Usefulness of Motor Functional MRI Correlated to Cortical Mapping in Rolandic Low-Grade Astrocytomas

1999 ◽  
Vol 141 (1) ◽  
pp. 71-79 ◽  
Author(s):  
F. E. Roux ◽  
K. Boulanouar ◽  
J. P. Ranjeva ◽  
M. Tremoulet ◽  
P. Henry ◽  
...  
Keyword(s):  
Functional Mri ◽  
Cortical Mapping ◽  
Low Grade

Combined Utility of Functional MRI, Cortical Mapping, and Frameless Stereotaxy in the Resection of Lesions in Eloquent Areas of Brain in Children

1997 ◽  
Vol 26 (2) ◽  
pp. 68-82 ◽  
Author(s):  
Simon R. Stapleton ◽  
Elaine Kiriakopoulos ◽  
David Mikulis ◽  
James M. Drake ◽  
Harold J. Hoffman ◽  
...  
Keyword(s):  
Functional Mri ◽  
Cortical Mapping ◽  
Frameless Stereotaxy ◽  
Eloquent Areas

BRMP-01. Awake cranial surgery with intraoperative language mapping for brain tumors. A single-center experience

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi223-vi223
Author(s):  
Andrés Cervio ◽  
Sebastían Giovannini ◽  
Sonia Hasdeu ◽  
Lucía Pertierra ◽  
Blanca Diez
Keyword(s):  
Brain Tumors ◽  
Functional Mri ◽  
Tumor Resection ◽  
Awake Surgery ◽  
Anesthetic Technique ◽  
Low Grade ◽  
Safe Procedure ◽  
Language Mapping ◽  
Cranial Surgery

Abstract BACKGROUND Maximal safe resection of brain tumors affecting language areas has been a matter of increasing interest worldwide in the last decades. Functional MRI, tractography, and awake cranial surgery are standard procedures in our department since 2006. The aim of this study was to describe our experience in a series of 58 patients who underwent awake cranial surgery with intraoperative language mapping. METHODS Retrospective study of 58 adult patients who underwent awake surgery for brain tumors between January 2006 and January 2021. Preoperative neuropsychological assessment served as inclusion criteria. Language was evaluated according to the BDAE (Boston diagnostic aphasia examination) and WAB (Western aphasia battery) and strength according to the MRC (Medical Research Council) motor scale in the preoperative, immediate postoperative, and 3-months follow up. Functional MRI and tractography depicting white-matter tracts, neuronavigation, cortical and subcortical stimulation were performed in all cases. Conscious sedation was the anesthetic technique (propofol, fentanyl, and NSAIDs). Minimum follow-up was 6 months. FINDINGS The average age was 35 years (16–74). The anatomopathological findings were: low-grade glioma in 75,8% (n = 44), high-grade glioma in 15,6% (n = 9) and others in 8,6% (n = 5). No complications were registered during postoperative course. At the immediate postoperative evaluation 65% of patients presented with speech disturbances but at the 3-months follow up speech recovery was observed in all cases. Only 1 patient remained with moderate aphasia. mRS score at 3- months follow up was ≤ 1 in 96% of patients. Two patients had a persistent moderate hemiparesis. CONCLUSION Tumor resection in awake patients showed to be a safe procedure, and well tolerated by the patients. Preoperative planning of anatomical and functional aspects and intraoperative neurophysiological assessment are the cornerstones for pursuing maximal safe resection.

scholarly journals A functional MRI study of presurgical cognitive deficits in glioma patients

2020 ◽  
Author(s):  
Irena T Schouwenaars ◽  
Miek J de Dreu ◽  
Geert-Jan M Rutten ◽  
Nick F Ramsey ◽  
Johan M Jansma
Keyword(s):  
Functional Mri ◽  
Cognitive Deficits ◽  
Brain Activity ◽  
Neuropsychological Testing ◽  
Region Of Interest ◽  
High Grade Glioma ◽  
Brain Regions ◽  
Brain State ◽  
Low Grade ◽  
Activity Levels

