI: 10.1017/cjn.2021.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
7
|
Krishna S, Kakaizada S, Almeida N, Brang D, Hervey-Jumper S. Central Nervous System Plasticity Influences Language and Cognitive Recovery in Adult Glioma. Neurosurgery 2021; 89:539-548. [PMID: 33476391 DOI: 10.1093/neuros/nyaa456] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/05/2020] [Indexed: 01/01/2023] Open
Abstract
Gliomas exist within the framework of complex neuronal circuitry in which network dynamics influence both tumor biology and cognition. The generalized impairment of cognition or loss of language function is a common occurrence for glioma patients. The interface between intrinsic brain tumors such as gliomas and functional cognitive networks are poorly understood. The ability to communicate effectively is critically important for receiving oncological therapies and maintaining a high quality of life. Although the propensity of gliomas to infiltrate cortical and subcortical structures and disrupt key anatomic language pathways is well documented, there is new evidence offering insight into the network and cellular mechanisms underpinning glioma-related aphasia and aphasia recovery. In this review, we will outline the current understanding of the mechanisms of cognitive dysfunction and recovery, using aphasia as an illustrative model.
Collapse
Affiliation(s)
- Saritha Krishna
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Sofia Kakaizada
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Nyle Almeida
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - David Brang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| |
Collapse
|
8
|
Ghinda DC, Yang Y, Wu S, Lu J, Su L, Damiani S, Tumati S, Jansen G, Duffau H, Wu JS, Northoff G. Personalized Multimodal Demarcation of Peritumoral Tissue in Glioma. JCO Precis Oncol 2020; 4:1128-1140. [PMID: 35050774 DOI: 10.1200/po.20.00115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Gliomas are life-threatening brain tumors, and the extent of surgical resection is one of the strongest influences on survival rate. However, the proper distinction of infiltrated tissue remains elusive. The aim of this study was to use multimodal analyses to demarcate peritumoral tissue (PT) from tumoral (TT) and healthy tissue (HT). METHODS A total of 40 patients with histologically confirmed glioma were recruited. We analyzed resting-state functional magnetic resonance imaging (rs-fMRI) using the voxel-based mean blood-oxygen-level-dependent (BOLD) signal and the corresponding structural MRI (s-MRI) alongside RNA sequencing, whole-exome sequencing, and histology results of biopsy samples obtained from PT, HT, and TT. RESULTS We demarcated a functionally defined PT area where the mean BOLD signal gradually decreased near the edge of the tumor and extended beyond the TT borders (as defined by s-MRI), which was confirmed on a case-by-case basis. Correspondingly, genetic analyses showed a gene expression pattern and mutational landscape of the PT that were distinct from that seen in HT and TT. The genetic characterization of PT relative to HT and TT converged with the MRI-defined PT zones. This was confirmed in three individual cases after additional histologic analysis. A wider PT was associated with a longer progression-free survival, which suggests PT might act as an intermediate area between TT and HT. CONCLUSION Combined multimodal imaging and genetic analyses can allow for an objective demarcation of the PT in glioma and a robust classification of the degree of infiltration of the PT. These findings could help improve both neurosurgical resection and radio-oncologic therapy.
Collapse
Affiliation(s)
- Diana C Ghinda
- Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Yufei Yang
- Genetron Health (Beijing) Co Ltd, Beijing, China
| | - Shuai Wu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junfeng Lu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Su
- Genetron Health (Beijing) Co Ltd, Beijing, China
| | - Stefano Damiani
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Shankar Tumati
- Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Gerard Jansen
- Department of Neuropathology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France.,Brain Plasticity, Stem Cells, and Glial Tumors Team, National Institute for Health and Medical Research, Montpellier, France
| | - Jin-Song Wu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Georg Northoff
- Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
9
|
de la Peña MJ, Gil-Robles S, de Vega VM, Aracil C, Acevedo A, Rodríguez MR. A Practical Approach to Imaging of the Supplementary Motor Area and Its Subcortical Connections. Curr Neurol Neurosci Rep 2020; 20:50. [PMID: 32930895 DOI: 10.1007/s11910-020-01070-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW First, an anatomical and functional review of these cortical areas and subcortical connections with T-fMRI and tractography techniques; second, to demonstrate the value of this approach in neurosurgical planning in a series of patients with tumors close to the SMA. RECENT FINDINGS Implications in language and cognitive networks with a clear hemispheric lateralization of these SMA/pre-SMA. The recommendation of the use of the advanced neuroimaging studies for surgical planning and preservation of these areas. The SMA/pre-SMA and their subcortical connections are functional areas to be taken into consideration in neurosurgical planning. These areas would be involved in the control/inhibition of movement, in verbal expression and fluency and in tasks of cognitive control capacity. Its preservation is key to the patient's postsurgical cognitive and functional evolution.
