Transopercular Insular Approach, Overcoming the Training Curve Using a Cadaveric Simulation Model: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Carlos Santos ◽  
Carlos Velasquez ◽  
Jesus Esteban ◽  
Leticia Fernandez ◽  
Emmanuel Mandonnet ◽  
...  
Keyword(s):  
White Matter ◽  
Video Recording ◽  
Insular Cortex ◽  
Cost Effective ◽  
Training Model ◽  
Surgical Skills ◽  
Low Grade ◽  
Eloquent Areas ◽  
Landmark Identification ◽  
Neuronavigation System

Abstract Transopercular approach to the insula is indicated for resection of insular low-grade gliomas, particularly for Yasargil's 3B, 5A, and 5B types. Nevertheless, the infrequent location and its challenging approach make it difficult to master the surgery. Consequently, a realistic laboratory training model might help to acquire key surgical skills. In this video, we describe a cadaveric-based model simulating the resection of a temporo-insular low-grade glioma. Kingler's fixation technique was used to fix the cadaver head before injecting red and blue colorants for a realistic vascular appearance. Hemisphere was frozen for white matter tract dissection. Tractography and intraoperative eloquent areas were extrapolated from a glioma patient by using a neuronavigation system. Then, a fronto-temporal craniotomy was performed through a question mark incision, exposing from inferior temporal gyrus up to middle frontal gyrus. After cortical anatomic landmark identification, eloquent areas were extrapolated creating a simulated functional cortical map. Then, transopercular noneloquent frontal and temporal corticectomies were performed, followed by subpial resection. Detailed identification of Sylvian vessels and insular cortex was demonstrated. Anatomic resection limits were exposed, and implicated white matter bundles, uncinate and fronto-occipital fascicles, were identified running through the temporal isthmus. Finally, a temporo-mesial resection was performed. In summary, this model provides a simple, cost-effective, and very realistic simulation of a transopercular approach to the insula, allowing the development of surgical skills needed to treat insular tumors in a safe environment. Besides, the integration of simulated navigation has proven useful in better understanding the complex white matter anatomy involved. Cadaver donation, subject or relatives, includes full consent for publication of the images. For the purpose of this video, no ethics committee approval was needed. Images correspond to a cadaver head donation. Cadaver donation, subject or relatives, includes full consent for any scientific purposes involving the corpse. The consent includes image or video recording. Regarding the intraoperative surgical video and tractography, the patient gave written consent for scientific divulgation prior to surgery.

scholarly journals Dissociated Crossed Speech Areas in a Tumour Patient

2017 ◽  
Vol 9 (2) ◽  
pp. 131-136 ◽  
Author(s):  
Jörg Mauler ◽  
Irene Neuner ◽  
Georg Neuloh ◽  
Bruno Fimm ◽  
Frank Boers ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Insular Cortex ◽  
Low Grade ◽  
Wada Test ◽  
Brain Hemispheres ◽  
Eloquent Areas ◽  
Tumour Removal ◽  
Frontal Operculum ◽  
The Right ◽  
Impaired Speech

In the past, the eloquent areas could be deliberately localised by the invasive Wada test. The very rare cases of dissociated crossed speech areas were accidentally found based on the clinical symptomatology. Today functional magnetic resonance imaging (fMRI)-based imaging can be employed to non-invasively localise the eloquent areas in brain tumour patients for therapy planning. A 41-year-old, left-handed man with a low-grade glioma in the left frontal operculum extending to the insular cortex, tension headaches, and anomic aphasia over 5 months underwent a pre-operative speech area localisation fMRI measurement, which revealed the evidence of the transhemispheric disposition, where the dominant Wernicke speech area is located on the left and the Broca’s area is strongly lateralised to the right hemisphere. The outcome of the Wada test and the intraoperative cortico-subcortical stimulation mapping were congruent with this finding. After tumour removal, language area function was fully preserved. Upon the occurrence of brain tumours with a risk of impaired speech function, the rare dissociate crossed speech areas disposition may gain a clinically relevant meaning by allowing for more extended tumour removal. Hence, for its identification, diagnostics which take into account both brain hemispheres, such as fMRI, are recommended.

scholarly journals Risk Assessment by Pre-surgical Tractography in Left Hemisphere Low-Grade Gliomas

