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Baro V, Caliri S, Sartori L, Facchini S, Guarrera B, Zangrossi P, Anglani M, Denaro L, d’Avella D, Ferreri F, Landi A. Preoperative Repetitive Navigated TMS and Functional White Matter Tractography in a Bilingual Patient with a Brain Tumor in Wernike Area. Brain Sci 2021; 11:brainsci11050557. [PMID: 33924964 PMCID: PMC8145512 DOI: 10.3390/brainsci11050557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 01/10/2023] Open
Abstract
Awake surgery and intraoperative neuromonitoring represent the gold standard for surgery of lesion located in language-eloquent areas of the dominant hemisphere, enabling the maximal safe resection while preserving language function. Nevertheless, this functional mapping is invasive; it can be executed only during surgery and in selected patients. Moreover, the number of neuro-oncological bilingual patients is constantly growing, and performing awake surgery in this group of patients can be difficult. In this scenario, the application of accurate, repeatable and non-invasive preoperative mapping procedures is needed, in order to define the anatomical distribution of both languages. Repetitive navigated transcranial magnetic stimulation (rnTMS) associated with functional subcortical fiber tracking (nTMS-based DTI-FT) represents a promising and comprehensive mapping tool to display language pathway and function reorganization in neurosurgical patients. Herein we report a case of a bilingual patient affected by brain tumor in the left temporal lobe, who underwent rnTMS mapping for both languages (Romanian and Italian), disclosing the true eloquence of the anterior part of the lesion in both tests. After surgery, language abilities were intact at follow-up in both languages. This case represents a preliminary application of nTMS-based DTI-FT in neurosurgery for brain tumor in eloquent areas in a bilingual patient.
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Affiliation(s)
- Valentina Baro
- Academic Neurosurgery, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (S.C.); (L.S.); (B.G.); (P.Z.); (L.D.); (D.d.); (A.L.)
- Correspondence:
| | - Samuel Caliri
- Academic Neurosurgery, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (S.C.); (L.S.); (B.G.); (P.Z.); (L.D.); (D.d.); (A.L.)
| | - Luca Sartori
- Academic Neurosurgery, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (S.C.); (L.S.); (B.G.); (P.Z.); (L.D.); (D.d.); (A.L.)
| | - Silvia Facchini
- Department of Neuroscience DNS, University of Padova, 35128 Padova, Italy;
| | - Brando Guarrera
- Academic Neurosurgery, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (S.C.); (L.S.); (B.G.); (P.Z.); (L.D.); (D.d.); (A.L.)
| | - Pietro Zangrossi
- Academic Neurosurgery, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (S.C.); (L.S.); (B.G.); (P.Z.); (L.D.); (D.d.); (A.L.)
| | | | - Luca Denaro
- Academic Neurosurgery, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (S.C.); (L.S.); (B.G.); (P.Z.); (L.D.); (D.d.); (A.L.)
| | - Domenico d’Avella
- Academic Neurosurgery, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (S.C.); (L.S.); (B.G.); (P.Z.); (L.D.); (D.d.); (A.L.)
| | - Florinda Ferreri
- Unit of Neurology and Neurophysiology, Department of Neuroscience, University of Padova, 35128 Padova, Italy;
| | - Andrea Landi
- Academic Neurosurgery, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (S.C.); (L.S.); (B.G.); (P.Z.); (L.D.); (D.d.); (A.L.)
