scholarly journals A neurosurgical challenge: awake mapping in „critical” language area tumours

2019 ◽  
pp. 355-362
Author(s):  
Mihaela Cosman ◽  
Ionut Mihail Pantiru ◽  
Bogdan Florin Iliescu ◽  
Nina Straticiuc ◽  
Iulia Aldea ◽  
...  
Keyword(s):  
Technological Development ◽  
Progression Free Survival ◽  
Epileptic Seizures ◽  
Awake Craniotomy ◽  
Male Dominance ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Tumour Resection ◽  
Presenting Symptoms ◽  
Language Area

Introduction. Despite the technological development lesion located in or near language area still represent a challenge for every neurosurgeon. Awake craniotomy and intraoperative neurophysiological monitoring come to our help. Different techniques variation exists among specialized centres. We present our experience and the set up for this procedure. Materials and methods. We conducted a retrospective analysis of collected data from 10 patients with brain tumours located in or near language area to which we performed awake craniotomy and intraoperative neurophysiological monitoring. They were admitted in Third Department of Neurosurgery,” Prof. Dr. N. Oblu” Emergency Clinical Hospital, Yassi, Romania, between January 2014 and July 2018. Results. Presenting symptoms had a duration more than a month in 60 % of patients. In 80% of them were represented by epileptic seizures and the rest of 20 % had transient aphasia elements. The median age of presentation was 28 years old with a male dominance. The histological reports indicated: fibrillary astrocytoma – 40%, anaplastic astrocytoma – 30%, oligodendroglioma – 20% and metastases – 10%. Gross total resection was performed in half of the cases and subtotal in just one case, in which the spontaneous speech and object naming showed repeated impairment in time of tumour debulking. The surgical intervention was well tolerated by all the patients. The intensity of cortical stimulation used was between 4 – 10 mA. Postoperatively two patients had neurological aggravation, with full recovery at 3 months follow up period, two were stationary and six had symptoms remission. Conclusion. A young age of presentation, a paucity of symptoms, the chance for an increase in overall survival and progression free survival impose the need for direct communication and feedback with the patient in time of tumour resection. Thus, awake craniotomy and intraoperative neurophysiological monitoring is the golden standard for selected cases of language area tumours.

Continuous Intraoperative Neurophysiological Monitoring of the Motor Pathways Using Depth Electrodes During Surgical Resection of an Epileptogenic Lesion: A Novel Technique

2021 ◽  
Author(s):  
Denise F Chen ◽  
Jon T Willie ◽  
David Cabrera ◽  
Katie L Bullinger ◽  
Ioannis Karakis
Keyword(s):  
Motor Cortex ◽  
Surgical Resection ◽  
Radiation Necrosis ◽  
World Health ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Epileptogenic Zone ◽  
Motor Pathways ◽  
Depth Electrodes ◽  
Epileptogenic Lesion

Abstract BACKGROUND AND IMPORTANCE Intraoperative neurophysiological monitoring of the motor pathways during epilepsy surgery is essential to safely achieve maximal resection of the epileptogenic zone. Motor evoked potential (MEP) recording is usually performed intermittently during resection using a handheld stimulator or continuously through an electrode array placed on the motor cortex. We present a novel variation of continuous MEP acquisition through previously implanted depth electrodes in the perirolandic cortex. CLINICAL PRESENTATION A 60-yr-old woman with a history of a left frontal meningioma (World Health Organization [WHO] grade II) treated with surgical resection and radiation presented with residual right hemiparesis and refractory epilepsy. Imaging demonstrated a perirolandic lesion with surrounding edema and mass effect in the prior surgical site, suspicious for radiation necrosis versus tumor recurrence. Presurgical electrocorticography (ECoG) with orthogonal, stereotactically implanted depth electrodes (stereoelectroencephalography [SEEG]) of the perirolandic cortex captured seizure onsets from the supplementary motor area (SMA) and primary motor cortex (PMC). The patient underwent a left frontal craniotomy for repeat resection and tissue diagnosis. Intraoperative ECoG and MEPs were obtained continuously with direct cortical stimulation through the indwelling SEEG electrodes in the PMC. Maximal resection was achieved with preservation of direct cortical MEPs and without deterioration of her baseline hemiparesis. Biopsy revealed radiation necrosis. At 30-mo follow-up, the patient had only rare seizures (Engel class IIB). CONCLUSION Intraoperative cortical MEP acquisition through implanted SEEG electrode arrays is a potentially safe and effective alternative approach to continuously monitor the motor pathways during the resection of a perirolandic epileptogenic lesion, without the need for surgical interruptions.

scholarly journals PATH-18. A MULTI-CENTER CASE SERIES OF ADULT K27M MUTATED DIFFUSE MIDLINE GLIOMAS REVEALING A POPULATION UNIQUE FROM PAEDIATRIC CASES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii167-ii168
Author(s):  
Alexander Yuile ◽  
Madhawa De Silva ◽  
Marina Kastelan ◽  
Veronica Cheung ◽  
Joanne Sy ◽  
...  
Keyword(s):  
Older Patients ◽  
Selection Criteria ◽  
Case Series ◽  
Progression Free Survival ◽  
Paediatric Population ◽  
Asia Pacific ◽  
Royal North Shore Hospital ◽  
Free Survival ◽  
Delay In Diagnosis ◽  
Presenting Symptoms

