scholarly journals Awake Craniotomy for Left Insular Low-Grade Glioma Removal on a Patient with Learning Disabilities

2017 ◽  
Vol 06 (01) ◽  
pp. 041-043 ◽  
Author(s):  
Andrej Vranic ◽  
Blaz Koritnik ◽  
Jasmina Markovic-Bozic
Keyword(s):  
Learning Disabilities ◽  
Case Report ◽  
Brain Tumors ◽  
Awake Craniotomy ◽  
Awake Surgery ◽  
Cortical Mapping ◽  
Low Grade ◽  
Low Grade Gliomas ◽  
Eloquent Areas ◽  
Slow Growing

Introduction Low-grade gliomas (LGG) are slow-growing primary brain tumors in adults, with high tropism for eloquent areas. Standard approach in treatment of LGG is awake craniotomy with intraoperative cortical mapping — a method which is usually used on adult and fully cooperative patients. Case Report We present the case of a patient with learning disabilities (PLD) who was operated for left insular LGG awake craniotomy, and intraoperative cortical mapping were performed and the tumor was gross totally removed. Conclusion Awake surgery for left insular LGG removal is challenging; however, it can be performed safely and successfully on PLD.

scholarly journals When tumefactive demyelination is truly a tumor: case report of a radiographic misdiagnosis

CNS Oncology ◽  
2021 ◽  
pp. CNS69
Author(s):  
Breanna Taylor ◽  
Mallika P Patel ◽  
Katherine B Peters
Keyword(s):  
Multiple Sclerosis ◽  
Case Report ◽  
Brain Tumors ◽  
Disease Progression ◽  
Symptom Management ◽  
Low Grade ◽  
Appropriate Therapy ◽  
Well Differentiated ◽  
Adult Male Patient ◽  
Slow Growing

Oligodendrogliomas are slow-growing tumors that account for 15–20% of gliomas. This case report describes the case of an adult male patient diagnosed initially with tumefactive demyelination and multiple sclerosis, which was subsequently found to be a well-differentiated low-grade oligodendroglioma. This case emphasizes the importance of timely diagnosis in oligodendrogliomas and other brain tumors for the prompt initiation of appropriate therapy, to minimize the likelihood of disease progression, ensure symptom management and escalation of unnecessary treatments for multiple sclerosis.

Surgical benefits of combined awake craniotomy and intraoperative magnetic resonance imaging for gliomas associated with eloquent areas

2017 ◽  
Vol 127 (4) ◽  
pp. 790-797 ◽  
Author(s):  
Kazuya Motomura ◽  
Atsushi Natsume ◽  
Kentaro Iijima ◽  
Shunichiro Kuramitsu ◽  
Masazumi Fujii ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Awake Craniotomy ◽  
The Other ◽  
Intraoperative Mri ◽  
Awake Surgery ◽  
Eloquent Areas ◽  
Mri Studies ◽  
The Brain

OBJECTIVEMaximum extent of resection (EOR) for lower-grade and high-grade gliomas can increase survival rates of patients. However, these infiltrative gliomas are often observed near or within eloquent regions of the brain. Awake surgery is of known benefit for the treatment of gliomas associated with eloquent regions in that brain function can be preserved. On the other hand, intraoperative MRI (iMRI) has been successfully used to maximize the resection of tumors, which can detect small amounts of residual tumors. Therefore, the authors assessed the value of combining awake craniotomy and iMRI for the resection of brain tumors in eloquent areas of the brain.METHODSThe authors retrospectively reviewed the records of 33 consecutive patients with glial tumors in the eloquent brain areas who underwent awake surgery using iMRI. Volumetric analysis of MRI studies was performed. The pre-, intra-, and postoperative tumor volumes were measured in all cases using MRI studies obtained before, during, and after tumor resection.RESULTSIntraoperative MRI was performed to check for the presence of residual tumor during awake surgery in a total of 25 patients. Initial iMRI confirmed no further tumor resection in 9 patients (36%) because all observable tumors had already been removed. In contrast, intraoperative confirmation of residual tumor during awake surgery led to further tumor resection in 16 cases (64%) and eventually an EOR of more than 90% in 8 of 16 cases (50%). Furthermore, EOR benefiting from iMRI by more than 15% was found in 7 of 16 cases (43.8%). Interestingly, the increase in EOR as a result of iMRI for tumors associated mainly with the insular lobe was significantly greater, at 15.1%, than it was for the other tumors, which was 8.0% (p = 0.001).CONCLUSIONSThis study revealed that combining awake surgery with iMRI was associated with a favorable surgical outcome for intrinsic brain tumors associated with eloquent areas. In particular, these benefits were noted for patients with tumors with complex anatomy, such as those associated with the insular lobe.

