Left Pan-Hippocampal Low Grade Glioma—2-Stage Transsylvian Transventricular and Paramedian Supracerebellar Transtentorial Approaches: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. E82-E82
Author(s):  
Juan C Fernandez-Miranda
Keyword(s):  
Tumor Resection ◽  
Spatial Relationship ◽  
Low Grade Glioma ◽  
Parahippocampal Gyrus ◽  
Surgical Approaches ◽  
Low Grade ◽  
Fiber Tractography ◽  
High Definition ◽  
Posterior Portion ◽  
Fiber Tracts

Abstract The surgical goal for low-grade gliomas (LGGs) is to maximize resection while minimizing morbidity. Pan-hippocampal LGGs extend from the hippocampal head to the hippocampal tail, and involve the parahippocampal gyrus and uncus. Given their anteroposterior extension, they cannot be completely removed with 1 single approach, requiring a 2-stage front-to-back operation.  In this video, we present the case of a 52-yr-old man with new onset of generalized seizures and a dominant-side, nonenhancing, pan-hippocampal infiltrative lesion compatible with a low-grade glioma. Preoperative high-definition fiber tractography (HDFT) showed the spatial relationship of the tumor with surrounding fiber tracts, such as the arcuate, inferior fronto-occipital, and middle longitudinal fascicles, and optic radiations.  Surgical resection was planned in 2 separate stages. The first stage consisted of a transsylvian transinferior insular sulcus approach to the extra- and intraventricular aspects of the uncohippocampal region. The entire anterior and middle portions of the tumor were successfully removed with minimal morbidity, including transient naming difficulties and permanent superior quadrantanopia. Postoperative HDFT showed preservation of all fiber tracts, except for a portion of Meyer's loop and the inferior-most aspect of the inferior fronto-occipital fascicle. The second stage was completed 8 wk later and consisted of a paramedian supracerebellar-transtentorial approach on sitting position. The posterior portion of the tumor was entirely removed to achieve a complete macroscopic tumor resection. The final diagnosis was IDH1-positive LGG.  Pan-hippocampal tumors remain a surgical challenge but accurate knowledge of surgical neuroanatomy and surgical approaches facilitates their safe and effective treatment.  The patient signed an informed consent including the use of photographic and video material for educational or academic purposes.

scholarly journals The epitrigeminal approach to the brainstem

2018 ◽  
Vol 128 (5) ◽  
pp. 1512-1521 ◽  
Author(s):  
Georgios Andrea Zenonos ◽  
David Fernandes-Cabral ◽  
Maximiliano Nunez ◽  
Stefan Lieber ◽  
Juan Carlos Fernandez-Miranda ◽  
...  
Keyword(s):  
Cavernous Malformation ◽  
Anatomical Study ◽  
Normal Subjects ◽  
Surgical Approaches ◽  
Illustrative Case ◽  
Fiber Tractography ◽  
High Definition ◽  
Entry Zone ◽  
Corticospinal Tracts ◽  
Direct Distance

OBJECTIVESurgical approaches to the ventrolateral pons pose a significant challenge. In this report, the authors describe a safe entry zone to the brainstem located just above the trigeminal entry zone which they refer to as the “epitrigeminal entry zone.”METHODSThe approach is presented in the context of an illustrative case of a cavernous malformation and is compared with the other commonly described approaches to the ventrolateral pons. The anatomical nuances were analyzed in detail with the aid of surgical images and video, anatomical dissections, and high-definition fiber tractography (HDFT). In addition, using the HDFT maps obtained in 77 normal subjects (154 sides), the authors performed a detailed anatomical study of the surgically relevant distances between the trigeminal entry zone and the corticospinal tracts.RESULTSThe patient treated with this approach had a complete resection of his cavernous malformation, and improvement of his symptoms. With regard to the HDFT anatomical study, the average direct distance of the corticospinal tracts from the trigeminal entry zone was 12.6 mm (range 8.7–17 mm). The average vertical distance was 3.6 mm (range −2.3 to 8.7 mm). The mean distances did not differ significantly from side to side, or across any of the groups studied (right-handed, left-handed, and ambidextrous).CONCLUSIONSThe epitrigeminal entry zone to the brainstem appears to be safe and effective for treating intrinsic ventrolateral pontine pathological entities. A possible advantage of this approach is increased versatility in the rostrocaudal axis, providing access both above and below the trigeminal nerve. Familiarity with the subtemporal transtentorial approach, and the reliable surgical landmark of the trigeminal entry zone, should make this a straightforward approach.