2021 ◽  
Vol 12 ◽  
Author(s):  
Tamara Ius ◽  
Teresa Somma ◽  
Cinzia Baiano ◽  
Ilaria Guarracino ◽  
Giada Pauletto ◽  
...  
Keyword(s):  
White Matter ◽  
Structural Changes ◽  
Insular Cortex ◽  
Fiber Tracking ◽  
Comparative Approach ◽  
Low Grade ◽  
Low Grade Gliomas ◽  
Neurological Outcomes ◽  
Operative Outcomes ◽  
Operative Planning

Background: Tracking the white matter principal tracts is routinely typically included during the pre-surgery planning examinations and has revealed to limit functional resection of low-grade gliomas (LGGs) in eloquent areas.Objective: We examined the integrity of the Superior Longitudinal Fasciculus (SLF) and Inferior Fronto-Occipital Fasciculus (IFOF), both known to be part of the language-related network in patients with LGGs involving the temporo-insular cortex. In a comparative approach, we contrasted the main quantitative fiber tracking values in the tumoral (T) and healthy (H) hemispheres to test whether or not this ratio could discriminate amongst patients with different post-operative outcomes.Methods: Twenty-six patients with LGGs were included. We obtained quantitative fiber tracking values in the tumoral and healthy hemispheres and calculated the ratio (HIFOF–TIFOF)/HIFOF and the ratio (HSLF–TSLF)/HSLF on the number of streamlines. We analyzed how these values varied between patients with and without post-operative neurological outcomes and between patients with different post-operative Engel classes.Results: The ratio for both IFOF and SLF significantly differed between patient with and without post-operative neurological language deficits. No associations were found between white matter structural changes and post-operative seizure outcomes.Conclusions: Calculating the ratio on the number of streamlines and fractional anisotropy between the tumoral and the healthy hemispheres resulted to be a useful approach, which can prove to be useful during the pre-operative planning examination, as it gives a glimpse on the potential clinical outcomes in patients with LGGs involving the left temporo-insular cortex.

scholarly journals Immunohistochemical Biomarkers as a Surrogate of Molecular Analysis in Ovarian Carcinomas: A Review of the Literature

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 199 ◽  
Author(s):  
Giacomo Santandrea ◽  
Simonetta Piana ◽  
Riccardo Valli ◽  
Magda Zanelli ◽  
Elisa Gasparini ◽  
...  
Keyword(s):  
Ovarian Carcinoma ◽  
Molecular Analysis ◽  
Immunohistochemical Analysis ◽  
Cost Effective ◽  
Mucinous Carcinoma ◽  
Serous Carcinoma ◽  
Malignant Neoplasms ◽  
Low Grade ◽  
Ovarian Carcinomas ◽  
Novel Target

The term “ovarian carcinoma” encompasses at least five different malignant neoplasms: high-grade serous carcinoma, low-grade serous carcinoma, endometrioid carcinoma, mucinous carcinoma, and clear cell carcinoma. These five histotypes demonstrated distinctive histological, molecular, and clinical features. The rise of novel target therapies and of a tailored oncological approach has demanded an integrated multidisciplinary approach in the setting of ovarian carcinoma. The need to implement a molecular-based classification in the worldwide diagnostic and therapeutic setting of ovarian cancer demanded a search for easy-to-use and cost-effective molecular-surrogate biomarkers, relying particularly on immunohistochemical analysis. The present review focuses on the role of immunohistochemistry as a surrogate of molecular analysis in the everyday diagnostic approach to ovarian carcinomas.

scholarly journals 934 Remote one-to-one virtual surgical skills training: Evolving the delivery of operative skills training in the UK

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Christian Asher ◽  
Ibrahim Ibrahim ◽  
Eyfrossini Katsarma
Keyword(s):  
Surgical Training ◽  
Wound Closure ◽  
Cost Effective ◽  
Skills Training ◽  
Training Programme ◽  
Surgical Skills ◽  
Wound Closure Techniques ◽  
Surgical Skills Training ◽  
Speciality Training ◽  
One To One

Abstract Introduction COVID-19 has had an unprecedented effect on surgical training, including prerequisite entry-level courses to speciality training. We describe the implementation of a virtual, one-to-one training programme aimed at the acquisition and retention of operative skills. Methods Enrolment commenced 8th May 2020 for wound closure techniques or an extended programme including tendon repairs, delivered by Specialist Registrars in Plastic Surgery using Zoom® (v. 5.0.5) via mobile device. Participant feedback was collected retrospectively using a 5-point scale following course completion. Results 5 participants completed the wound closure programme, and 3 the extended programme, over an average of 5 weeks, with 2 sessions per week. 5 participants were male, 3 female and were of the following grades: 2 CT2, 4 FY2, 1 FY1 and 1 medical student. A total of 103.5 hours of training was recorded to 7 September 2020. Participants reported that all virtual skills taught were readily transferable to the theatre environment. Following the course, all participants felt confident to complete the skills learnt independently, rating the course as excellent. Conclusions The COVID-19 crisis has placed insurmountable obstacles in the face of surgical training. With further validation, we aim to develop surgical skills training with virtual, easily reproducible, cost-effective, trainee centred programmes.