scholarly journals Usefulness of Awake Craniotomy for Low-grade Gliomas in Eloquent Areas

2017 ◽  
Vol 51 (2) ◽  
pp. 74-78
Author(s):  
Hemant Bhagat ◽  
Dibya J Mahakul ◽  
Ashish Aggarwal ◽  
Amey R Savardekar ◽  
Chirag K Ahuja ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Neurological Function ◽  
Awake Craniotomy ◽  
Low Grade ◽  
Tumor Excision ◽  
Low Grade Gliomas ◽  
Eloquent Areas ◽  
Patient Cooperation ◽  
Novel Method

ABSTRACT The biggest dilemma in a neurosurgeon's mind while operating upon low-grade gliomas in eloquent areas is—how to achieve maximal tumor excision while preserving the neurological function. This aim is difficult to achieve once patient is under general anesthesia and hence, patient cooperation cannot be sought to know the neurological function. A novel method to overcome this hurdle is to excise gliomas (especially in eloquent areas) in awake stage while constantly seeking patient cooperation to know the corresponding neurological function. In this study, we operated 10 patients in awake stage and achieved reasonable tumor excision with no added deficits at 3 months follow-up. Hence, this technique achieves a compromise between oncological principle of maximal tumor excision while simultaneously following the neurosurgical principle of no new added deficits. How to cite this article Mahakul DJ, Aggarwal A, Savardekar AR, Bhagat H, Ahuja CK, Gupta SK. Usefulness of Awake Craniotomy for Low-grade Gliomas in Eloquent Areas. J Postgrad Med Edu Res 2017;51(2):74-78.

scholarly journals Surgical resection of low-grade gliomas in eloquent areas with the guidance of the preoperative functional magnetic resonance imaging and craniometric points

2016 ◽  
Vol 7 (04) ◽  
pp. 571-576 ◽  
Author(s):  
Ahmed Abdullah ◽  
Hisham El Shitany ◽  
Waleed Abbass ◽  
Amr Safwat ◽  
Amr K Elsamman ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Functional Magnetic Resonance Imaging ◽  
Surgical Resection ◽  
Awake Craniotomy ◽  
Low Grade ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Low Grade Gliomas ◽  
Eloquent Areas

ABSTRACT Objectives: Surgical resection of low-grade gliomas (LGGs) in eloquent areas is one of the challenges in neurosurgery, using assistant tools to facilitate effective excision with minimal postoperative neurological deficits has been previously discussed (awake craniotomy and intraoperative cortical stimulation); however, these tools could have their own limitations thus implementation of a simple and effective technique that can guide to safe excision is needed in many situations. Materials and Methods: The authors conducted a retrospective analysis of a prospectively collected data of 76 consecutive surgical cases of LGGs of these 21 cases were situated in eloquent areas. Preoperative functional magnetic resonance imaging (fMRI), pre- and post-operative MRI with volumetric analysis of the tumor size was conducted, and intraoperative determination of the craniometric points related to the tumor (navigation guided in 10 cases) were studied to evaluate the effectiveness of the aforementioned tools in safe excision of the aforementioned tumors. Results: Total-near total excision in 14 (66.67%) subtotal in 6 (28.57%), and biopsy in 1 case (4.57%). In long-term follow–up, only one case experienced persistent dysphasia. Conclusion: In spite of its simplicity, the identification of the safe anatomical landmarks guided by the preoperative fMRI is a useful technique that serves in safe excision of LGGs in eloquent areas. Such technique can replace intraoperative evoked potentials or the awake craniotomy in most of the cases. However, navigation-guided excision might be crucial in deeply seated and large tumors to allow safe and radical excision.

Awake surgery in low-grade gliomas harboring eloquent areas: 3-year mean follow-up

2011 ◽  
Vol 32 (5) ◽  
pp. 801-810 ◽  
Author(s):  
S. Sarubbo ◽  
F. Latini ◽  
A. Panajia ◽  
C. Candela ◽  
R. Quatrale ◽  
...  
Keyword(s):  
Awake Surgery ◽  
Low Grade ◽  
Low Grade Gliomas ◽  
Eloquent Areas

BRMP-01. Awake cranial surgery with intraoperative language mapping for brain tumors. A single-center experience

