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

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.

scholarly journals Oncological and functional outcomes of supratotal resection of IDH1 wild-type glioblastoma based on 11C-methionine PET: a retrospective, single-center study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seiichiro Hirono ◽  
Ko Ozaki ◽  
Masayoshi Kobayashi ◽  
Ayaka Hara ◽  
Tomohiro Yamaki ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Awake Craniotomy ◽  
Rank Test ◽  
Wild Type ◽  
Log Rank Test ◽  
Positron Emission ◽  
Single Center Study ◽  
Supratotal Resection ◽  
Subcortical Mapping

AbstractThe oncological and functional outcomes in glioblastoma (GBM) patients following supratotal resection (SupTR), involving complete resection of contrast-enhancing enhanced (CE) tumors and areas of methionine (Met) uptake on 11C-met positron emission tomography (Met-PET), are unknown. We conducted a retrospective review in newly diagnosed, IDH1 wild-type GBM patients, comparing SupTR with gross total resection (GTR), in which only CE tumor tissue was resected. All patients underwent standard radiotherapy and temozolomide treatment, and were followed for tumor recurrence and overall survival (OS). Among the 30 patients included in this study, 7 underwent SupTR and 23 underwent GTR. Awake craniotomy with cortical and subcortical mapping was more frequently performed in the SupTR group than in the GTR group. During the follow-up period, significantly different patterns of disease progression were observed between groups. Although more than 80% of recurrences were local in the GTR group, all recurrences in the SupTR group were distant. Median OS in the GTR and SupTR groups was 18.5 months (95% confidence interval [CI] 14.2–35.1) and not reached (95% CI 30.5-not estimable), respectively; this difference was statistically significant (p = 0.03 by log-rank test). No postoperative neurocognitive decline was evident in patients who underwent SupTR. Compared to GTR alone, aggressive resection of both CE tumors and areas with Met uptake (SupTR) under awake craniotomy with functional mapping results in a survival benefit associated with better local control and neurocognitive preservation.

scholarly journals Awake Craniotomy in a Child: Assessment of Eligibility with a Simulated Theatre Experience

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Jason Labuschagne ◽  
Clover-Ann Lee ◽  
Denis Mutyaba ◽  
Tatenda Mbanje ◽  
Cynthia Sibanda
Keyword(s):  
Young Patients ◽  
Nasal Cannula ◽  
Awake Craniotomy ◽  
Awake Surgery ◽  
Tumour Resection ◽  
Surgical Removal ◽  
Child Assessment ◽  
Mild Degree ◽  
Pressure Cuff ◽  
Subcortical Mapping

Background. Awake craniotomy is a useful surgical approach to identify and preserve eloquent areas during tumour resection, during surgery for arteriovenous malformation resections and for resective epilepsy surgery. With decreasing age, a child’s ability to cooperate and mange an awake craniotomy becomes increasingly relevant. Preoperative screening is essential to identify the child who can undergo the procedure safely. Case Description. A 11-year-old female patient presented with a tumour in her right motor cortex, presumed to be a dysembryoplastic neuroepithelial tumour (DNET). We had concerns regarding the feasibility of performing awake surgery in this patient as psychological testing revealed easy distractibility and an inability to follow commands repetitively. We devised a simulated surgical experience to assess her ability to manage such a procedure. During the simulated theatre experience, attempts were made to replicate the actual theatre experience as closely as possible. The patient was dressed in theatre attire and brought into the theatre on a theatre trolley. She was then transferred onto the theatre bed and positioned in the same manner as she would be for the actual surgery. Her head was placed on a horseshoe headrest, and she was made to lie in a semilateral position, as required for the surgery. A blood pressure cuff, pulse oximeter, nasal cannula with oxygen flow, and calf pumps were applied. She was then draped precisely as she would have been for the procedure. Theatre lighting was set as it would be for the surgical case. The application of the monitoring devices, nasal cannula, and draping was meant not only to prepare her for the procedure but to induce a mild degree of stress such that we could assess the child’s coping skills and ability to undergo the procedure. The child performed well throughout the simulated run, and surgery was thus offered. An asleep-awake-asleep technique was planned and employed for surgical removal of the tumour. Cortical and subcortical mapping was used to identify the eloquent tissue. Throughout the procedure, the child was cooperative and anxiety free. Follow-up MRI revealed gross total removal of the lesion. Conclusion. A simulated theatre experience allowed us to accurately determine that this young patient, despite relative contraindications, was indeed eligible for awake surgery. We will continue to use this technique for all our young patients in assessing their eligibility for these procedures.

