MS-1 Surgical strategy for brain tumor based on molecular and functional connectomics profiles

Abstract It is reported that the development of new perioperative motor deficits was associated with decreased overall survival despite similar extent of resection and adjuvant therapy. The maximum safe resection without any neurological deficits is required to improve overall survival in patients with brain tumor. Surgery is performed with various modalities, such as neuro-monitoring, photodynamic diagnosis, neuro-navigation, awake craniotomy, intraoperative MRI, and so on. Above all, awake craniotomy technique is now the standard procedure to achieve the maximum safe resection in patients with brain tumor. It is well known that before any treatment, gliomas generate globally (and not only focally) altered functional connectomics profiles, with various patterns of neural reorganization allowing different levels of cognitive compensation. Therefore, perioperative cortical mapping and elucidation of functional network, neuroplasticity and reorganization are important for brain tumor surgery. On the other hand, recent studies have proposed several gene signatures as biomarkers for different grades of gliomas from various perspectives. Then, we aimed to identify these biomarkers in pre-operative and/or intra-operative periods, using liquid biopsy, immunostaining and various PCR methods including rapid genotyping assay. In this presentation, we would like to demonstrate our surgical strategy based on molecular and functional connectomics profiles.

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Methodological and Technical Issues for Integrating Functional Magnetic Resonance Imaging Data in a Neuronavigational System

Neurosurgery ◽

10.1097/00006123-200111000-00025 ◽

2001 ◽

Vol 49 (5) ◽

pp. 1145-1157 ◽

Cited By ~ 12

Author(s):

Franck-Emmanuel Roux ◽

Danielle Ibarrola ◽

Michel Tremoulet ◽

Yves Lazorthes ◽

Patrice Henry ◽

...

Keyword(s):

Brain Tumor ◽

Motor Cortex ◽

Brain Mapping ◽

Fmri Data ◽

Electrode Placement ◽

Cortical Mapping ◽

Tumor Surgery ◽

Motor Cortex Stimulation ◽

Functional Magnetic Resonance ◽

Brain Tumor Surgery

ABSTRACT OBJECTIVE The aim of this article was to analyze the technical and methodological issues resulting from the use of functional magnetic resonance image (fMRI) data in a frameless stereotactic device for brain tumor or pain surgery (chronic motor cortex stimulation). METHODS A total of 32 candidates, 26 for brain tumor surgery and six chronic motor cortex stimulation, were studied by fMRI scanning (61 procedures) and intraoperative cortical brain mapping under general anesthesia. The fMRI data obtained were analyzed with the Statistical Parametric Mapping 99 software, with an initial analysis threshold corresponding to P < 0.001. Subsequently, the fMRI data were registered in a frameless stereotactic neuronavigational device and correlated to brain mapping. RESULTS Correspondence between fMRI-activated areas and cortical mapping in primary motor areas was good in 28 patients (87%), although fMRI-activated areas were highly dependent on the choice of paradigms and analysis thresholds. Primary sensory- and secondary motor-activated areas were not correlated to cortical brain mapping. Functional mislocalization as a result of insufficient correction of the echo-planar distortion was identified in four patients (13%). Analysis thresholds (from P < 0.0001 to P < 10−12) more restrictive than the initial threshold (P < 0.001) had to be used in 25 of the 28 patients studied, so that fMRI motor data could be matched to cortical mapping spatial data. These analysis thresholds were not predictable preoperatively. Maximal tumor resection was accomplished in all patients with brain tumors. Chronic motor cortex electrode placement was successful in each patient (significant pain relief >50% on the visual analog pain scale). CONCLUSION In brain tumor surgery, fMRI data are helpful in surgical planning and guiding intraoperative brain mapping. The registration of fMRI data in anatomic slices or in the frameless stereotactic neuronavigational device, however, remained a potential source of functional mislocalization. Electrode placement for chronic motor cortex stimulation is a good indication to use fMRI data registered in a neuronavigational system and could replace somatosensory evoked potentials in detection of the central sulcus.

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Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period

Journal of Neurosurgery ◽

10.3171/2014.10.jns141520 ◽

2015 ◽

Vol 123 (2) ◽

pp. 325-339 ◽

Cited By ~ 141

Author(s):

Shawn L. Hervey-Jumper ◽

Jing Li ◽

Darryl Lau ◽

Annette M. Molinaro ◽

David W. Perry ◽

...