scholarly journals Intramedullary spinal cord tumor resection

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1
Author(s):  
Mari L. Groves ◽  
Patricia L. Zadnik ◽  
Pablo F. Recinos ◽  
Violette Renard ◽  
George I. Jallo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Progression Free Survival ◽  
Low Grade ◽  
High Definition ◽  
En Bloc ◽  
Intramedullary Spinal Cord ◽  
Free Survival ◽  
Intramedullary Spinal Cord Tumor

The authors present a case of a 27-year-old patient who presented with spastic gait and worsening difficulty walking over a 6 month period. Spinal MR imaging revealed a heterogeneously enhancing intramedullary spinal cord tumor (IMSCT) with associated syrinx in the cervical spine. The lesion was resected through posterior en bloc laminotomy, durotomy, and microscopic resection of the intramedullary component followed by laminoplasty reconstruction. Surgical resections with a goal of gross total resection can significantly improve overall survival and progression free survival in patients with low-grade IMSCT. The procedure is presented in an edited, high-definition format with accompanying narrative. The video can be found here: http://youtu.be/Ui9bn82PtP8.

scholarly journals Three-Year Survival Rate in All Kinds of Glioma Tumors in One Institution, Iran, 2001-2010

2020 ◽  
Vol 6 (2) ◽  
pp. 67-72
Author(s):  
Masih Rezaee ◽  
◽  
Bahram Amin Mansour ◽  
Keyword(s):  
Survival Rate ◽  
Survival Rates ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
Good Prognosis ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Diffuse Astrocytoma ◽  
And Gender ◽  
Glioma Tumors

Background and Aim: The survival rate of brain tumors has not yet been reported in Iran. The purpose of this study, given the lack of such information, was to evaluate the 3-year survival rate in patients with all kinds of glioma tumors. Methods and Materials/Patients: This study was descriptive and retrospective, including 222 patients who had been diagnosed clinically with one type of glioma tumor and admitted to Al-Zahra hospital, Isfahan, Iran during 2001-2010. All patients (for minors, their parents) were contacted by phone. They were asked about the 3-year survival rate following their tumor resection surgery. Data such as patient’s age on admission, gender, histological diagnosis of tumor, and treatment regimen (surgical/non-surgical, radiation, and/or chemotherapy) were collected from medical records. The 3-year survival rate and frequency of each tumor based on age and gender were measured. Results: The 3-year survival rates for Glioblastoma Multiform (GBM) and anaplastic astrocytoma were 8.7% and 0%, respectively following surgery and chemo-radiation. These tumors were categorized as high-grade glioma with poor prognosis. The 3-year survival rate for diffuse astrocytoma, low-grade oligodendroglioma, low-grade ependymoma, and pilocytic astrocytoma following surgery and radiation were 100%, 95.2%, 100%, and 100%, respectively. These tumors were categorized as low-grade glioma, which has a good prognosis. Conclusion: In this study, the 3-year survival rate in patients with low-grade glioma following surgery and radiation was almost 100%. In contrast, the 3-year survival rate in patients with highgrade glioma following surgery and chemo-radiation was almost 0%.

Survival, prognostic factors, and therapeutic efficacy in low-grade glioma: a retrospective study in 379 patients.

1997 ◽  
Vol 15 (9) ◽  
pp. 3129-3140 ◽  
Author(s):  
K Lote ◽  
T Egeland ◽  
B Hager ◽  
B Stenwig ◽  
K Skullerud ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Median Survival ◽  
Tumor Resection ◽  
Low Grade Glioma ◽  
World Health ◽  
Symptom Duration ◽  
Low Grade ◽  
Age Group ◽  
Patient Age ◽  
Patient Âgé