Abstract Background The main goal of this functional MRI (fMRI) study was to examine whether cognitive deficits in glioma patients prior to treatment are associated with abnormal brain activity in either the central executive network (CEN) or default mode network (DMN). Methods Forty-six glioma patients, and 23 group-matched healthy controls (HCs) participated in this fMRI experiment, performing an N-back task. Additionally, cognitive profiles of patients were evaluated outside the scanner. A region of interest–based analysis was used to compare brain activity in CEN and DMN between groups. Post hoc analyses were performed to evaluate differences between low-grade glioma (LGG) and high-grade glioma (HGG) patients. Results In-scanner performance was lower in glioma patients compared to HCs. Neuropsychological testing indicated cognitive impairment in LGG as well as HGG patients. fMRI results revealed normal CEN activation in glioma patients, whereas patients showed reduced DMN deactivation compared to HCs. Brain activity levels did not differ between LGG and HGG patients. Conclusions Our study suggests that cognitive deficits in glioma patients prior to treatment are associated with reduced responsiveness of the DMN, but not with abnormal CEN activation. These results suggest that cognitive deficits in glioma patients reflect a reduced capacity to achieve a brain state necessary for normal cognitive performance, rather than abnormal functioning of executive brain regions. Solely focusing on increases in brain activity may well be insufficient if we want to understand the underlying brain mechanism of cognitive impairments in patients, as our results indicate the importance of assessing deactivation.

scholarly journals NI-59 * TABLET TECHNOLOGY FOR IMPROVED PREOPERATIVE SPEECH MAPPING USING FUNCTIONAL MRI IN PATIENTS WITH LOW-GRADE GLIOMA

2014 ◽  
Vol 16 (suppl 5) ◽  
pp. v151-v151
Author(s):  
M. Morrison ◽  
L. Golestanirad ◽  
T. Schweizer ◽  
S. Graham ◽  
S. Das
Keyword(s):  
Functional Mri ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Speech Mapping

scholarly journals Three-dimensional image reconstruction for low-grade glioma surgery

1998 ◽  
Vol 4 (4) ◽  
pp. E9 ◽  
Author(s):  
Alexandra Chabrerie ◽  
Fatma Ozlen ◽  
Shin Nakajima ◽  
Michael E. Leventon ◽  
Hideki Atsumi ◽  
...  
Keyword(s):  
Image Reconstruction ◽  
Local Anesthetic ◽  
Surgical Planning ◽  
Surgical Navigation ◽  
Three Dimensional ◽  
Cortical Mapping ◽  
Low Grade ◽  
Glioma Surgery ◽  
Dimensional Image ◽  
Low Grade Gliomas

Three-dimensional image reconstruction for preoperative surgical planning and intraoperative navigation for the resection of low-grade gliomas was performed in 20 patients. Thirteen of these surgeries were performed while the patient received a local anesthetic to allow for cortical mapping. Ninety percent of the patients were functionally intact postoperatively. The authors propose that the combination of the three-dimensional image reconstruction and surgical navigation, in conjunction with intraoperative cortical mapping, provides an additional means for surgeons to improve the safety and precision of the procedures.

scholarly journals Surgical approaches to tumors and epileptogenic zones close to Wernicke's area

1995 ◽  
Vol 53 (3b) ◽  
pp. 587-591 ◽  
Author(s):  
Arthur Cukiert ◽  
Gary Gronich ◽  
Raul Marino Jr
Keyword(s):  
Local Anesthesia ◽  
Surgical Procedures ◽  
Local Anesthetic ◽  
Clinical Presentation ◽  
Brain Regions ◽  
Cortical Mapping ◽  
Surgical Approaches ◽  
Low Grade ◽  
Severe Morbidity ◽  
Wernicke’S Area