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Barresi V, Lionti S, La Rocca L, Caliri S, Caffo M. High p-mTOR expression is associated with recurrence and shorter disease-free survival in atypical meningiomas. Neuropathology 2018; 39:22-29. [PMID: 30511495 DOI: 10.1111/neup.12524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/06/2018] [Accepted: 10/06/2018] [Indexed: 01/15/2023]
Abstract
Due to their widely variable clinical behavior, the post-surgical treatment of atypical meningiomas is controversial. Therefore, prognostic factors able to identify high-risk cases, which may benefit from adjuvant treatments, are warranted. Mammalian target of rapamycin (mTOR) belongs to the PI3K-AKT pathway. Its phosphorylated form (p-mTOR Ser2448) is involved in cell growth, differentiation and tumorigenesis. The aim of this study was to evaluate p-mTOR Ser2448 expression and its eventual correlation with clinicopathological features, recurrence, or disease-free survival (DFS), in atypical meningiomas. p-mTOR immunohistochemical expression was analyzed in 48 atypical meningiomas and correlated with clinicopathological parameters and with DFS. Eighty-one percent of atypical meningiomas expressed p-mTOR Ser2448. High immuno-expression was significantly associated with recurrences (P = 0.01) and lower DFS (P = 0.01). The presence of brain invasion, high mitotic index plus sheeting, and Simpson grade were significant and independent prognostic variables at multivariate analysis. p-mTOR Ser2448 is expressed in atypical meningiomas. High expression predicts development of recurrences and shorter DFS in patients affected by these tumors. Since p-mTOR Ser2448 is a target of anti-neoplastic drugs, evaluation of its expression may be used, not only to identify atypical meningiomas at higher risk of recurrence, but also to select those to submit to adjuvant targeted chemotherapy.
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Affiliation(s)
- Valeria Barresi
- Departments of Pathology in Adulthood and Evolutive Age, University of Messina, Messina, Italy
| | - Simona Lionti
- Departments of Pathology in Adulthood and Evolutive Age, University of Messina, Messina, Italy
| | - Lilli La Rocca
- Departments of Pathology in Adulthood and Evolutive Age, University of Messina, Messina, Italy
| | - Samuel Caliri
- Departments of Pathology in Adulthood and Evolutive Age, University of Messina, Messina, Italy
| | - Maria Caffo
- Biomedical and Odontoiatric Sciences, and of Morphological and Functional Images, University of Messina, Messina, Italy
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Barresi V, Lionti S, Caliri S, Caffo M. Histopathological features to define atypical meningioma: What does really matter for prognosis? Brain Tumor Pathol 2018; 35:168-180. [PMID: 29671247 DOI: 10.1007/s10014-018-0318-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/12/2018] [Indexed: 12/18/2022]
Abstract
Atypical meningiomas are diagnosed in the presence of: (1) three or more of the following minor atypical criteria: increased cellularity, small cells with a high nuclear/cytoplasmic ratio, prominent nucleoli, sheeting, and foci of spontaneous or geographic necrosis; (2) mitotic count ≥ 4 mitoses per 10 HPF (high mitotic index); (3) brain invasion. The 5-year disease-free survival (DFS) is around 50%. Due to their heterogeneous behavior, the post-surgical treatment of atypical meningiomas is controversial. This study investigated the ability of histopathological features to predict recurrence risk of atypical meningiomas. Meningiomas classified as atypical only on minor atypical criteria had low recurrence risk. Brain invasion, high mitotic index and sheeting were significantly associated with shorter disease-free survival (DFS) (P = 0.001; P = 0.01; P = 0.01). The presence of brain invasion and the co-presence of sheeting and high mitotic index had the highest ability to identify recurring meningiomas (P = 0.0001) (sensitivity: 90.9%; specificity: 86.7%). Our results suggest reconsideration of classification of meningiomas as atypical based only on minor atypical criteria. The presence of brain invasion and the co-occurrence of sheeting and high mitotic count may be useful to identify high risk cases, which may benefit from adjuvant treatments.
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Affiliation(s)
- Valeria Barresi
- Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva "G. Barresi", AOU Policlinico G. Martino, Pad D, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
| | - Simona Lionti
- Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva "G. Barresi", AOU Policlinico G. Martino, Pad D, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Samuel Caliri
- Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva "G. Barresi", AOU Policlinico G. Martino, Pad D, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Maria Caffo
- Dipartimento di Scienze biomediche, odontoiatriche e delle immagini morfologiche e funzionali, University of Messina, Messina, Italy
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