Collapse
Affiliation(s)
- Mar Jiménez de la Peña
- Department of Radiology, Hospital Universitario QuironSalud Madrid, C/ Diego de Velázquez 1, Pozuelo de Alarcón, 28223, Madrid, Spain.
| | - Santiago Gil-Robles
- Department of Neurosurgery, Hospital Universitario QuironSalud Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Vicente Martínez de Vega
- Department of Radiology, Hospital Universitario QuironSalud Madrid, C/ Diego de Velázquez 1, Pozuelo de Alarcón, 28223, Madrid, Spain
| | - Cristina Aracil
- Department of Neurosurgery, Hospital Universitario QuironSalud Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Agustín Acevedo
- Department of Pathology, Hospital Universitario QuironSalud Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Manuel Recio Rodríguez
- Department of Radiology, Hospital Universitario QuironSalud Madrid, C/ Diego de Velázquez 1, Pozuelo de Alarcón, 28223, Madrid, Spain
| |
Collapse
|
10
|
Nakajima R, Kinoshita M, Nakada M. Motor Functional Reorganization Is Triggered by Tumor Infiltration Into the Primary Motor Area and Repeated Surgery. Front Hum Neurosci 2020; 14:327. [PMID: 32922279 PMCID: PMC7457049 DOI: 10.3389/fnhum.2020.00327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022] Open
Abstract
In patients with gliomas, motor deficits are not always observed, even though tumor cells infiltrate into the motor area. Currently, it is recognized that this phenomenon can occur through the neuroplasticity potential. The aim of this study is to investigate the characteristics of motor functional reorganization in gliomas. Out of 100 consecutive patients who underwent awake surgery, 29 patients were assessed as regards their motor function and were retrospectively explored to determine whether positive motor responses were elicited. A total of 73 positive mapping sites from 27 cases were identified, and their spatial anatomical locations and activated region by functional MRI were analyzed. Additionally, the factors promoting neuroplasticity were analyzed through multiple logistic regression analysis. As a result, a total of 60 points (21 cases) were found in place, while 13 points (17.8%) were found to be shifted from anatomical localization. Reorganizations were classified into three categories: Type 1 (move to ipsilateral different gyrus) was detected at nine points (four cases), and they moved into the postcentral gyrus. Type 2 (move within the ipsilateral precentral gyrus) was detected at four points (two cases). Unknown type (two cases) was categorized as those whose motor functional cortex was moved to other regions, although we could not find the compensated motor area. Two factors for the onset of reorganization were identified: tumor cells infiltrate into the primary motor area and repeated surgery (p < 0.0001 and p = 0.0070, respectively). Our study demonstrated that compensation can occur mainly in two ways, and it promoted repeated surgery and infiltration of tumor into the primary motor area.
Collapse
Affiliation(s)
- Riho Nakajima
- Department of Occupational Therapy, Faculty of Health Science, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Masashi Kinoshita
- Department of Neurosurgery, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| |
Collapse
|
11
|
Vanderweyen DC, Theaud G, Sidhu J, Rheault F, Sarubbo S, Descoteaux M, Fortin D. The role of diffusion tractography in refining glial tumor resection. Brain Struct Funct 2020; 225:1413-1436. [PMID: 32180019 DOI: 10.1007/s00429-020-02056-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022]
Abstract
Primary brain tumors are notoriously hard to resect surgically. Due to their infiltrative nature, finding the optimal resection boundary without damaging healthy tissue can be challenging. One potential tool to help make this decision is diffusion-weighted magnetic resonance imaging (dMRI) tractography. dMRI exploits the diffusion of water molecule along axons to generate a 3D modelization of the white matter bundles in the brain. This feature is particularly useful to visualize how a tumor affects its surrounding white matter and plan a surgical path. This paper reviews the different ways in which dMRI can be used to improve brain tumor resection, its benefits and also its limitations. We expose surgical tools that can be paired with dMRI to improve its impact on surgical outcome, such as loading the 3D tractography in the neuronavigation system and direct electrical stimulation to validate the position of the white matter bundles of interest. We also review articles validating dMRI findings using other anatomical investigation techniques, such as postmortem dissections, manganese-enhanced MRI, electrophysiological stimulations, and phantom studies with known ground truth. We will be discussing the areas of the brain where dMRI performs well and where the future challenges are. We will conclude this review with suggestions and take home messages for neurosurgeons, tractographers, and vendors for advancing the field and on how to benefit from tractography's use in clinical practice.
