scholarly journals The Merits of Awake Craniotomy for Glioblastoma in the Left Hemispheric Eloquent Area: One Institution Experience

2021 ◽  
Vol 200 ◽  
pp. 106343
Author(s):  
Ying-Ching Li ◽  
Hsiao-Yean Chiu ◽  
Ya-Jui Lin ◽  
Ko-Ting Chen ◽  
Peng-Wei Hsu ◽  
...  
Keyword(s):  
Awake Craniotomy ◽  
Eloquent Area

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.

scholarly journals Contribution of combined intraoperative electrophysiological investigation with 3-T intraoperative MRI for awake cerebral glioma surgery: comprehensive review of the clinical implications and radiological outcomes

2016 ◽  
Vol 40 (3) ◽  
pp. E14 ◽  
Author(s):  
Diana Ghinda ◽  
Nan Zhang ◽  
Junfeng Lu ◽  
Cheng-Jun Yao ◽  
Shiwen Yuan ◽  
...  
Keyword(s):  
Learning Curve ◽  
High Grade Glioma ◽  
Awake Craniotomy ◽  
Low Grade ◽  
High Grade ◽  
Short Term ◽  
Glioma Surgery ◽  
Eloquent Area ◽  
Short And Long Term

OBJECTIVE This study aimed to assess the clinical efficiency of combined awake craniotomy with 3-T intraoperative MRI (iMRI)–guided resection of gliomas adjacent to eloquent cortex performed at a single center. It also sought to explore the contribution of iMRI to surgeons' learning process of maximal safe resection of gliomas. METHODS All patients who underwent an awake craniotomy and iMRI for resection of eloquent area glioma during the 53 months between January 2011 and June 2015 were included. The cases were analyzed for short- and long-term neurological outcome, progression-free survival (PFS), overall survival (OS), and extent of resection (EOR). The learning curve was assessed after dividing the cohort into Group A (first 27 months) and Group B (last 26 months). Statistical analyses included univariate logistic regression analysis on clinical and radiological variables. Kaplan-Meier and Cox regression models were used for further analysis of OS and PFS. A p value < 0.05 was considered statistically significant. RESULTS One hundred six patients were included in the study. Over an average follow-up period of 24.8 months, short- and long-term worsening of the neurological function was noted in 48 (46.2%) and 9 (8.7%) cases, respectively. The median and mean EOR were 100% and 92%, respectively, and complete radiographic resection was achieved in 64 (60.4%) patients. The rate of gross-total resection (GTR) in the patients with low-grade glioma (89.06% ± 19.6%) was significantly lower than that in patients with high-grade glioma (96.4% ± 9.1%) (p = 0.026). Thirty (28.3%) patients underwent further resection after initial iMRI scanning, with a 10.1% increase of the mean EOR. Multivariate Cox proportional hazards modeling demonstrated that the final EOR was a significant predictor of PFS (HR 0.225, 95% CI 0.070–0.723, p = 0.012). For patients with high-grade glioma, the GTR (p = 0.033), the presence of short-term motor deficit (p = 0.027), and the WHO grade (p = 0.005) were independent prognostic factors of OS. Performing further resection after the iMRI (p = 0.083) and achieving GTR (p = 0.05) demonstrated a PFS benefit trend for the patients affected by a low-grade glioma. Over time, the rate of performing further resection after an iMRI decreased by 26.1% (p = 0.005). A nonsignificant decrease in the rate of short-term (p = 0.101) and long-term (p = 0.132) neurological deficits was equally noted. CONCLUSIONS Combined awake craniotomy and iMRI is a safe and efficient technique allowing maximal safe resection of eloquent area gliomas with possible subsequent OS and PFS benefits. Although there is a learning curve for applying this technique, it can also improve the surgeon's ability in eloquent glioma surgery.

scholarly journals High resolution passive speech mapping in dominant hemisphere glioma surgery

2019 ◽  
Vol 21 (3) ◽  
pp. 37-43 ◽  
Author(s):  
M. V. Sinkin ◽  
A. E. Osadchiy ◽  
M. A. Lebedev ◽  
K. V. Volkova ◽  
M. S. Kondratova ◽  
...  
Keyword(s):  
High Resolution ◽  
Gamma Oscillations ◽  
Awake Craniotomy ◽  
Cortical Mapping ◽  
Broca’S Area ◽  
Broca's Area ◽  
Study Objective ◽  
Speech Mapping ◽  
Number Of Patients ◽  
Eloquent Area