scholarly journals Enhanced Thermoelectric Performance of n-Type Bi2Se3 Nanosheets through Sn Doping

Nanomaterials ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1827
Author(s):  
Mengyao Li ◽  
Yu Zhang ◽  
Ting Zhang ◽  
Yong Zuo ◽  
Ke Xiao ◽  
...  
Keyword(s):  
Figure Of Merit ◽  
Cost Effective ◽  
Low Grade ◽  
Hot Press ◽  
Processing Technologies ◽  
Sn Doping ◽  
Practical Applications ◽  
Alternative Materials ◽  
The Cost ◽  
Low Grade Heat

The cost-effective conversion of low-grade heat into electricity using thermoelectric devices requires developing alternative materials and material processing technologies able to reduce the currently high device manufacturing costs. In this direction, thermoelectric materials that do not rely on rare or toxic elements such as tellurium or lead need to be produced using high-throughput technologies not involving high temperatures and long processes. Bi2Se3 is an obvious possible Te-free alternative to Bi2Te3 for ambient temperature thermoelectric applications, but its performance is still low for practical applications, and additional efforts toward finding proper dopants are required. Here, we report a scalable method to produce Bi2Se3 nanosheets at low synthesis temperatures. We studied the influence of different dopants on the thermoelectric properties of this material. Among the elements tested, we demonstrated that Sn doping resulted in the best performance. Sn incorporation resulted in a significant improvement to the Bi2Se3 Seebeck coefficient and a reduction in the thermal conductivity in the direction of the hot-press axis, resulting in an overall 60% improvement in the thermoelectric figure of merit of Bi2Se3.

scholarly journals Low-grade astrocytoma: surgical outcomes in eloquent versus non-eloquent brain areas

2013 ◽  
Vol 71 (1) ◽  
pp. 31-34 ◽  
Author(s):  
André de Macedo Bianco ◽  
Flavio Key Miura ◽  
Carlos Clara ◽  
Jose Reynaldo W. Almeida ◽  
Clemar Correa da Silva ◽  
...  
Keyword(s):  
Overall Survival ◽  
Tumor Resection ◽  
Progression Free Survival ◽  
Subtotal Resection ◽  
Low Grade ◽  
Brain Areas ◽  
Free Survival ◽  
Eloquent Areas ◽  
Eloquent Area ◽  
Extent Of Surgical Resection

A retrospective study of 81 patients with low-grade astrocytoma (LGA) comparing the efficacy of aggressive versus less aggressive surgery in eloquent and non-eloquent brain areas was conducted. Extent of surgical resection was analyzed to assess overall survival (OS) and progression- free survival (PFS). Degree of tumor resection was classified as gross total resection (GTR), subtotal resection (STR) or biopsy. GTR, STR and biopsy in patients with tumors in non-eloquent areas were performed in 31, 48 and 21% subjects, whereas in patients with tumors in eloquent areas resections were 22.5, 35 and 42.5%. Overall survival was 4.7 and 1.9 years in patients with tumors in non-eloquent brain areas submitted to GTR/STR and biopsy (p=0.013), whereas overall survival among patients with tumors in eloquent area was 4.5 and 2.1 years (p=0.33). Improved outcome for adult patients with LGA is predicted by more aggressive surgery in both eloquent and non-eloquent brain areas.

scholarly journals Developing students' listening metacognitive strategies using online videotext self-dictation-generation learning activity

2014 ◽  
Vol 22 (1) ◽  
pp. 3 ◽  
Author(s):  
Ching Chang ◽  
Chih-Kai Chang
Keyword(s):  
Strategy Instruction ◽  
Cost Effective ◽  
Training Model ◽  
Learning Activity ◽  
Online Video ◽  
Listening Skills ◽  
Instructional Process ◽  
Learning Framework ◽  
Learning Platform ◽  
Listening Strategies