Collapse
Affiliation(s)
- Davy Charles Vanderweyen
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, University of Sherbrooke, 3001 12 Ave N, Sherbrooke, QC, J1H 5H3, Canada.
| | - Guillaume Theaud
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - Jasmeen Sidhu
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - François Rheault
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - Silvio Sarubbo
- Division of Neurosurgery, Emergency Area, Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - David Fortin
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, University of Sherbrooke, 3001 12 Ave N, Sherbrooke, QC, J1H 5H3, Canada
| |
Collapse
|
12
|
Yao S, Liebenthal E, Juvekar P, Bunevicius A, Vera M, Rigolo L, Golby AJ, Tie Y. Sex Effect on Presurgical Language Mapping in Patients With a Brain Tumor. Front Neurosci 2020; 14:4. [PMID: 32038154 PMCID: PMC6992642 DOI: 10.3389/fnins.2020.00004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/06/2020] [Indexed: 12/12/2022] Open
Abstract
Differences between males and females in brain development and in the organization and hemispheric lateralization of brain functions have been described, including in language. Sex differences in language organization may have important implications for language mapping performed to assess, and minimize neurosurgical risk to, language function. This study examined the effect of sex on the activation and functional connectivity of the brain, measured with presurgical functional magnetic resonance imaging (fMRI) language mapping in patients with a brain tumor. We carried out a retrospective analysis of data from neurosurgical patients treated at our institution who met the criteria of pathological diagnosis (malignant brain tumor), tumor location (left hemisphere), and fMRI paradigms [sentence completion (SC); antonym generation (AG); and resting-state fMRI (rs-fMRI)]. Forty-seven patients (22 females, mean age = 56.0 years) were included in the study. Across the SC and AG tasks, females relative to males showed greater activation in limited areas, including the left inferior frontal gyrus classically associated with language. In contrast, males relative to females showed greater activation in extended areas beyond the classic language network, including the supplementary motor area (SMA) and precentral gyrus. The rs-fMRI functional connectivity of the left SMA in the females was stronger with inferior temporal pole (TP) areas, and in the males with several midline areas. The findings are overall consistent with theories of greater reliance on specialized language areas in females relative to males, and generalized brain areas in males relative to females, for language function. Importantly, the findings suggest that sex could affect fMRI language mapping. Thus, considering sex as a variable in presurgical language mapping merits further investigation.
Collapse
Affiliation(s)
- Shun Yao
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Center for Pituitary Tumor Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Wuhan School of Clinical Medicine, Southern Medical University, Wuhan, China
| | - Einat Liebenthal
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Institute for Technology in Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, United States
| | - Parikshit Juvekar
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Adomas Bunevicius
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Matthew Vera
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Laura Rigolo
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Alexandra J. Golby
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Yanmei Tie
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
13
|
Foesleitner O, Nenning KH, Bartha-Doering L, Baumgartner C, Pataraia E, Moser D, Schwarz M, Schmidbauer V, Hainfellner JA, Czech T, Dorfer C, Langs G, Prayer D, Bonelli S, Kasprian G. Lesion-Specific Language Network Alterations in Temporal Lobe Epilepsy. AJNR Am J Neuroradiol 2020; 41:147-154. [PMID: 31896570 DOI: 10.3174/ajnr.a6350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Temporal lobe epilepsy, structural or nonlesional, may negatively affect language function. However, little is known about the lesion-specific influence on language networks. We hypothesized that different epileptogenic lesions are related to distinct alterations in the functional language connectome detected by fMRI. MATERIALS AND METHODS One hundred one patients with epilepsy due to mesiotemporal sclerosis (21 left, 22 right), low-grade mesiotemporal tumors (12 left), or nonlesional temporal lobe epilepsy (22 left, 24 right) and 22 healthy subjects performed 3T task-based language fMRI. Task-based activation maps (laterality indices) and functional connectivity analysis (global and connectivity strengths between language areas) were correlated with language scores. RESULTS Laterality indices based on fMRI activation maps failed to discriminate among patient groups. Functional connectivity analysis revealed the most extended language network alterations in left mesiotemporal sclerosis (involving the left temporal pole, left inferior frontal gyrus, and bilateral premotor areas). The other patient groups showed less extended but also predominantly ipsilesional network changes compared with healthy controls. Left-to-right hippocampal connectivity strength correlated positively with naming function (P = .01), and connectivity strength between the left Wernicke area and the left hippocampus was linked to verbal fluency scores (P = .01) across all groups. CONCLUSIONS Different pathologies underlying temporal lobe epilepsy are related to distinct alterations of the functional language connectome visualized by fMRI functional connectivity analysis. Network analysis allows new insights into language organization and provides possible imaging biomarkers for language function. These imaging findings emphasize the importance of a personalized treatment strategy in patients with epilepsy.
