scholarly journals Cognitive Deficits in Patients with Gliomas in Eloquent Areas Before and After Awake Surgery

2010 ◽  
Vol 6 ◽  
pp. 53-54
Author(s):  
Evy Visch-Brink
Neurosurgery ◽  
2010 ◽  
Vol 66 (3) ◽  
pp. 523-529 ◽  
Author(s):  
Hugues Duffau

Abstract OBJECTIVE During the past decade, numerous reports have supported the contribution of awake mapping in surgical removal of brain lesions in eloquent areas, with a significant increase of the extent of resection while minimizing the risk of permanent deficit—and even improving quality of life. METHODS Most of these awake procedures were performed in patients with lesions in language areas, to avoid postoperative aphasia. Surprisingly, mapping of nonlanguage functions received less attention, despite the possible consequences of deficits other than aphasia on daily life. Visuospatial and cognitive deficits are reported after brain surgery, because of more objective and extensive neuropsychological assessments. RESULTS AND CONCLUSION This review provides new insights into the indications of awake craniotomies for nonlanguage mapping in surgery for lesions in areas not related to language processing.


2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi114-vi114
Author(s):  
Marie-Therese Forster ◽  
Irina Lortz ◽  
Volker Seifert ◽  
Christian Senft

Abstract OBJECTIVE Pursuing a profession is an indispensable component of human happiness. The aim of this study was to analyze patients′ professional, socio-economic and psychological outcomes besides their neuro-oncological and functional evaluation after awake surgery for gliomas in eloquent areas. METHODS The neuro-oncological and functional outcomes of patients with gliomas other than glioblastoma undergoing awake surgery during a period of 5 years were prospectively assessed within our routine oncological follow-up. Repercussions of the disease on their professional status, socio-economic situation, and neurocognitive function were evaluated retrospectively with structured interviews. RESULTS We analyzed data of 37 patients with gliomas (3 WHO Grade I, 6 WHO grade II, 28 WHO grade III). Gross total and subtotal tumor resections were performed in 20 (54.1%) and 11 (29.7%) patients, respectively, whereas in 7 patients (16.2%) resection had to remain partial. Median follow up was 24.1 months (range: 5–61 months). 31 patients (83.8%) had stable disease, 2 (5.4%) patients suffered from tumor progression and 4 (10.8%) patients died. Prior to surgery, all but one patient were employed. At the time of analysis, 24 (72.7%) of 33 alive patients had resumed their profession. 5 patients (15.2%) were on incapacity pension, 2 patients were on sick leave, and 2 had retired. The median time until return to work following surgery was 5.9 ±4.6 months. Young age (< 40 years) was the only factor statistically significantly associated with the ability to return to work (p< 0.001). CONCLUSION Despite brain tumor surgery in eloquent regions, the majority of patients with WHO grade II or III gliomas are able to return to work. Employing awake techniques in order to preserve neurological function is of utmost relevance for individual patients′ quality of life and may also decrease the economic burden due to work loss frequently encountered in glioma patients.


2018 ◽  
Vol 17 (3) ◽  
pp. E124-E129 ◽  
Author(s):  
Jiri Bartek ◽  
Gerald Cooray ◽  
Mominul Islam ◽  
Margret Jensdottir

Abstract BACKGROUND AND IMPORTANCE Stereotactic brain biopsy (SB) is an important part of the neurosurgical armamentarium, with the possibility of achieving histopathological diagnosis in otherwise inaccessible lesions of the brain. Nevertheless, the procedure is not without the risk of morbidity, which is especially true for lesions in eloquent parts of the brain, where even a minor adverse event can result in significant deficits. Navigated transcranial magnetic stimulation (nTMS) is widely used to chart lesions in eloquent areas, successfully guiding maximal safe resection, while its potential role in aiding with the planning of a stereotactic biopsy is so far unexplored. CLINICAL PRESENTATION Magnetic resonance imaging of a 67-yr-old woman presenting with dysphasia revealed a noncontrast enhancing left-sided lesion in the frontal and parietal pars opercularis. Due to the location of the lesion, nTMS was used to chart both primary motor and language cortex, utilizing this information to plan a safe SB trajectory and sampling area according to the initial work-up recommendations from the multidisciplinary neuro-oncology board. The SB was uneventful, with histology revealing a ganglioglioma, WHO I. The patient was discharged the following day, having declined to proceed with tumor resection (awake surgery) due to the non-negligible risk of morbidity. Upon 1- and 3-mo follow-up, she showed no signs of any procedure-related deficits. CONCLUSION nTMS can be implemented to aid with the planning of a stereotactic biopsy procedure in eloquent areas of the brain, and should be considered part of the neurosurgical armamentarium.