PURPOSE We report survival, prognostic factors, and treatment efficacy in low-grade glioma. PATIENTS AND METHODS A total of 379 patients with histologic intracranial low-grade glioma received post-operative radiotherapy (n = 361) and intraarterial carmustine (BCNU) chemotherapy (n = 153). Overall survival and prognostic factors were evaluated with the SPSS statistical program (SPSS Inc, Chicago, IL). RESULTS Median survival (all patients) was 100 months (95% confidence interval [CI], B7 to 113); in age group 0 to 19 years (n = 41), 226 months; in age group 20 to 49 years (n = 263), 106 months; in age group 50 to 59 years (n = 49), 76 months; and for older patients (n = 26), 39 months. Projected survival at 10 and 15 years was 42% and 29%, respectively. Patient age, World Health Organization (WHO) performance status, tumor computed tomography (CT) contrast enhancement, mental changes, or initial corticosteroid dependency were significant independent prognostic factors (p < .05), while histologic subgroup, focal deficits, presence of seizures, prediagnostic symptom duration, tumor category, and tumor stage were not. Patients aged 20 to 49 years with no independent negative prognostic factors (n = 132) had a median survival time of 139 months versus 41 months in patients with two or more factors (n = 33). Patients who presented with symptoms of expansion (n = 97) survived longer when resected (P < .03); otherwise no survival benefit was associated with initial tumor resection compared with biopsy. Intraarterial chemotherapy and radiation doses more than 55 Gy were not associated with prolonged survival. Among 66 reoperated patients, 45% progressed to high-grade histology within 25 months. CONCLUSION Prognosis in low-grade glioma following postoperative radiotherapy seems largely determined by the inherent biology of the glioma and patient age at diagnosis.

High-Definition Fiber Tractography of the Human Brain

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 430-453 ◽  
Author(s):  
Juan C. Fernandez-Miranda ◽  
Sudhir Pathak ◽  
Johnathan Engh ◽  
Kevin Jarbo ◽  
Timothy Verstynen ◽  
...  
Keyword(s):  
White Matter ◽  
Human Brain ◽  
Structural Connectivity ◽  
Low Grade ◽  
Superior Cerebellar Peduncle ◽  
Fiber Tractography ◽  
Imaging Data ◽  
Thalamic Nuclei ◽  
High Definition ◽  
Diffusion Spectrum Imaging

Abstract BACKGROUND: High-definition fiber tracking (HDFT) is a novel combination of processing, reconstruction, and tractography methods that can track white matter fibers from cortex, through complex fiber crossings, to cortical and subcortical targets with subvoxel resolution. OBJECTIVE: To perform neuroanatomical validation of HDFT and to investigate its neurosurgical applications. METHODS: Six neurologically healthy adults and 36 patients with brain lesions were studied. Diffusion spectrum imaging data were reconstructed with a Generalized Q-Ball Imaging approach. Fiber dissection studies were performed in 20 human brains, and selected dissection results were compared with tractography. RESULTS: HDFT provides accurate replication of known neuroanatomical features such as the gyral and sulcal folding patterns, the characteristic shape of the claustrum, the segmentation of the thalamic nuclei, the decussation of the superior cerebellar peduncle, the multiple fiber crossing at the centrum semiovale, the complex angulation of the optic radiations, the terminal arborization of the arcuate tract, and the cortical segmentation of the dorsal Broca area. From a clinical perspective, we show that HDFT provides accurate structural connectivity studies in patients with intracerebral lesions, allowing qualitative and quantitative white matter damage assessment, aiding in understanding lesional patterns of white matter structural injury, and facilitating innovative neurosurgical applications. High-grade gliomas produce significant disruption of fibers, and low-grade gliomas cause fiber displacement. Cavernomas cause both displacement and disruption of fibers. CONCLUSION: Our HDFT approach provides an accurate reconstruction of white matter fiber tracts with unprecedented detail in both the normal and pathological human brain. Further studies to validate the clinical findings are needed.

JS01.4.A The neurocognitive function changes with awake craniotomy for low-grade glioma in the left hemispheric eloquent regions

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii5-ii5
Author(s):  
Y Wang ◽  
P Ji ◽  
S Guo ◽  
J Liu ◽  
Y Zhai ◽  
...  
Keyword(s):  
Cognitive Performance ◽  
Brain Mapping ◽  
Treatment Strategy ◽  
Cognitive Assessment ◽  
Tumor Resection ◽  
Tumor Location ◽  
Low Grade Glioma ◽  
Awake Craniotomy ◽  
Low Grade ◽  
Eloquent Area