Collapse
Affiliation(s)
- O Foesleitner
- From the Departments of Biomedical Imaging and Image-Guided Therapy (O.F., K.-H.N., M.S., V.S., G.L., D.P., G.K.)
| | - K-H Nenning
- From the Departments of Biomedical Imaging and Image-Guided Therapy (O.F., K.-H.N., M.S., V.S., G.L., D.P., G.K.)
| | | | - C Baumgartner
- General Hospital Hietzing with Neurological Center Rosenhuegel (C.B.), Vienna, Austria
| | | | - D Moser
- Neurology (E.P., D.M., S.B.)
| | - M Schwarz
- From the Departments of Biomedical Imaging and Image-Guided Therapy (O.F., K.-H.N., M.S., V.S., G.L., D.P., G.K.)
| | - V Schmidbauer
- From the Departments of Biomedical Imaging and Image-Guided Therapy (O.F., K.-H.N., M.S., V.S., G.L., D.P., G.K.)
| | | | - T Czech
- Neurosurgery (T.C., C.D.), Medical University of Vienna, Vienna, Austria
| | - C Dorfer
- Neurosurgery (T.C., C.D.), Medical University of Vienna, Vienna, Austria
| | - G Langs
- From the Departments of Biomedical Imaging and Image-Guided Therapy (O.F., K.-H.N., M.S., V.S., G.L., D.P., G.K.)
| | - D Prayer
- From the Departments of Biomedical Imaging and Image-Guided Therapy (O.F., K.-H.N., M.S., V.S., G.L., D.P., G.K.)
| | | | - G Kasprian
- From the Departments of Biomedical Imaging and Image-Guided Therapy (O.F., K.-H.N., M.S., V.S., G.L., D.P., G.K.)
| |
Collapse
|
14
|
Lin CHA, Berger MS. Advancing neuro-oncology of glial tumors from big data and multidisciplinary studies. J Neurooncol 2019; 146:1-7. [PMID: 31853838 DOI: 10.1007/s11060-019-03369-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/11/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Multidisciplinary studies for glial tumors has produced an enormous amount of information including imaging, histology, and a large cohort of molecular data (i.e. genomics, epigenomics, metabolomics, proteomics, etc.). The big data resources are made possible through open access that offers great potential for new biomarker or therapeutic intervention via deep-learning and/or machine learning for integrated multi-omics analysis. An equally important effort to define the hallmarks of glial tumors will also advance precision neuro-oncology and inform patient-specific therapeutics. This review summarizes past studies regarding tumor classification, hallmarks of cancer, and hypothetical mechanisms. Leveraging on advanced big data approaches and ongoing cross-disciplinary endeavors, this review also discusses how to integrate multiple layers of big data toward the goal of precision medicine. RESULTS In addition to basic research of cancer biology, the results from integrated multi-omics analysis will highlight biological processes and potential candidates as biomarkers or therapeutic targets. Ultimately, these collective resources built upon an armamentarium of accessible data can re-form clinical and molecular data to stratify patient-tailored therapy. CONCLUSION We envision that a comprehensive understanding of the link between molecular signatures, tumor locations, and patients' history will identify a molecular taxonomy of glial tumors to advance the improvements in early diagnosis, prevention, and treatment.
Collapse
Affiliation(s)
- Chin-Hsing Annie Lin
- Department of Biology, University of Texas at San Antonio, BSB 2.03.24, One UTSA Circle, San Antonio, TX, USA
- Neuroscience Institute, University of Texas at San Antonio, San Antonio, TX, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA, USA.
| |
Collapse
|
15
|
Sollmann N, Kelm A, Ille S, Schröder A, Zimmer C, Ringel F, Meyer B, Krieg SM. Setup presentation and clinical outcome analysis of treating highly language-eloquent gliomas via preoperative navigated transcranial magnetic stimulation and tractography. Neurosurg Focus 2019; 44:E2. [PMID: 29852769 DOI: 10.3171/2018.3.focus1838] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Awake surgery combined with intraoperative direct electrical stimulation (DES) and intraoperative neuromonitoring (IONM) is considered the gold standard for the resection of highly language-eloquent brain tumors. Different modalities, such as functional magnetic resonance imaging (fMRI) or magnetoencephalography (MEG), are commonly added as adjuncts for preoperative language mapping but have been shown to have relevant limitations. Thus, this study presents a novel multimodal setup consisting of preoperative navigated transcranial magnetic stimulation (nTMS) and nTMS-based diffusion tensor imaging fiber tracking (DTI FT) as an adjunct to awake surgery. METHODS Sixty consecutive patients (63.3% men, mean age 47.6 ± 13.3 years) suffering from highly language-eloquent left-hemispheric low- or high-grade glioma underwent preoperative nTMS language mapping and nTMS-based DTI FT, followed by awake surgery for tumor resection. Both nTMS language mapping and DTI FT data were available for resection planning and intraoperative guidance. Clinical outcome parameters, including craniotomy size, extent of resection (EOR), language deficits at different time points, Karnofsky Performance Scale (KPS) score, duration of surgery, and inpatient stay, were assessed. RESULTS According to postoperative evaluation, 28.3% of patients showed tumor residuals, whereas new surgery-related permanent language deficits occurred in 8.3% of patients. KPS scores remained unchanged (median preoperative score 90, median follow-up score 90). CONCLUSIONS This is the first study to present a clinical outcome analysis of this very modern approach, which is increasingly applied in neurooncological centers worldwide. Although human language function is a highly complex and dynamic cortico-subcortical network, the presented approach offers excellent functional and oncological outcomes in patients undergoing surgery of lesions affecting this network.
