Comparison of diffusion signal models for fiber tractography in eloquent glioma surgery – determination of accuracy under awake craniotomy conditions

There is increasing evidence that the extent of tumor removal in low-grade glioma surgery is related to patient survival time. Thus, the goal of resecting the largest amount of tumor possible without leading to permanent neurological sequelae is a challenge for the neurosurgeon. Electrical stimulation of the brain to detect cortical and axonal areas involved in motor, language, and cognitive function and located within the tumor or along its boundaries has become an essential tool in combination with awake craniotomy. Based on a literature review, discussions within the European Low-Grade Glioma Group, and illustrative clinical experience, the authors of this paper provide an overview for neurosurgeons, neurophysiologists, linguists, and anesthesiologists as well as those new to the field about the stimulation techniques currently being used for mapping sensorimotor, language, and cognitive function in awake surgery for low-grade glioma. The paper is intended to help the understanding of these techniques and facilitate a comparison of results between users.

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Awake Craniotomy in Glioma Surgery

Local Therapies for Glioma Present Status and Future Developments ◽

10.1007/978-3-7091-6090-9_6 ◽

2003 ◽

pp. 31-35 ◽

Cited By ~ 2

Author(s):

J. Jääskeläinen ◽

T. Randell

Keyword(s):

Awake Craniotomy ◽

Glioma Surgery

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Intraoperative Seizure Detection During Active Resection of Glioblastoma Through a Novel Hollow Circular Electrocorticography Array

Operative Neurosurgery ◽

10.1093/ons/opab110 ◽

2021 ◽

Author(s):

Ricardo A Domingo ◽

Tito Vivas-Buitrago ◽

Gaetano De Biase ◽

Erik H Middlebrooks ◽

Perry S Bechtle ◽

...

Keyword(s):

Surgical Resection ◽

Clinical Evidence ◽

Additional Data ◽

Brain Lesion ◽

Awake Craniotomy ◽

Circular Array ◽

Unique Case ◽

Glioma Surgery ◽

Electrographic Seizures ◽

Subcortical Mapping

Abstract BACKGROUND AND IMPORTANCE Data supporting the use of electrocorticography (ECoG) monitoring during electrical stimulation in awake craniotomies for resection of supratentorial neoplasms is robust, but its applicability during active resection is often limited by the inability to keep the array in place. Given the known survival benefit of gross total resection in glioma surgery, novel approaches to surgical monitoring are warranted to maximize safe resection and optimize surgical outcomes in patients with glioblastoma. CLINICAL PRESENTATION A 68-yr-old right-handed woman presented to the emergency department with confusion. Imaging studies revealed a bifrontal intra-axial brain lesion. She underwent a left-sided awake craniotomy procedure with cortical and subcortical mapping. During surgical resection, multiple electrographic seizures were detected on continuous ECoG monitoring with a customized 22-channel high-density hollow circular array. She remained without clinical evidence of seizures at 3 mo after surgery. CONCLUSION We report a unique case of serial electrographic seizures detected during continuous intraoperative ECoG monitoring during active surgical resection of a glioblastoma using a novel circular hollow array during an awake craniotomy. The use of continuous ECoG monitoring during active resection may provide additional data, with potential influence in outcomes for patients undergoing resection of high-grade glial neoplasms.

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P03.06 Boolean logic puzzles as a neurosurgical mapping tool to preserve programming skill

Neuro-Oncology ◽

10.1093/neuonc/noab180.058 ◽

2021 ◽

Vol 23 (Supplement_2) ◽

pp. ii18-ii18

Author(s):

M Donders-Kamphuis ◽

K J Miller ◽

B F W van der Kallen ◽

M L D Broekman

Keyword(s):

Electrical Stimulation ◽

Programming Language ◽

Computer Programming ◽

Extent Of Resection ◽

Brodmann Area ◽

Awake Craniotomy ◽

Boolean Logic ◽

Direct Electrical Stimulation ◽

Glioma Surgery ◽

Mapping Tool

Abstract BACKGROUND In glioma surgery, awake craniotomy with Direct Electrical Stimulation (DES) is increasingly becoming the gold standard treatment to preserve language, cognition and motor function and to optimize extent of resection. Computer programming is historically seen as an integration of cognition, language, and mathematics but an intraoperative task to monitor computer programming does not exist yet. In this study we describe a new task for intraoperative monitoring, using visual Boolean Logic Puzzles. MATERIAL AND METHODS We describe a computer programmer who underwent awake craniotomy to resect an anaplastic astrocytoma in the left superior frontal gyrus. At the request of the patient we tested programming language. We developed a new task and set of logic puzzle visual stimuli to monitor underlying cognitive function used for programming language. This test was used during preoperative functional MRI (fMRI), direct electrical stimulation (DES) and ongoing monitoring during resection. RESULTS In fMRI this task showed bilateral activation in Brodmann area 6 and 8 and for left hemisphere in Brodmann area 10. These areas are below and lateral of the tumor. Monitoring of language, motor skills and Boolean mapping was performed during DES and while resection was performed. No deficits in programming ability could be identified intra- and postoperatively. CONCLUSION Boolean Logic Puzzles may be a useful intraoperative task to preserve programming skills.

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