Background. Intraoperative brain mapping is one of the most critical stages of neurosurgical intervention in the eloquent area of the cerebral cortex. Traditionally direct cortical electrical stimulation is used for these purposes, but it can lead to seizures and loss of consciousness that makes it impossible to continue the procedure. Moreover, it significantly changes the surgery plan, especially in case of speech mapping during awake craniotomy.The study objective is to create a setup for intraoperative eloquent cortical areas passive mapping, and to compare informativity and safety of passive and active speech mapping.Materials and methods. We have created and tested a mobile device for high-resolution mapping of the Broca’s area that uses the analysis of the desynchronization processes in high-gamma oscillations in 64 micro-contact grid electrode for electrocorticography during awake craniotomy when patient pronounces the objects and actions.Results. We found precise coincidence for localization of the Broca’s area, determined by analyzing of bioelectric signal obtained from the electrocorticography and cortical mapping performed by bipolar direct cortical stimulation using Penfield method.Conclusion. The passive cortical speech mapping expands the potentialities of neurosurgical operations in the eloquent area of the brain and can increase the number of patients for whom this study is achievable. Further studies needed to evolve algorithms and sets of stimuli to expand the list of functional zones that can be mapped passively.

Awake craniotomy and electrophysiological mapping for eloquent area tumours

2013 ◽  
Vol 115 (3) ◽  
pp. 329-334 ◽  
Author(s):  
Ari George Chacko ◽  
Santhosh George Thomas ◽  
K. Srinivasa Babu ◽  
Roy Thomas Daniel ◽  
Geeta Chacko ◽  
...  
Keyword(s):  
Awake Craniotomy ◽  
Eloquent Area

Awake Craniotomy–An Anesthesiologist Point of View

2015 ◽  
Vol 76 (S 02) ◽  
Author(s):  
Inga Batinica ◽  
K. Rotim ◽  
T. Sajko ◽  
M. Schonwald ◽  
S. Salkičević
Keyword(s):  
Point Of View ◽  
Awake Craniotomy

TRANSIENT FACIAL NERVE PALSY AFTER SCALP BLOCK FOR AWAKE CRANIOTOMY: A CASE REPORT

2018 ◽  
Vol 4 (5) ◽  
pp. 369-371
Author(s):  
Rajashree U Gandhe . ◽  
Chinmaya P Bhave . ◽  
Avinash S Kakde . ◽  
Neha T Gedam .
Keyword(s):  
Case Report ◽  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Awake Craniotomy ◽  
Scalp Block

scholarly journals A Novel Language Paradigm for Intraoperative Language Mapping: Feasibility and Evaluation

2021 ◽  
Vol 10 (4) ◽  
pp. 655
Author(s):  
Katharina Rosengarth ◽  
Delin Pai ◽  
Frank Dodoo-Schittko ◽  
Katharina Hense ◽  
Teele Tamm ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Intraoperative Complications ◽  
Evaluation Study ◽  
Awake Craniotomy ◽  
Language Mapping ◽  
Tumor Patients ◽  
Language Functions ◽  
Before And After ◽  
Assessment Time ◽  
Neuropsychological Outcomes

(1) Background—Mapping language using direct cortical stimulation (DCS) during an awake craniotomy is difficult without using more than one language paradigm that particularly follows the demand of DCS by not exceeding the assessment time of 4 s to prevent intraoperative complications. We designed an intraoperative language paradigm by combining classical picture naming and verb generation, which safely engaged highly relevant language functions. (2) Methods—An evaluation study investigated whether a single trial of the language task could be performed in less than 4 s in 30 healthy subjects and whether the suggested language paradigm sufficiently pictured the cortical language network using functional magnetic resonance imaging (fMRI) in 12 healthy subjects. In a feasibility study, 24 brain tumor patients conducted the language task during an awake craniotomy. The patients’ neuropsychological outcomes were monitored before and after surgery. (3) Results—The fMRI results in healthy subjects showed activations in a language-associated network around the (left) sylvian fissure. Single language trials could be performed within 4 s. Intraoperatively, all tumor patients showed DCS-induced language errors while conducting the novel language task. Postoperatively, mild neuropsychological impairments appeared compared to the presurgical assessment. (4) Conclusions—These data support the use of a novel language paradigm that safely monitors highly relevant language functions intraoperatively, which can consequently minimize negative postoperative neuropsychological outcomes.

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