Collapse
Affiliation(s)
- Nico Sollmann
- 1Department of Diagnostic and Interventional Neuroradiology.,3TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Anna Kelm
- 2Department of Neurosurgery, and.,3TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Sebastian Ille
- 2Department of Neurosurgery, and.,3TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Germany
| | | | - Claus Zimmer
- 1Department of Diagnostic and Interventional Neuroradiology.,3TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Germany
| | | | | | - Sandro M Krieg
- 2Department of Neurosurgery, and.,3TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Germany
| |
Collapse
|
16
|
Das S, Morrison M, Tam F, Graham S. Spatial reorganisation of the somatosensory cortex in a patient with a low-grade glioma. BMJ Case Rep 2019; 12:12/5/e228971. [PMID: 31061181 DOI: 10.1136/bcr-2018-228971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Multiple authors have speculated that functional plasticity of the neural networks required for speech and motor function may occur in the setting of low-grade brain tumours. Here, we present the case of a 39-year-old right-handed woman found on presentation for intermittent right-hand tingling and twitching to have a low-grade glioma involving the somatosensory cortex on both structural and functional MRI. Intraoperative awake mapping identified gyral dissociation of the somateosensory areas for right arm and leg sensation. These findings demonstrate that brain plasticity may be dramatic in the setting of a low-grade glioma, and emphasise the critical need for careful brain mapping when considering tumour resection in these patients.
Collapse
Affiliation(s)
- Sunit Das
- Neurosurgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Morrison
- Department of Medicine, Imperial College London, Hammersmith Campus, London, UK
| | - Fred Tam
- Department of Medical Biophysics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Simon Graham
- Department of Medical Biophysics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
17
|
Bertolini G, La Corte E, Aquino D, Greco E, Rossini Z, Cardia A, Nicolosi F, Bauer D, Bruzzone MG, Ferroli P, Serrao G. Real-Time Ex-Vivo Magnetic Resonance Image-Guided Dissection of Human Brain White Matter: A Proof-of-Principle Study. World Neurosurg 2019; 125:198-206. [PMID: 30743041 DOI: 10.1016/j.wneu.2019.01.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Modern neuroanatomic education should be based on interdisciplinary methods that allow an understanding of the cerebral circuitry, which is at the base of the structural connectivity. Ex-vivo MRI-guided dissection is an essential method for developing and refining the knowledge of complex 3-dimensional brain anatomy and the mutual relationships between structures and architecture of the white matter bundles. The aim of this technical note is to present a new and innovative method of studying human brain white matter. METHODS Four adult human cerebral hemispheres were prepared according to the Klinger's method. T1-weighted and T2-weighted and fluid attenuated inversion recovery images were obtained with a 3T magnetic resonance machine. The dissection was performed in a dedicated neurosurgical laboratory equipped with a microscope and an electromagnetic neuronavigation system that guided the whole white matter dissection. RESULTS Gyri and sulci morphology were studied in detail. The relations between superficial and inner structures were observed before and after the dissection. Gray matter was carefully removed with blunt dissectors, and the U-fibers were exposed. Afterwards, deeper association and projection fibers, such as the arcuate fasciculus, superior and inferior longitudinal fasciculus, corona radiata, extreme and external capsule, claustrum, anterior commissure, and internal capsule were visualized under high magnification. The neuronavigation system was crucial for continuously checking the whole dissection procedure to avoid any accidental excision of fibers. CONCLUSION Image-guided neuronavigated dissection can significantly improve the quality of white matter dissection and represents a valid tool for learning the 3-dimensional anatomy of the human brain tracts.
Collapse
Affiliation(s)
- Giacomo Bertolini
- Department of Health Sciences, University of Milan, Milan, Italy; Department of Neurosurgery, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy.