Author(s):  
Daniel J. O’Hara ◽  
John Goodden ◽  
Ryan Mathew ◽  
Rebecca Chan ◽  
Paul Chumas

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1074-1084 ◽  
Author(s):  
Alessandro De Benedictis ◽  
Sylvie Moritz-Gasser ◽  
Hugues Duffau

Abstract BACKGROUND Awake craniotomy with intraoperative electrical mapping is a reliable method to minimize the risk of permanent deficit during surgery for low-grade glioma located within eloquent areas classically considered inoperable. However, it could be argued that preservation of functional sites might lead to a lesser degree of tumor removal. To the best of our knowledge, the extent of resection has never been directly compared between traditional and awake procedures. OBJECTIVE We report for the first time a series of patients who underwent 2 consecutive surgeries without and with awake mapping. METHODS Nine patients underwent surgery for a low-grade glioma in functional sites under general anesthesia in other institutions. The resection was subtotal in 3 cases and partial in 6 cases. There was a postoperative worsening in 3 cases. We performed a second surgery in the awake condition with intraoperative electrostimulation. The resection was performed according to functional boundaries at both the cortical and subcortical levels. RESULTS Postoperative magnetic resonance imaging showed that the resection was complete in 5 cases and subtotal in 4 cases (no partial removal) and that it was improved in all cases compared with the first surgery (P = .04). There was no permanent neurological worsening. Three patients improved compared with the presurgical status. All patients returned to normal professional and social lives. CONCLUSION Our results demonstrate that awake surgery, known to preserve the quality of life in patients with low-grade glioma, is also able to significantly improve the extent of resection for lesions located in functional regions.


2021 ◽  
Vol 12 ◽  
Author(s):  
Jin Liu ◽  
Bangshan Liu ◽  
Mi Wang ◽  
Yumeng Ju ◽  
Qiangli Dong ◽  
...  

Background: Cognitive deficits have shown progressive feature in major depressive disorder (MDD). However, it remains unknown which component of cognitive function is progressively impaired across episodes of MDD. Here we aim to identify the progressively impaired cognitive components in patients with MDD.Methods: A comprehensive neurocognitive test battery was used to assess the cognitive components (executive function, attention, processing speed, memory, working memory, inhibition, shifting, and verbal fluency) in 35 patients with first-episode MDD (FED), 60 patients with recurrent MDD (RD) and 111 matched healthy controls (HCs). After 6 months of treatment with antidepressant, 20 FED and 36 RD patients achieved clinical remission and completed their second-time neurocognitive tests. Statistical analyses were conducted to identify the impaired cognitive components in the FED and RD groups before and after treatment, and to assess the relationship between the cognitive components and the number of episodes and total illness duration in the MDD patient group.Results: At baseline, both the FED and RD groups showed impairments in all of the cognitive components; the FED and RD groups showed no significant difference in all of the components except for shifting. After remission, only shifting in the RD group showed no significant improvement and remained in an impaired status. Furthermore, shifting was the only component negatively correlated with the number of episodes as well as the total illness duration.Conclusions: Shifting may serve as the progressive cognitive deficit across episodes of MDD.Clinical Trials Registration: Registry name: HPA function and MRI study of trauma-related depression; Registration number: ChiCTR1800014591; URL: http://www.chictr.org.cn/edit.aspx?pid=24669&amp;htm=4.


2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Ching-Yi Wu ◽  
Shuan-Ju Hung ◽  
Keh-chung Lin ◽  
Kai-Hua Chen ◽  
Poyu Chen ◽  
...  

Objective. Persons with stroke frequently suffer from cognitive impairment. The Montreal Cognitive Assessment (MoCA), a recently developed screening tool, is sensitive to poststroke cognitive deficits. The present study assessed its psychometric and clinimetric properties (i.e., responsiveness, minimal clinically important difference (MCID), and criterion validity) in stroke survivors receiving rehabilitative therapy. Method. The MoCA and the Stroke Impact Scale (SIS) were administered to 65 stroke survivors before and after 4 to 5 weeks of therapy. The effect size and standardized response mean (SRM) were calculated for responsiveness. Anchor- and distribution-based methods were used to estimate the MCID. Criterion validity was measured with the Spearman correlation coefficient. Results. The responsiveness of the MoCA was moderate (SRM=0.67). Participants exceeding the MCID according to the anchor- and distribution-based approaches were 33 (50.77%) and 20 (30.77%), respectively. Fair to good concurrent validity was reported between the MoCA and the SIS communication subscale. The MoCA had satisfactory predictive validity with the SIS communication and memory subscales. Conclusion. This study may support the responsiveness, MCID, and criterion validity of the MoCA in stroke populations. Future studies with larger sample sizes are needed to validate the current findings.


SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A114-A114
Author(s):  
Michelle Stepan ◽  
Kristine Wilckens ◽  
Dave Hostler ◽  
Peter Franzen

Abstract Introduction Insufficient sleep impairs cognitive function which results in costly errors. Firefighter shifts regularly exceed 24-hrs with little to no sleep. Nevertheless, firefighters must maintain and flexibly shift attention in high-pressure scenarios. Firefighters also engage in strenuous physical exertion during fire suppression activities. However, it is unclear whether physical exertion acts as another stressor, exasperating cognitive deficits due to insufficient sleep, or whether physical exertion enhances arousal to reduce cognitive deficits. Moreover, the effects of physical exertion may depend on the type of cognitive process and extent of sleep loss. We examined the effect of physical exertion on vigilant attention and task-switching in firefighters who underwent sleep-deprivation or sleep-disruption. Methods Participants were 17 healthy young adult males who participated in a within-subjects crossover design with three experimental lab visits: sleep-deprivation, sleep-disruption (woken 3 times for 60-min each), and normal sleep. The next day, participants completed a 50-min treadmill exercise task in a heated room in firefighter protective clothing. Participants completed a vigilant attention task (Psychomotor Vigilance Task, PVT) and a task-switching task five to nine times each visit. The five timepoints of interest–before and after the sleep manipulation night, before and after the treadmill exercise task, and recovery (approximately 180-min following exercise)–were examined using linear mixed effects models. Results We analyzed lapses (reaction times [RT]&gt;500ms) on the PVT and switch-trial RT and accuracy on the task-switching task for sleep-deprivation and sleep-disruption conditions relative to normal sleep. Sleep-disruption, p=.001, and sleep-deprivation, p&lt;.001, increased lapses. Sleep-disruption increased switch-trial RT, p=.01, and sleep-deprivation reduced switch-trial accuracy, p=.01. Only switch-trial accuracy improved immediately after the treadmill exercise task and only for the sleep-deprivation condition, p=.01. During recovery, lapses lessened for the sleep-deprivation condition, p=.049, and switch-trial accuracy improved for both sleep-deprivation, p=.01, and sleep-disruption conditions, p=.049. Conclusion Physical exertion reduced task-switching and attentional deficits caused by insufficient sleep, with more benefits observed during recovery. We found no evidence for performance decrements due to physical exertion. Physical exertion may interact with the extent of sleep loss–primarily benefitting performance under conditions of total sleep-deprivation. Support (if any) DSF Charitable Foundation and University of Pittsburgh Clinical and Translational Science Institute UL1TR001857.


2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii461-iii462
Author(s):  
Juri Kiyokawa ◽  
Shinji Yamamoto ◽  
Yasuhiro Murota ◽  
Mariko Ishikawa ◽  
Hiroto Yamaoka ◽  
...  

Abstract BACKGROUND An awake surgery is a useful measure to remove tumors located close to eloquent areas of the brain to reduce surgical complications and maximize the resection. However, it has some disadvantages compared to surgeries under general anesthesia. Generally speaking, applying it to a child under 15 years-old (y/o) is hesitating because of anxiety, poor tolerance, failure to cooperate in tasks and so forth. Here, we present a case of a 13y/o girl who underwent an awake surgery due to dysembryplastic neuroepithelial tumor (DNT) located in the left parietal lobe. CASE PRESENTATION: She consulted our hospital for epileptic seizures. MRI showed a multilocular mass lesion in the left parietal lobe. The tumor was located in or close to eloquent areas. The epilepsy was refractory even with multiple antiepileptic drugs (AEDs). A Wada examination revealed that her speech area is on the left hemisphere. The operations were performed in two stages. Prior to the operations, we had several thought-out simulations in the operating room and ICU with her, her parents, and our staff including nurses and lab technicians. The first operation was to perform tumor biopsy and place intracranial electrodes. The histological diagnosis was DNT. Video electroencephalogram showed that the epileptogenic lesion was around the tumor. The second operation resulted in total tumor resection and reduction of paroxysmal epileptic spikes without major complications. She is seizure free for more than three years with two AEDs. CONCLUSION Careful preparations may enable an awake surgery even for a child under 15y/o.


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