Keyword(s):

Brain Tumor ◽

Systemic Disease ◽

Awake Craniotomy ◽

Vascular Tumors ◽

Low Grade ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Mapping Procedure ◽

The University ◽

Sedation Regimen

OBJECT Awake craniotomy is currently a useful surgical approach to help identify and preserve functional areas during cortical and subcortical tumor resections. Methodologies have evolved over time to maximize patient safety and minimize morbidity using this technique. The goal of this study is to analyze a single surgeon's experience and the evolving methodology of awake language and sensorimotor mapping for glioma surgery. METHODS The authors retrospectively studied patients undergoing awake brain tumor surgery between 1986 and 2014. Operations for the initial 248 patients (1986–1997) were completed at the University of Washington, and the subsequent surgeries in 611 patients (1997–2014) were completed at the University of California, San Francisco. Perioperative risk factors and complications were assessed using the latter 611 cases. RESULTS The median patient age was 42 years (range 13–84 years). Sixty percent of patients had Karnofsky Performance Status (KPS) scores of 90–100, and 40% had KPS scores less than 80. Fifty-five percent of patients underwent surgery for high-grade gliomas, 42% for low-grade gliomas, 1% for metastatic lesions, and 2% for other lesions (cortical dysplasia, encephalitis, necrosis, abscess, and hemangioma). The majority of patients were in American Society of Anesthesiologists (ASA) Class 1 or 2 (mild systemic disease); however, patients with severe systemic disease were not excluded from awake brain tumor surgery and represented 15% of study participants. Laryngeal mask airway was used in 8 patients (1%) and was most commonly used for large vascular tumors with more than 2 cm of mass effect. The most common sedation regimen was propofol plus remifentanil (54%); however, 42% of patients required an adjustment to the initial sedation regimen before skin incision due to patient intolerance. Mannitol was used in 54% of cases. Twelve percent of patients were active smokers at the time of surgery, which did not impact completion of the intraoperative mapping procedure. Stimulation-induced seizures occurred in 3% of patients and were rapidly terminated with ice-cold Ringer's solution. Preoperative seizure history and tumor location were associated with an increased incidence of stimulation-induced seizures. Mapping was aborted in 3 cases (0.5%) due to intraoperative seizures (2 cases) and patient emotional intolerance (1 case). The overall perioperative complication rate was 10%. CONCLUSIONS Based on the current best practice described here and developed from multiple regimens used over a 27-year period, it is concluded that awake brain tumor surgery can be safely performed with extremely low complication and failure rates regardless of ASA classification; body mass index; smoking status; psychiatric or emotional history; seizure frequency and duration; and tumor site, size, and pathology.

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Awake craniotomy may further improve neurological outcome of intraoperative MRI-guided brain tumor surgery

Acta Neurochirurgica ◽

10.1007/s00701-013-1837-3 ◽

2013 ◽

Vol 155 (10) ◽

pp. 1805-1812 ◽

Cited By ~ 26

Author(s):

Juho Tuominen ◽

Sanna Yrjänä ◽

Anssi Ukkonen ◽

John Koivukangas

Keyword(s):

Brain Tumor ◽

Neurological Outcome ◽

Awake Craniotomy ◽

Intraoperative Mri ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Mri Guided

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COT-13 Luminance analysis of 5-aminolevulinic acid using Image J for malignant brain tumor

Neuro-Oncology Advances ◽

10.1093/noajnl/vdab159.117 ◽

2021 ◽

Vol 3 (Supplement_6) ◽

pp. vi30-vi30

Author(s):

Takashi Kon ◽

Yusuke Kobayashi ◽

Yosuke Sato ◽

Katsuyoshi Shimizu ◽

Tohru Mizutani

Keyword(s):

Brain Tumor ◽

Malignant Glioma ◽

Aminolevulinic Acid ◽

Malignant Gliomas ◽

Malignant Brain Tumor ◽

Photodynamic Diagnosis ◽

Tumor Surgery ◽

Maximum Luminance ◽

Brain Tumor Surgery ◽

Average Maximum

Abstract Purpose: For malignant brain tumor surgery, photodynamic diagnosis (PDD) with 5-aminolevulinic acid (5-ALA) is useful for maximal removal of the tumor. Although it has the advantage of identifying the presence or absence of residual tumors during surgery, there are variations in positive rates, and the classification is limited, based on visual inspection such as Stummer’s classification (strong, vague, none). We analyzed the luminance of positive findings using software Image J for brain tumor surgery using 5-ALA, and we report the results. Materials and Methods: From April 2018 to March 2021, 31 patients with suspected malignant glioma before surgery were included. Intraoperative 5-ALA positive findings were analyzed by software Image J (Wayne Rasband: NIH), the luminance was measured with a histogram, and compared the maximum luminance titer. Results: Among the positive cases, the average maximum luminance value for malignant glioma was 101 (50–168), which consisted of 11 cases of Glioblastoma, 1 case of Oligodendroglioma, and 1 case of anaplastic astrocytoma. The average maximum brightness of metastatic brain tumors is lower than that of malignant gliomas, even if they are visually strong, 83.5 (28–121). Conclusions: Even if it is visually strong in the conventional Stummer classification, it may be possible to classify in detail by analyzing luminance with Image J. In addition, more objective index is necessary to classify the vague findings.

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