| | - Emanuele La Corte
- Department of Health Sciences, University of Milan, Milan, Italy; Department of Neurosurgery, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy
| | - Domenico Aquino
- Department of Neuroradiology, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy
| | - Elena Greco
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Zefferino Rossini
- Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Andrea Cardia
- Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Federico Nicolosi
- Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Dario Bauer
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Maria Grazia Bruzzone
- Department of Neuroradiology, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy
| | - Graziano Serrao
- Department of Health Sciences, University of Milan, Milan, Italy
| |
Collapse
|
18
|
Corrivetti F, de Schotten MT, Poisson I, Froelich S, Descoteaux M, Rheault F, Mandonnet E. Dissociating motor–speech from lexico-semantic systems in the left frontal lobe: insight from a series of 17 awake intraoperative mappings in glioma patients. Brain Struct Funct 2019; 224:1151-1165. [DOI: 10.1007/s00429-019-01827-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 01/05/2019] [Indexed: 10/27/2022]
|
19
|
Yordanova YN, Cochereau J, Duffau H, Herbet G. Combining resting state functional MRI with intraoperative cortical stimulation to map the mentalizing network. Neuroimage 2018; 186:628-636. [PMID: 30500423 DOI: 10.1016/j.neuroimage.2018.11.046] [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] [Received: 08/20/2018] [Revised: 11/02/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To infer the face-based mentalizing network from resting-state functional MRI (rsfMRI) using a seed-based correlation analysis with regions of interest identified during intraoperative cortical electrostimulation. METHODS We retrospectively included 23 patients in whom cortical electrostimulation induced transient face-based mentalizing impairment during 'awake' craniotomy for resection of a right-sided diffuse low-grade glioma. Positive stimulation sites were recorded and transferred to the patients' preoperative normalized MRI, and then used as seeds for subsequent seed-to-voxel functional connectivity analyses. The analyses, conducted with an uncorrected voxel-level p-value of 0.001 and a false-discovery-rate cluster-level p-value of 0.05, allowed identification of the cortical structures, functionally coupled with the mentalizing-related sites. RESULTS Two clusters of responsive stimulations were identified intraoperatively - one in the right dorsolateral prefrontal cortex (dlPFC, n = 13) and the other in the right inferior frontal gyrus (IFG, n = 10). A whole group level analysis revealed that stimulation sites correlated mainly with voxels located in the pars triangularis of the IFG, the dorsolateral and dorsomedial prefrontal cortices, the temporo-parietal junction, the posterior superior temporal sulcus, and the posterior inferior temporal/fusiform gyrus. Other analyses, taking into consideration the location of the responsive sites (IFG versus dlPFC cluster), highlighted only minor differences between both groups. CONCLUSIONS The present study successfully demonstrated the involvement of a large-scale neural network in the face-based mentalizing that strongly matches networks, classically identified using task-based fMRI paradigms. We thus validated the combination of rsfMRI and stimulation mapping as a powerful approach to identify functional networks in brain-damaged patients.
Collapse
Affiliation(s)
- Yordanka Nikolova Yordanova
- Department of Neurosurgery, 'Percy' Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France; National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, France.
| | - Jérôme Cochereau
- Department of Neurosurgery, Gui de Chauliac Hospital, 80 avenue Augustin Fliche, 34295, France; National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, France.
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, 80 avenue Augustin Fliche, 34295, France; National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, France; University of Montpellier, France.
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, 80 avenue Augustin Fliche, 34295, France; National Institute for Health and Medical Research (INSERM), U1051, Team "Plasticity of the Central Nervous System, Human Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, France; University of Montpellier, France.
| |
Collapse
|
20
|
Picart T, Herbet G, Moritz-Gasser S, Duffau H. Iterative Surgical Resections of Diffuse Glioma With Awake Mapping: How to Deal With Cortical Plasticity and Connectomal Constraints? Neurosurgery 2018; 85:105-116. [DOI: 10.1093/neuros/nyy218] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/28/2018] [Indexed: 01/17/2023] Open
Affiliation(s)
- Thiébaud Picart
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors,” INSERM U1051, Institute for Neurosciences of Montpellier, Montpellier, France
| | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors,” INSERM U1051, Institute for Neurosciences of Montpellier, Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors,” INSERM U1051, Institute for Neurosciences of Montpellier, Montpellier, France
| |
Collapse
|
21
|
Abstract
INTRODUCTION Radical glioma resection improves overall survival, both in low-grade and high-grade glial tumors. However, preservation of the quality of life is also crucial. Areas covered: Due to the diffuse feature of gliomas, which invade the central nervous system, and due to considerable variations of brain organization among patients, an individual cerebral mapping is mandatory to solve the classical dilemma between the oncological and functional issues. Because functional neuroimaging is not reliable enough, intraoperative electrical stimulation, especially in awake patients benefiting from a real-time cognitive monitoring, is the best way to increase the extent of resection while sparing eloquent neural networks. Expert commentary: Here, we propose a paradigmatic shift from image-guided resection to functional mapping-guided resection, based on the study of the dynamic distribution of delocalized cortico-subcortical circuits at the individual level, i.e., the investigation of brain connectomics and neuroplastic potential. This surgical philosophy results in an improvement of both oncological outcomes and quality of life. This highlights the need to reinforce the link between glioma surgery and cognitive neurosciences.