Abstract BACKGROUND Histone mutations in the K27M gene were first described in 2014, and incorporated into the WHO CNS tumour classification system in 2016. They are typically associated with diffuse midline gliomas (DMG). Presenting symptoms vary greatly, with some experiencing significant delay in diagnosis. Median survival is only 9-12 months for these patients. Biopsy samples are small, and in some due to location, not performed. Although data is predominately based on the paediatric population, DMGs are seen in both adolescence and adults. In this multi-site retrospective study, we describe 11 adult patients with K27M DMG gliomas across two tertiary Neuro-Oncology services in Sydney, Australia. To the authors’ knowledge we present the largest known collection of adult K27M cases in the Asia-Pacific region with correlation of treatment, clinicopathologic and radiologic features with outcomes. METHODS The glioma databases of Royal North Shore Hospital (RNSH) and Royal Prince Alfred Hospital (RPAH) between January 2009 and March 2020 were interrogated to identify patients. Selection criteria included patients aged ≥ 18 years who presented with a DMG, had undergone biopsy, and had confirmed K27M via next generation sequencing. Clinicopathologic, radiologic and treatment outcomes were extracted for correlation. RESULTS Eleven patients fitting the selection criteria were identified and reported. The median age at diagnosis was 30 years and 4 were female. Five presented with hydrocephalus, the most common presenting symptoms were headaches and nausea and/or vomiting (n= 4 and n= 2 respectively). The median progression-free survival was 13 months (4-31 months) and the median overall survival was 23 months (4-59 months). CONCLUSION This case series reports the outcomes of older patients with K27M. The clinical course demonstrated suggests a divergence from paediatric biology. Ongoing studies are required to further characterise the histopathological and clinical differences of these tumours in older patients.

Predictors of tumor progression among children with gangliogliomas

2009 ◽  
Vol 3 (6) ◽  
pp. 461-466 ◽  
Author(s):  
Mostafa El Khashab ◽  
Lynn Gargan ◽  
Linda Margraf ◽  
Korgun Koral ◽  
Farideh Nejat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tumor Progression ◽  
Cox Regression ◽  
Tumor Resection ◽  
Progression Free Survival ◽  
Initial Presentation ◽  
Subtotal Resection ◽  
Low Grade ◽  
Cox Regression Analysis ◽  
Presenting Symptoms

Object Few reports describe the outcome and prognostic factors for children with gangliogliomas. The objective of this report was to describe the progression-free survival (PFS) for children with low-grade gangliogliomas and identify risk factors for tumor progression. Methods A retrospective study was performed in children with low-grade gangliogliomas who were evaluated and treated in the neuro-oncology department between 1986 and 2006 to determine risk factors for subsequent tumor progression. Results A total of 38 children with newly diagnosed gangliogliomas were included in this report. Thirty-four children were treated with surgery alone, 3 with subtotal resection and radiation therapy, and 1 with subtotal resection and chemotherapy. The follow-up ranged from 4 months to 15.8 years (mean 5.7 ± 4.2 years [± SD]). Seven children have experienced tumor progression, and 1 child died after his tumor subsequently underwent malignant transformation. The 5-year PFS was calculated to be 81.2% using Kaplan-Meier survival analysis. Initial presentation with seizures (p = 0.004), tumor location in the cerebral hemisphere (p = 0.020), and complete tumor resection (p = 0.035) were associated with prolonged PFS. Further analysis of the above significant variables by a Cox regression model identified initial presentation with seizures as being associated with prolonged PFS (p = 0.028). Conclusions The PFS and overall survival of children with gangliogliomas are good. Tumors located in the cerebral hemispheres, the achievement of total resection, and seizures at presentation were associated with prolonged PFS. Cox regression analysis identified presenting symptoms including seizures as significant predictive factors of PFS. Prospective studies with larger numbers of children are needed to define the significant factors of tumor progression.

scholarly journals Clinicopathological review of epithelial ovarian tumors in young females and reproductive and survival outcome: Ten years expierence from a tertiary center

2016 ◽  
Author(s):  
Kusum Lata ◽  
Nutan Agarwal ◽  
Neerja Bhatla ◽  
Alka Kriplani
Keyword(s):  
Age Groups ◽  
Young Patients ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Survival Outcome ◽  
Ovarian Tumors ◽  
Tertiary Referral Hospital ◽  
Young Females ◽  
Presenting Symptoms ◽  
Tertiary Center

Objective: To find out the prevalence of epithelial ovarian tumors in young females and correlation with reproductive and survival outcome. Design: Retrospective study. Setting: Tertiary referral hospital. Methods: A retrospective analysis of females from 9-35 year of age group treated for ovarian tumors between January 2003 to July 2013 was performed. Variables studied included age, presenting symptoms, imaging, tumor markers, surgical findings, type of surgery, histopathology reports and follow-up. Main Outcome Measures: Histopathological variant, FIGO stage, reproductive and survival outcome. Results: A total of 155 patients were found to have ovarian tumors. Mean age at time of diagnosis was 24.9 ± 1.8 years (range 9-35). Clinical presentation in majority of the cases was abdominal pain in 68 (43.8%), ascites in 13 (8.3%) mass in abdomen in 25 (16%), followed by irregular menstrual cycles in 15 (9.6%), infertility in 18 (11.6%) 12 (7.7%) were found to be incidental on ultrasound examination while 4 women were found to have virilising symptoms. There were 76 (49.1%) cases of epithelial ovarian tumors, 6 (0.03%) of borderline tumors and 30 (19.3%) were of malignant ovarian tumors while 40 (25.8%) were benign. Stage IA (N = 80), Stage I 8 (n = 2), Stage III (N = 6) and Stage IV (N = 12). Females were further subdivided into three age groups 9-15 years, 15-25 years and 25 to 35 years for determining outcome of epitheliail tumors. Reproductive and survival outcome were studied in each stage. Conclusions: Limited data exists about the histological type distribution, surgical treatment and overall survival of epithelial ovarian tumors in women aged below 35 years. Young patients have higher overall progression-free survival and a better clinical outcome than older patients. Any women presenting with pain and nonspecific symptoms should be investigated and evaluated properly.

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