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi223-vi223
Author(s):  
Andrés Cervio ◽  
Sebastían Giovannini ◽  
Sonia Hasdeu ◽  
Lucía Pertierra ◽  
Blanca Diez
Keyword(s):  
Brain Tumors ◽  
Functional Mri ◽  
Tumor Resection ◽  
Awake Surgery ◽  
Anesthetic Technique ◽  
Low Grade ◽  
Safe Procedure ◽  
Language Mapping ◽  
Cranial Surgery

Abstract BACKGROUND Maximal safe resection of brain tumors affecting language areas has been a matter of increasing interest worldwide in the last decades. Functional MRI, tractography, and awake cranial surgery are standard procedures in our department since 2006. The aim of this study was to describe our experience in a series of 58 patients who underwent awake cranial surgery with intraoperative language mapping. METHODS Retrospective study of 58 adult patients who underwent awake surgery for brain tumors between January 2006 and January 2021. Preoperative neuropsychological assessment served as inclusion criteria. Language was evaluated according to the BDAE (Boston diagnostic aphasia examination) and WAB (Western aphasia battery) and strength according to the MRC (Medical Research Council) motor scale in the preoperative, immediate postoperative, and 3-months follow up. Functional MRI and tractography depicting white-matter tracts, neuronavigation, cortical and subcortical stimulation were performed in all cases. Conscious sedation was the anesthetic technique (propofol, fentanyl, and NSAIDs). Minimum follow-up was 6 months. FINDINGS The average age was 35 years (16–74). The anatomopathological findings were: low-grade glioma in 75,8% (n = 44), high-grade glioma in 15,6% (n = 9) and others in 8,6% (n = 5). No complications were registered during postoperative course. At the immediate postoperative evaluation 65% of patients presented with speech disturbances but at the 3-months follow up speech recovery was observed in all cases. Only 1 patient remained with moderate aphasia. mRS score at 3- months follow up was ≤ 1 in 96% of patients. Two patients had a persistent moderate hemiparesis. CONCLUSION Tumor resection in awake patients showed to be a safe procedure, and well tolerated by the patients. Preoperative planning of anatomical and functional aspects and intraoperative neurophysiological assessment are the cornerstones for pursuing maximal safe resection.

“The Mute Who Can Sing”: a cortical stimulation study on singing

2009 ◽  
Vol 110 (2) ◽  
pp. 282-288 ◽  
Author(s):  
Franck-Emmanuel Roux ◽  
Stefano Borsa ◽  
Jean-François Démonet
Keyword(s):  
Brain Tumors ◽  
Special Interest ◽  
Clear Distinction ◽  
Awake Surgery ◽  
Cortical Mapping ◽  
Cortical Areas ◽  
Left Handed ◽  
Surgical Data ◽  
The Right ◽  
Language Areas

Object In an attempt to identify cortical areas involved in singing in addition to language areas, the authors used a singing task during direct cortical mapping in 5 patients who were amateur singers and had undergone surgery for brain tumors. The organization of the cortical areas involved in language and singing was analyzed in relation with these surgical data. Methods One left-handed and 4 right-handed patients with brain tumors in left (2 cases) and right (3 cases) hemispheres and no significant language or singing deficits underwent surgery with the “awake surgery” technique. All patients had a special interest in singing and were involved in amateur singing activities. They were tested using naming, reading, and singing tasks. Results Outside primary sensorimotor areas, singing interferences were rare and were exclusively localized in small cortical areas (< 1 cm2). A clear distinction was found between speech and singing in the Broca region. In the Broca region, no singing interference was found in areas in which interference in naming and reading tasks were detected. Conversely, a specific singing interference was found in nondominant middle frontal gyri in one patient. This interference consisted of abrupt singing arrest without apparent face, mouth, and tongue contraction. Finally, nonspecific singing interferences were found in the right and left precentral gyri in all patients (probably by interference in final articulatory mechanisms of singing). Conclusions Dissociations between speech and singing found outside primary sensorimotor areas showed that these 2 functions use, in some cortical stages, different cerebral pathways.

scholarly journals O8.01 * PRE-OPERATIVE CHEMOTHERAPY AS A NEW STRATEGY IN TREATING LOW GRADE GLIOMAS IN ELOQUENT AREAS

2014 ◽  
Vol 16 (suppl 2) ◽  
pp. ii17-ii18
Author(s):  
L. Bertero ◽  
R. Ruda ◽  
A. Castellano ◽  
E. Trevisan ◽  
M. Magistrello ◽  
...  
Keyword(s):  
Low Grade ◽  
Low Grade Gliomas ◽  
Eloquent Areas ◽  
New Strategy
Sign in / Sign up

Export Citation Format

Share Document