Collapse
Affiliation(s)
| | - Hugues Duffau
- b Department of Neurosurgery , Gui de Chauliac Hospital, Montpellier University Medical Center , Montpellier , France.,c National Institute for Health and Medical Research (INSERM), U1051 Laboratory, Team "Brain Plasticity, Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier , Montpellier University Medical Center , Montpellier , France
| |
Collapse
|
22
|
Ghinda DC, Wu JS, Duncan NW, Northoff G. How much is enough-Can resting state fMRI provide a demarcation for neurosurgical resection in glioma? Neurosci Biobehav Rev 2017; 84:245-261. [PMID: 29198588 DOI: 10.1016/j.neubiorev.2017.11.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 01/09/2023]
Abstract
This study represents a systematic review of the insights provided by resting state functional MRI (rs-fMRI) use in the glioma population. Following PRISMA guidelines, 45 studies were included in the review and were classified in glioma-related neuronal changes (n=28) and eloquent area localization (n=17). Despite the heterogeneous nature of the studies, there is considerable evidence of diffuse functional reorganization occurring in the setting of gliomas with local and interhemispheric functional connectivity alterations involving different functional networks. The studies showed evidence of decreased long distance functional connectivity and increased global local efficiency occurring in the setting of gliomas. The tumour grade seems to correlate with distinct functional connectivity changes. Overall, there is a potential clinical utility of rs-fMRI for identifying the functional brain network disruptions occurring in the setting of gliomas. Further studies utilizing standardized analytical methods are required to elucidate the mechanism through which gliomas induce global changes in brain connectivity.
Collapse
Affiliation(s)
- Diana C Ghinda
- Ottawa Hospital Research Institute, University of Ottawa, Division of Neurosurgery, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada; Mind, Brain Imaging and Neuroethics, Canada Research Chair, EJLB-Michael Smith Chair for Neuroscience and Mental Health, Royal Ottawa Mental Health Centre, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Rm. 6435, Ottawa, ON, K1Z 7K4, Canada.
| | - Jin-Song Wu
- Glioma Surgery Division, Department of Neurological Surgery, Huashan Hospital, Fudan University, 518 Wuzhong E Rd, Shanghai, China.
| | - Niall W Duncan
- Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, 250 Wu-Xing Street, Taipei, 11031, Taiwan.
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics, Canada Research Chair, EJLB-Michael Smith Chair for Neuroscience and Mental Health, Royal Ottawa Mental Health Centre, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Rm. 6435, Ottawa, ON, K1Z 7K4, Canada; Mental Health Center/7th Hospital, Zhejiang University School of Medicine, 305 Tianmu Road, Hangzhou, Zhejiang Province, 310013, China.
| |
Collapse
|
23
|
Duffau H. Is non-awake surgery for supratentorial adult low-grade glioma treatment still feasible? Neurosurg Rev 2017; 41:133-139. [PMID: 29105013 DOI: 10.1007/s10143-017-0918-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/10/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Abstract
In this short review, the author performs a database search, summarizes, and discusses studies that provide information on the need to perform awake surgery to preserve quality of life/return to work of adult patients who undergo resection for a supratentorial low-grade glioma (LGG). Based upon the currently available data, the author concludes that in LGG, patients with no or only mild deficits at diagnosis, non-awake surgery can no longer be achieved. Indeed, awake craniotomy with intrasurgical electrical mapping has resulted in an increase of the extent of resection and overall survival in LGG. Furthermore, in order to resume a normal familial, social, and professional life, LGG patients with a prolonged survival expectancy have to benefit not only from language mapping when the tumor involves the left "dominant" hemisphere, but also from intraoperative mapping of sensorimotor, visuospatial, higher cognitive, and emotional functions under local anesthesia, even for gliomas situated within presumed "non-language" areas such as the right "non-dominant" hemisphere. In other words, the ultimate goal is to map the functional connectome for each patient in order to perform the resection up to the eloquent networks and then to optimize the onco-functional balance of LGG surgery. To this end, an objective neuropsychological assessment has to be achieved in a more systematic manner before and after resection. Early postoperative cognitive rehabilitation is also recommended, whenever needed.
Collapse
Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, CHU Montpellier, Montpellier University Medical Center, 80, Avenue Augustin Fliche, 34295, Montpellier, France. .,Institute for Neuroscience of Montpellier, INSERM U1051, Team "Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors," Saint Eloi Hospital, Montpellier University Medical Center, Montpellier, France.
| |
Collapse
|
24
|
Bourdillon P, Apra C, Guénot M, Duffau H. Similarities and differences in neuroplasticity mechanisms between brain gliomas and nonlesional epilepsy. Epilepsia 2017; 58:2038-2047. [PMID: 29105067 DOI: 10.1111/epi.13935] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To analyze the conceptual and practical implications of a hodotopic approach in neurosurgery, and to compare the similarities and the differences in neuroplasticity mechanisms between low-grade gliomas and nonlesional epilepsy. METHODS We review the recent data about the hodotopic organization of the brain connectome, alongside the organization of epileptic networks, and analyze how these two structures interact, suggesting therapeutic prospects. Then we focus on the mechanisms of neuroplasticity involved in glioma natural course and after glioma surgery. Comparing these mechanisms with those in action in an epileptic brain highlights their differences, but more importantly, gives an original perspective to the consequences of surgery on an epileptic brain and what could be expected after pathologic white matter removal. RESULTS The organization of the brain connectome and the neuroplasticity is the same in all humans, but different pathologic mechanisms are involved, and specific therapeutic approaches have been developed in epilepsy and glioma surgery. We demonstrate that the "connectome" point of view can enrich epilepsy care. We also underscore how theoretical and practical tools commonly used in epilepsy investigations, such as invasive electroencephalography, can be of great help in awake surgery in general. SIGNIFICANCE Putting together advances in understanding of connectomics and neuroplasticity, leads to significant conceptual improvements in epilepsy surgery.