Surgical procedures near to language related brain regions may cause severe morbidity in relation to speech. Operations performed under local anesthesia and intraoperative cortical mapping may minimize these risks. Six patients with tumors near the Wernicke's area were treated (2 low-grade astrocytomas, 1 ganglioglioma, 1 xanthoastrocytoma, 1 metastasis, 1 glioblastoma). Their clinical presentation consisted of epilepsy (n=4) and dysphasia (n=2). The skin and periosteum were infiltrated with local anesthetic and an ample craniotomy was performed. Cortical stimulation with an unipolar electrode was then carried out with concomitant speech testing (mainly comprehension and sequential speech). After mapping, the best surgical approach aiming to avoid the mapped area was elected. In 5 cases the resection was total and in 1, partial (glioblastoma). There was a transitory (10 days) worsening of the pre-operative deficit in 1 case (glioblastoma). In 3 patients, the speech areas were displaced: posteriorly (n=2) or anteriorly (n=l). Surgical procedures under local anesthesia are safe and may avoid post-operative language disturbances in patients with tumors near to Wernicke's area.

scholarly journals Evaluation of Postoperative Deficits following Motor Cortex Tumor Resection using Small Craniotomy

2019 ◽  
Vol 05 (01) ◽  
pp. e8-e13 ◽  
Author(s):  
Wellingson Paiva ◽  
Erich Fonoff ◽  
André Beer-Furlan ◽  
Bárbara Morais ◽  
Iuri Neville ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Motor Cortex ◽  
Eastern Cooperative Oncology Group ◽  
Tumor Resection ◽  
Cortical Mapping ◽  
Motor Deficits ◽  
Karnofsky Performance Scale ◽  
Low Grade ◽  
Precentral Gyrus ◽  
A Prospective Study

Introduction Surgical treatment of brain tumors in eloquent areas has always been considered a major challenge because removal-related cortical damage can cause serious functional impairment. However, few studies have investigated the association between small craniotomies and the higher risk of incidence of motor deficits and prolonged recovery time. Here, we analyzed neurologic deficits and the prognostic variables after surgery guided by navigation for motor cortex tumors under general anesthesia. Methods This was a prospective study that included 47 patients with tumors in the precentral gyrus. All surgeries were performed with neuronavigation and cortical mapping, with direct electrical stimulation of the motor cortex. We evaluated the prognostic evolution of patients with pre- and postoperative Karnofsky Performance Scale using the Eastern Cooperative Oncology Group scale. Results Complete resection was verified in all 18 cases of metastasis, 13 patients with glioblastoma multiforme, and 5 patients with low-grade gliomas. An analysis of the motor deficits revealed that 11 patients experienced worsening of the deficit on the first day after surgery. Only four patients developed new deficits in the immediate postoperative period, and these improved after 3 weeks. After 3 months, only two patients had deficits that were worse those experienced prior to surgery; both patients had glioblastoma multiforme. Conclusion In our series, motor deficits prior to surgery were the most important factors associated with persistent postoperative deficits. Small craniotomy with navigation associated with intraoperative brain mapping allowed a safe resection and motor preservation in patients with motor cortex brain tumor.

scholarly journals Awake Craniotomy for Left Insular Low-Grade Glioma Removal on a Patient with Learning Disabilities

2017 ◽  
Vol 06 (01) ◽  
pp. 041-043 ◽  
Author(s):  
Andrej Vranic ◽  
Blaz Koritnik ◽  
Jasmina Markovic-Bozic
Keyword(s):  
Learning Disabilities ◽  
Case Report ◽  
Brain Tumors ◽  
Awake Craniotomy ◽  
Awake Surgery ◽  
Cortical Mapping ◽  
Low Grade ◽  
Low Grade Gliomas ◽  
Eloquent Areas ◽  
Slow Growing

Introduction Low-grade gliomas (LGG) are slow-growing primary brain tumors in adults, with high tropism for eloquent areas. Standard approach in treatment of LGG is awake craniotomy with intraoperative cortical mapping — a method which is usually used on adult and fully cooperative patients. Case Report We present the case of a patient with learning disabilities (PLD) who was operated for left insular LGG awake craniotomy, and intraoperative cortical mapping were performed and the tumor was gross totally removed. Conclusion Awake surgery for left insular LGG removal is challenging; however, it can be performed safely and successfully on PLD.

scholarly journals Awake Surgery for Left Posterior Insular Low-Grade Glioma Through the Parietorolandic Operculum: The Need to Preserve the Functional Connectivity. A Case Series