Abstract BACKGROUND Cognitive deficit was frequently observed in glioma patients, especially for those on the eloquent area. Considering the increased life expectancy, brain mapping during awake craniotomy was preferentially applied to exacerbate neurocognitive deficits. The aim of the current study was to evaluate the neurocognitive changes during the perioperative period of resection of low-grade glioma (LGG) in the left side eloquent area with awake craniotomy in a major neurosurgical center in China for 5 years. MATERIAL AND METHODS We retrospectively analyzed patients with left-sided glioma in eloquent areas, who received awake craniotomy during 2016–2020. Montreal Cognitive Assessment Scale, BN-20, and EORTC-QLQ-C30 questionnaire were applied for neurological cognitive assessment. We performed a correlation analysis between changes in cognitive performance and tumor characteristics, including tumor location, pathological grade. Treatment-related factors were also analyzed, such as the extent of resection (EOR), preoperative and postoperative Karnofsky Performance Score (KPS), postoperative treatment strategy (chemo- and radiotherapy), progression-free survival (PFS), overall survival (OS). RESULTS 68 patients were included in our current study. For the language domain, memory domain, and executive functions, 7.4% (5/68) patients presented mild postoperative cognitive performance deterioration compared to preoperative. Tumor location was the only factor that greatly influenced the postoperative cognitive performance, while other features (EOR, KPS, pathological grades) and treatment strategy were found no effect on cognitive change. The extent of tumor resection ranged from 81% to 100%. CONCLUSION Our study underlines the importance of the application of brain mapping during awake craniotomy, which helps to maximize extent of tumor resection while preserving cognitive function in individuals with LGG in eloquent regions.

Episodic nocturnal wandering in a patient with epilepsy due to a right temporoinsular low-grade glioma: relief following resection

2006 ◽  
Vol 104 (3) ◽  
pp. 436-439 ◽  
Author(s):  
Hugues Duffau ◽  
Michèle Kujas ◽  
Luc Taillandier
Keyword(s):  
Frontal Lobe ◽  
Antiepileptic Drugs ◽  
Tumor Resection ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Atypical Form ◽  
Patient Reported ◽  
History Of ◽  
Unusual Type

✓ Although controversial, episodic nocturnal wandering (ENW) is thought to be a rare and atypical form of nocturnal epilepsy, originating in the frontal lobe and responsive to antiepileptic drugs (AEDs). The authors report the case of a patient harboring a right temporoinsular low-grade glioma, who presented with a 3-year history of agitated somnambulent episodes resistant to AEDs. Interestingly, the ENW totally resolved after tumor resection and the patient reported no recurrence during a follow-up period of 4.5 years. To the authors’ knowledge, this is the first report of ENW due to a glioma; the findings support the theory that ENW may represent an unusual type of lesional epilepsy that is surgically correctable. Moreover, a temporoinsular origin of ENW can now be considered.

Surgery for insular low-grade glioma: predictors of postoperative seizure outcome

2014 ◽  
Vol 120 (1) ◽  
pp. 12-23 ◽  
Author(s):  
Tamara Ius ◽  
Giada Pauletto ◽  
Miriam Isola ◽  
Giorgia Gregoraci ◽  
Riccardo Budai ◽  
...  
Keyword(s):  
Seizure Control ◽  
Tumor Resection ◽  
Low Grade Glioma ◽  
Seizure Outcome ◽  
Low Grade ◽  
Class Iii ◽  
The Difference ◽  
Drug Resistant Epilepsy ◽  
Postoperative Seizure ◽  
The Impact

Object Although a number of recent studies on the surgical treatment of insular low-grade glioma (LGG) have demonstrated that aggressive resection leads to increased overall patient survival and decreased malignant progression, less attention has been given to the results with respect to tumor-related epilepsy. The aim of this investigation was to evaluate the impact of volumetric, histological, and intraoperative neurophysiological factors on seizure outcome in patients with insular LGG. Methods The authors evaluated predictors of seizure outcome with special emphasis on both the extent of tumor resection (EOR) and the tumor's infiltrative pattern quantified by computing the difference between the preoperative T2- and T1-weighted MR images (ΔVT2T1) in 52 patients with preoperative drug-resistant epilepsy. Results The 12-month postoperative seizure outcome (Engel class) was as follows: seizure free (Class I), 67.31%; rare seizures (Class II), 7.69%; meaningful seizure improvement (Class III), 15.38%; and no improvement or worsening (Class IV), 9.62%. Poor seizure control was more common in patients with a longer preoperative seizure history (p < 0.002) and higher frequency of seizures (p = 0.008). Better seizure control was achieved in cases with EOR ≥ 90% (p < 0.001) and ΔVT2T1 < 30 cm3 (p < 0.001). In the final model, ΔVT2T1 proved to be the strongest independent predictor of seizure outcome in insular LGG patients (p < 0.0001). Conclusions No or little postoperative seizure improvement occurs mainly in cases with a prevalent infiltrative tumor growth pattern, expressed by high ΔVT2T1 values, which consequently reflects a smaller EOR.