Collapse
Affiliation(s)
- Pierre Bourdillon
- Department of Neurosurgery, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,Brain and Spine Institute, INSERM U1127, CNRS 7225, Paris, France.,Claude Bernard University, University of Lyon, Lyon, France.,Pierre and Marie Curie University, Sorbonne University, Paris, France
| | - Caroline Apra
- Pierre and Marie Curie University, Sorbonne University, Paris, France
| | - Marc Guénot
- Department of Neurosurgery, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,Brain and Spine Institute, INSERM U1127, CNRS 7225, Paris, France.,Neuroscience Research Center of Lyon, INSERM U1028, CNRS 5292, Lyon, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier, France.,University of Montpellier, Montpellier, France.,Institute for Neurosciences of Montpellier, INSERM U1051, Montpellier, France
| |
Collapse
|
25
|
Cho NS, Jenabi M, Arevalo-Perez J, Brennan N, Young RJ, Karimi S, Holodny AI, Peck KK. Diffusion Tensor Imaging Shows Corpus Callosum Differences between High-Grade Gliomas and Metastases. J Neuroimaging 2017; 28:199-205. [PMID: 29064137 DOI: 10.1111/jon.12478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/20/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND PURPOSE The corpus callosum (CC) has an important role in regulating interhemispheric transfer and is thought to be instrumental in contralateral brain reorganization in patients with brain tumors, as suggested by a previous study reporting callosal differences between language dominance groups through diffusion tensor imaging (DTI) characteristics. The purpose of this study was to explore the structural differences in the CC between high-grade gliomas (HGGs) and metastatic tumors (METs) using the DTI characteristics of fractional anisotropy (FA), mean diffusivity (MD), and axial diffusivity (AD). METHODS HGG (n = 30) and MET (n = 20) subjects with Magnetic Resonance Imaging (MRI) scans including DTI were retrospectively studied. The tumor and CC were segmented using the 3-dimensional T1-weighted scans to determine their volumes. The region of interest (ROI; mean volume of the ROI = 3,090 ± 464 mm3 ) of the body of the CC was overlaid onto the DTI parametric maps to obtain the averaged FA, MD, and AD values. RESULTS There were significant differences in the distributions of FA and MD values between the two patient groups (mean FA for HGG/MET = .691/.646, P < .05; mean MD for HGG/MET = .894×10-3 mm 2/ second /.992×10-3 mm2 /second, P < .01), while there was no correlation between the DTI parameters and the anatomical volumes. CONCLUSION These results suggest that there is more contralateral brain reorganization in HGG patients than MET patients and that neither the tumor nor callosal volume impact the degree of contralateral brain reorganization.
Collapse
Affiliation(s)
- Nicholas S Cho
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY.,Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Mehrnaz Jenabi
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY.,Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Julio Arevalo-Perez
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY.,Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Nicole Brennan
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY.,Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Robert J Young
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY.,Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Sasan Karimi
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY.,Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY.,Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kyung K Peck
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY.,Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY
| |
Collapse
|
26
|
Glenn C, Conner AK, Rahimi M, Briggs RG, Baker C, Sughrue M. Common Disconnections in Glioma Surgery: An Anatomic Description. Cureus 2017; 9:e1778. [PMID: 29255657 PMCID: PMC5732013 DOI: 10.7759/cureus.1778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Within the surgical treatment of glioma, extended survival is predicated upon extent of resection which is limited by proximity and/or invasion of eloquent structures. Diffusion tensor imaging (DTI) tractography is a very useful tool for guiding supramaximal surgical resection while preserving eloquence. Although gliomas can vary significantly in size, shape, and invasion of functionally significant brain tissue, typical surgical disconnection patterns emerge. In this study, our typical surgical paradigm is outlined. We describe our surgical philosophy for resecting gliomas supramaximally summarized as define, divide, and destroy with the adjuvant utilization of neuronavigation and DTI. We describe the most common disconnections involved in glioma surgery at our institution; specifically, delineating tumor disconnections involving the medial posterior frontal, lateral posterior frontal, posterior temporal, anterior occipital, medial parietal, and insular regions. Although gliomas are highly variable, common patterns emerge in relation to the necessary disconnections required to preserve eloquent brain while maximizing the extent of resection.
Collapse
Affiliation(s)
- Chad Glenn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Meherzad Rahimi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Robert G Briggs
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Cordell Baker
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Michael Sughrue
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| |
Collapse
|