Meningioangiomatosis: Multimodal Analysis and Insights From a Systematic Review

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011372
Author(s):  
Alexandre Roux ◽  
Marc Zanello ◽  
Rossella Letizia Mancusi ◽  
Megan EH Still ◽  
Fábio A. Nascimento ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Resection ◽  
Epileptic Seizure ◽  
Seizure Control ◽  
Meta Analysis ◽  
Brain Lesion ◽  
Cochrane Library ◽  
Allelic Loss ◽  
Time Interval ◽  
Short Time Interval

Background:Meningioangiomatosis is a poorly studied, rare, benign, and epileptogenic brain lesion.Objective:To demonstrate that surgical resection and a short time interval to surgery improves epileptic seizure control, we performed a systematic review and meta-analysis of meningioangiomatosis cases.Methods:Using PRISMA-IPD guidelines, the authors performed a systematic review and meta-analysis of histopathologically proven meningioangiomatosis cases. Literature search in the French and English languages (PubMed, Embase, the Cochrane Library and the Science Citation Index) including all studies (January 1981 to June 2020) dealing with histopathologically proven meningioangiomatosis, without age restriction. We assessed clinical, imaging, histomolecular, management, and outcome findings of meningioangiomatosis patients.Results:Two-hundred and seven cases of meningioangiomatosis from 78 studies were included. The majority of meningioangiomatosis was sporadic, preferentially concerned male patients, younger than 20-year-old, and allowed a functionally independent status. Epileptic seizure was the main symptom, with 81.4% of patients having uncontrolled seizures at the time of surgery. Meningioangiomatosis mainly had frontal (32.3%) or temporal (30.7%) locations. Imaging presentation was heterogeneous, and the diagnosis was often missed pre-operatively. The histopathologic pattern was similar whatever the clinical presentation, and immunohistochemistry had limited diagnostic value. On molecular analysis, allelic loss at 22q12 was more frequent in samples of meningioangiomatosis-associated meningioma (37.5%) than in isolated meningioangiomatosis (23.1%). Time interval from diagnosis to surgery (p=0.011) and lack of surgical resection of the meningioangiomatosis (p=0.009) were independent predictors of post-operative seizure control.Conclusions:Due to low scientific evidence, a multicentric prospective study should help refining the management of meningioangiomatosis.

scholarly journals Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice

2010 ◽  
Vol 28 (2) ◽  
pp. E7 ◽  
Author(s):  
Andrea Szelényi ◽  
Lorenzo Bello ◽  
Hugues Duffau ◽  
Enrica Fava ◽  
Guenther C. Feigl ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Cognitive Function ◽  
Low Grade Glioma ◽  
Awake Craniotomy ◽  
Awake Surgery ◽  
Low Grade ◽  
Glioma Surgery ◽  
Neurological Sequelae ◽  
Intraoperative Electrical Stimulation ◽  
Methodological Aspects

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.

scholarly journals Surgical Resection of Gliomas in Motor Cortex: Prognostic Analysis in Awake Craniotomy and General Anesthesia Approaches

2018 ◽  
Author(s):  
Paulo de Aguiar ◽  
Bruno Camporeze ◽  
Chiara Caggiano ◽  
Stephanie Bologna ◽  
Cassiano Marchi ◽  
...  
Keyword(s):  
Motor Cortex ◽  
General Anesthesia ◽  
Surgical Resection ◽  
Awake Craniotomy ◽  
Prognostic Analysis

Vision Deterioration and Hydrocephalus: Rare Presentations of Vestibular Schwannoma and Evolution of Management

2021 ◽  
Author(s):  
Marte van Keulen ◽  
Jonathan Pace ◽  
Christopher J. Burant ◽  
David L. Penn ◽  
Betsy Wilson ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Resection ◽  
Vestibular Schwannoma ◽  
Clinical Evidence ◽  
Tumor Resection ◽  
Case Series ◽  
Rare Presentation ◽  
Visual Symptoms ◽  
Younger Age ◽  
Csf Diversion

Abstract Introduction The incidence of vestibular schwannoma is reported as 12 to 54 new cases per million per year, increasing over time. These patients usually present with unilateral sensorineural hearing loss, tinnitus, or vertigo. Rarely, these patients present with symptoms of hydrocephalus or vision changes. Objective The study aimed to evaluate the surgical management of vestibular schwannoma at a single institution and to identify factors that may contribute to hydrocephalus, papilledema, and the need for pre-resection diversion of cerebrospinal fluid. Patients and Methods A retrospective review examining the data of 203 patients with vestibular schwannoma managed with surgical resection from May 2008 to May 2020. We stratified patients into five different groups to analyze: tumors with a diameter of ≥40 mm, clinical evidence of hydrocephalus, and of papilledema, and patients who underwent pre-resection cerebrospinal fluid (CSF) diversion. Results From May 2008 to May 2020, 203 patients were treated with surgical resection. Patients with tumors ≥40 mm were more likely to present with visual symptoms (p < 0.001). Presentation with hydrocephalus was associated with larger tumor size (p < 0.001) as well as concomitant visual symptoms and papilledema (p < 0.001). Patients with visual symptoms presented at a younger age (p = 0.002) and with larger tumors (p < 0.001). Conclusion This case series highlights the rare presentation of vision changes and hydrocephalus in patients with vestibular schwannoma. We recommend urgent CSF diversion for patients with visual symptoms and hydrocephalus, followed by definitive resection. Further, vision may still deteriorate even after CSF diversion and tumor resection.