Impact of facility type and volume in low-grade glioma outcomes

2019 ◽  
pp. 1-11 ◽  
Author(s):  
Ping Zhu ◽  
Xianglin L. Du ◽  
Angel I. Blanco ◽  
Leomar Y. Ballester ◽  
Nitin Tandon ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Tumor Resection ◽  
High Volume ◽  
Cox Proportional Hazards ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Prolonged Length ◽  
Cox Proportional Hazards Models ◽  
Facility Type ◽  
The Impact

OBJECTIVEThe object of this study was to investigate the impact of facility type (academic center [AC] vs non-AC) and facility volume (high-volume facility [HVF] vs low-volume facility [LVF]) on low-grade glioma (LGG) outcomes.METHODSThis retrospective cohort study included 5539 LGG patients (2004–2014) from the National Cancer Database. Patients were categorized by facility type and volume (non-AC vs AC, HVF vs LVF). An HVF was defined as the top 1% of facilities according to the number of annual cases. Outcomes included overall survival, treatment receipt, and postoperative outcomes. Kaplan-Meier and Cox proportional-hazards models were applied. The Heller explained relative risk was computed to assess the relative importance of each survival predictor.RESULTSSignificant survival advantages were observed at HVFs (HR 0.67, 95% CI 0.55–0.82, p < 0.001) and ACs (HR 0.84, 95% CI 0.73–0.97, p = 0.015), both prior to and after adjusting for all covariates. Tumor resection was 41% and 26% more likely to be performed at HVFs vs LVFs and ACs vs non-ACs, respectively. Chemotherapy was 40% and 88% more frequently to be utilized at HVFs vs LVFs and ACs vs non-ACs, respectively. Prolonged length of stay (LOS) was decreased by 42% and 24% at HVFs and ACs, respectively. After tumor histology, tumor pattern, and codeletion of 1p19q, facility type and surgical procedure were the most important contributors to survival variance. The main findings remained consistent using propensity score matching and multiple imputation.CONCLUSIONSThis study provides evidence of survival benefits among LGG patients treated at HVFs and ACs. An increased likelihood of undergoing resections, receiving adjuvant therapies, having shorter LOSs, and the multidisciplinary environment typically found at ACs and HVFs are important contributors to the authors’ finding.

Impact of surgical treatment on tremor due to posterior fossa tumors

2008 ◽  
Vol 108 (4) ◽  
pp. 692-697 ◽  
Author(s):  
Thomas M. Kinfe ◽  
Hans-Holger Capelle ◽  
Joachim K. Krauss
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Dentate Nucleus ◽  
Tumor Resection ◽  
Low Grade Glioma ◽  
The Other ◽  
Low Grade ◽  
Posterior Fossa Tumors ◽  
History Of ◽  
The Impact

Object The object of this study was to investigate the impact of surgical treatment on tremor caused by posterior fossa tumors. Methods The authors performed a retrospective evaluation of 6 cases involving patients with tremors due to posterior fossa tumors. Patients who had been treated with neuroleptic medication or had a family history of movement disorders were excluded. All patients had postural or kinetic tremors. Tremor was mainly unilateral. The study group included 5 women and 1 man. Mean age at surgery was 59 years. Five patients underwent total or subtotal tumor resection, and 1 patient underwent stereotactic biopsy only. The histological diagnosis was epidermoid tumor in 2 patients, metastasis in 2 others, and vestibular schwannoma and low-grade glioma in 1 each. Results Two patients had no improvement of tremor, postoperatively. In both of these patients the tumor (low-grade glioma in 1, metastasis in the other) involved the dentate nucleus directly. In the other patients, a compressive effect on the dentate nucleus or the dentatothalamic pathways was present without invasion of the cerebellar structures, and immediate or gradual amelioration of the tremor was observed postoperatively. Conclusions The prognosis of tremor due to posterior fossa tumors appears to depend mainly on the involvement of tremor-generating structures. The prognosis appears to be favorable in those patients with compression of these substrates, whereas primary invasion by tumor has a poor prognosis. Caution must be used in generalizing the findings of this study because of the small number of cases in the series.

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