<span>The study is based on the use of a flexible learning framework to help students improve information processes underlying strategy instruction in EFL listening. By exploiting the online videotext self-dictation-generation (video-SDG) learning activity implemented on the YouTube caption manager platform, the learning cycle was emphasized to promote metacognitive listening development. Two theories were used to guide the online video-SDG learning activity: a student question-generation method and a metacognitive listening training model in a second language (L2). The study investigated how college students in the online video-SDG activity enhanced the use of listening strategies by developing metacognitive listening skills. With emphasis on the metacognitive instructional process, students could promote their listening comprehension of advertisement videos (AVs). Forty-eight students were recruited to participate in the study. Through data collected from the online learning platform, questionnaires, a focus-group interview, and pre- and post- achievement tests, the results revealed that the online video-SDG learning activity could effectively engage students in reflecting upon their perceptions of specific problems countered, listening strategy usages, and strategic knowledge exploited in the metacognitive instructional process. The importance of employing cost-effective online video-SGD learning activities is worthy of consideration in developing students’ metacognitive listening knowledge for enhancing EFL listening strategy instruction.</span>

scholarly journals Tactile direction discrimination in humans after stroke

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Linda C Lundblad ◽  
Håkan Olausson ◽  
Pontus Wasling ◽  
Katarina Jood ◽  
Anna Wysocka ◽  
...  
Keyword(s):  
White Matter ◽  
Functional Mri ◽  
Sensory System ◽  
Insular Cortex ◽  
Structural Mri ◽  
Skin Surface ◽  
Direction Discrimination ◽  
Healthy Humans ◽  
Tactile Stimuli ◽  
Hands And Feet

Abstract Sensing movements across the skin surface is a complex task for the tactile sensory system, relying on sophisticated cortical processing. Functional MRI has shown that judgements of the direction of tactile stimuli moving across the skin are processed in distributed cortical areas in healthy humans. To further study which brain areas are important for tactile direction discrimination, we performed a lesion study, examining a group of patients with first-time stroke. We measured tactile direction discrimination in 44 patients, bilaterally on the dorsum of the hands and feet, within 2 weeks (acute), and again in 28 patients 3 months after stroke. The 3-month follow-up also included a structural MRI scan for lesion delineation. Fifty-nine healthy participants were examined for normative direction discrimination values. We found abnormal tactile direction discrimination in 29/44 patients in the acute phase, and in 21/28 3 months after stroke. Lesions that included the opercular parietal area 1 of the secondary somatosensory cortex, the dorsolateral prefrontal cortex or the insular cortex were always associated with abnormal tactile direction discrimination, consistent with previous functional MRI results. Abnormal tactile direction discrimination was also present with lesions including white matter and subcortical regions. We have thus delineated cortical, subcortical and white matter areas important for tactile direction discrimination function. The findings also suggest that tactile dysfunction is common following stroke.

Diffuse White Matter Gliosis in Mental Defectives

1937 ◽  
Vol 83 (344) ◽  
pp. 258-267 ◽  
Author(s):  
A. Meyer ◽  
L. C. Cook
Keyword(s):  
White Matter ◽  
Short Note ◽  
Mental Deficiency ◽  
Point Of View ◽  
Short Paper ◽  
Full Description ◽  
Spastic Diplegia ◽  
Low Grade ◽  
Diffuse White Matter ◽  
Pathological Material

This paper is a preliminary report of some investigations we are now making into the pathology of mental deficiency, mainly from the histological point of view. We have so far examined 22 cases, comprising 7 low-grade defectives showing gross neurological lesions, chiefly of extrapyramidal character, 6 microcephalics with spastic diplegia and severe mental defect, 2 able-bodied microcephalics without gross neurological signs, 1 simple able-bodied idiot and 6 mongols. In this short paper it is impossible to give even the slightest indication of the wealth of pathological material found in such a variety of widely differing conditions. A full description of our findings, together with a more detailed discussion, must be left to further papers dealing with individual groups of cases. The purpose of making a short note at this stage is to draw attention to one particular finding which struck us by its surprising constancy, i.e., a proliferation of the fibrous glia, particularly pronounced within the cerebral and often also the cerebellar white matter. In many of the cases the cortical changes were slight compared with the intense lesions of the white matter. In none of them was demyelinization a well-marked feature, nor did its severity approach that of the glial proliferation; in many it was negligible, and there were none of the fatty breakdown products, characteristic of the demyelinizing disease of the white matter called after Schilder. The gliosis was either diffused or patchy, and was often markedly perivascular; even stripe-like scars, as described by Hallervorden (10), were to be seen, although, contrary to this author's observation, there was, as a rule, no corresponding myelin defect.

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