Awake Craniotomy in Arteriovenous Malformation Surgery: The Usefulness of Cortical and Subcortical Mapping of Language Function in Selected Patients

2015 ◽  
Vol 84 (5) ◽  
pp. 1394-1401 ◽  
Author(s):  
Alexander J. Gamble ◽  
Sarah G. Schaffer ◽  
Dominic J. Nardi ◽  
David J. Chalif ◽  
Jeffery Katz ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Awake Craniotomy ◽  
Language Function ◽  
Subcortical Mapping

Technical Considerations in Awake Craniotomy with Cortical and Subcortical Motor Mapping in Preadolescents: Pushing the Envelope

2021 ◽  
Vol 56 (2) ◽  
pp. 171-178
Author(s):  
Vishwaraj Ratha ◽  
Nishanth Sampath ◽  
Sudhakar Subramaniam ◽  
V.R. Roopesh Kumar
Keyword(s):  
Perioperative Complications ◽  
Pediatric Population ◽  
Awake Craniotomy ◽  
Neurophysiological Monitoring ◽  
Age Group ◽  
Neurological Assessment ◽  
Case Presentation ◽  
Motor Mapping ◽  
Combined Application ◽  
Subcortical Mapping

<b><i>Introduction:</i></b> Unlike adult gliomas, the utility of combined application of awake anesthesia and intraoperative neurophysiological monitoring (IONM) for maximal safe resection in eloquent region gliomas (ERG) has not been established for pediatric population while it remains unexplored in preadolescents (below 11 years old). <b><i>Case Presentation:</i></b> We report 2 cases of awake craniotomy with IONM in an 8 and 9 year old for safe maximal resection of ERG. In both the cases, repeated preoperative visits of the operating room was performed to familiarize and educate the children about intraoperative communication, comfortable positioning, and neurological assessment. Under conscious sedation protocol, cortical and subcortical mapping, and electrocorticography, gross total resection was achieved. In both the cases, there were no postoperative neurodeficits or perioperative complications. <b><i>Conclusion:</i></b> Our 2 cases illustrate the first instance of successful use of awake IONM for maximal safe resection of ERG in preadolescent age-group. We believe, with proper preoperative planning and careful titration of anesthetics, it is safe and feasible. The blanket notion that preadolescent age-group should be excluded from awake mapping needs to be challenged, rather curated on a case basis.

scholarly journals Oncological and functional outcomes of supratotal resection of IDH1 wild-type glioblastoma based on 11C-methionine PET: a retrospective, single-center study

2021 ◽  
Author(s):  
Seiichiro Hirono ◽  
Ko Ozaki ◽  
Masayoshi Kobayashi ◽  
Ayaka Hara ◽  
Tomohiro Yamaki ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Awake Craniotomy ◽  
Rank Test ◽  
Wild Type ◽  
Log Rank Test ◽  
Positron Emission ◽  
Single Center Study ◽  
Supratotal Resection ◽  
Subcortical Mapping

Abstract Purpose. The oncological and functional outcomes in glioblastoma (GBM) patients following supratotal resection (SupTR), involving complete resection of contrast-enhancing enhanced (CE) tumors and areas of methionine (Met) uptake on 11C-met positron emission tomography (Met-PET), are unknown.Methods. We conducted a retrospective review in newly diagnosed, IDH1 wild-type GBM patients, comparing SupTR with gross total resection (GTR), in which only CE tumor tissue was resected. All patients underwent standard radiotherapy and temozolomide treatment, and were followed for tumor recurrence and overall survival (OS).Results. Among the 30 patients included in this study, 7 underwent SupTR and 23 underwent GTR. Awake craniotomy with cortical and subcortical mapping was more frequently performed in the SupTR group than in the GTR group. During the follow-up period, significantly different patterns of disease progression were observed between groups. Although more than 80% of recurrences were local in the GTR group, all recurrences in the SupTR group were distant. Median OS in the GTR and SupTR groups was 18.5 months (95% confidence interval [CI], 14.2-35.1) and not reached (95% CI, 30.5-not estimable), respectively; this difference was statistically significant (p=0.03 by log-rank test). No postoperative neurocognitive decline was evident in patients who underwent SupTR.Conclusion. Compared to GTR alone, aggressive resection of both CE tumors and areas with Met uptake (SupTR) under awake craniotomy with functional mapping results in a survival benefit associated with better local control and neurocognitive preservation.

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