2022 ◽  
Vol 8 ◽  
Author(s):  
Hugues Duffau
Keyword(s):  
White Matter ◽  
Functional Connectivity ◽  
Case Series ◽  
Low Grade Glioma ◽  
Awake Surgery ◽  
Cortical Mapping ◽  
Lateral Part ◽  
Low Grade ◽  
Left Posterior ◽  
Transcortical Approach

Objective: Surgical approach to low-grade glioma (LGG) involving the posterior insula is challenging, especially in the left hemisphere, with a high risk of sensorimotor, language, or visual deterioration. In this study, a case series of 5 right-handed patients harboring a left posterior insular LGG is reported, by detailing a transcorticosubcortical approach.Method: The five surgeries were achieved in awake patients using cortical and axonal electrostimulation mapping. The glioma was removed through the left rolandic and/or parietal opercula, with preservation of the subcortical connectivity.Results: The cortical mapping was positive in the five patients, enabling the selection of an optimal transcortical approach, via the anterolateral supramarginal gyrus in four patients and/or via the lateral retrocentral gyrus in three cases (plus through the left superior temporal gyrus in one case). Moreover, the white matter tracts were identified in all cases, i.e., the lateral part of the superior longitudinal fasciculus (five cases), the arcuate fasciculus (four cases), the thalamocortical somatosensory pathways (four cases), the motor pathway (one case), the semantic pathway (three cases), and the optic tract (one case). Complete resection of the LGG was achieved in two patients and near-total resection in three patients. There were no postoperative permanent sensorimotor, language, or visual deficits.Conclusion: A transcortical approach through the parietorolandic operculum in awake patients represents safe and effective access to the left posterior insular LGG. Detection and preservation of the functional connectivity using direct electrostimulation of the white matter bundles are needed in this cross-road brain region to prevent otherwise predictable postsurgical impairments.

RESECTION OF WORLD HEALTH ORGANIZATION GRADE II GLIOMAS INVOLVING BROCA'S AREA

Neurosurgery ◽  
2007 ◽  
Vol 61 (4) ◽  
pp. 741-753 ◽  
Author(s):  
Mohammed Benzagmout ◽  
Peggy Gatignol ◽  
Hugues Duffau
Keyword(s):  
Brain Plasticity ◽  
Premotor Cortex ◽  
Intractable Epilepsy ◽  
World Health ◽  
Cortical Mapping ◽  
Magnetic Resonance Imaging Scan ◽  
Low Grade ◽  
Broca’S Area ◽  
Broca's Area ◽  
Health Organization

Abstract OBJECTIVE Advances in functional mapping have enabled us to extend the indications of surgery for low-grade gliomas (LGGs) within eloquent regions. However, to our knowledge, no study has been specifically dedicated to the resection of LGGs within Broca's area. We report the first surgical series of LGGs involving this area by focusing on methodological and functional considerations. METHODS Seven patients harboring an LGG in Broca's area (revealed by partial seizures) had a language functional magnetic resonance imaging scan and then underwent operation while awake using intrasurgical electrical mapping. RESULTS The neurological examination was normal in all patients despite mild language disturbances shown using the Boston Diagnosis Aphasia Examination. Both pre- and intraoperative cortical mapping found language reorganization with recruitment of the ventral and dorsal premotor cortices, orbitofrontal cortex, and insula, whereas no or few language sites were detected within Broca's area. Subcortically, electrostimulation allowed the identification and preservation of four structures still functional, including the arcuate fasciculus, fronto-occipital fasciculus, fibers from the ventral premotor cortex, and head of the caudate. Postoperatively, after transient language worsening, all patients recovered and returned to a normal socioprofessional life. The resection was total in three cases, subtotal in three, and partial in one patient (operated twice). CONCLUSION Our results indicate that, in patients with no aphasia despite LGGs within Broca's area, thanks to brain plasticity, the tumor can be removed while involving this “unresectable” structure without inducing sequelae and even improving the quality of life when intractable epilepsy is relieved on the condition that subcortical language connectivity is preserved.

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