scholarly journals Neuropsychological Outcomes After Awake Resections of Right Frontal IDH-Mutated Glioma: Insights From a Consecutive Series of 20 Cases.

2021 ◽  
Author(s):  
Marion Barberis ◽  
Isabelle Poisson ◽  
Valentine Facque ◽  
Sophie Letrange ◽  
Cécile Prévost-Tarabon ◽  
...  
Keyword(s):  
Frontal Lobe ◽  
Cognitive Deficits ◽  
Spatial Neglect ◽  
Awake Surgery ◽  
Consecutive Series ◽  
Low Grade ◽  
Worth Living ◽  
Behavioral Impairment ◽  
Dysexecutive Syndrome ◽  
The Right

Abstract Background Awake surgery for low-grade gliomas is currently considered the best procedure to improve the extent of resection and guarantee a "worth living life" for patients, meaning avoiding not only motor but also cognitive deficits. However, tumors located in the right hemisphere, especially in the right frontal lobe, are still rarely operated on in awake condition; one of the reasons possibly being that there is little information in the literature describing the rates and nature of long-lasting neuropsychological deficits following resection of right frontal glioma. Objective To investigate long-term cognitive deficits after awake surgery in right frontal IDH-mutated glioma. Methods We retrospectively analyzed a consecutive series of awake surgical resections between 2012 and 2020 for right frontal IDH-mutated glioma. We studied the patients' subjective complaints and objective neuropsychological evaluations, both before and after surgery. Our results were then put in perspective with the literature. Results Twenty surgical cases (including 5 cases of redo surgery) in eighteen patients (medium age: 42.5 [range 26–58]) were included in the study. The median preoperative volume was 37 cc; WHO grading was II, III and IV in 70%, 20%, and 10% of cases, respectively. Preoperatively, few patients had related subjective cognitive or behavioral impairment, while evaluations revealed mild deficits in 45% of cases, most often concerning executive functions, attention, working memory and speed processing. Immediate postoperative evaluations showed severe dysexecutive syndrome in 75% of cases but also attentional deficits (65%), spatial neglect (60%) and behavioral disturbances (apathy, aprosodia/amimia, emotional sensitivity, anosognosia). Four months after surgery, although psychometric z-scores were unchanged at the group level, individual evaluations showed a slight decrease in performance in 9/20 cases (dysexecutive syndrome, speed processing, attention, semantic cognition, social cognition). Conclusion Our results are generally consistent with those of the literature, confirming that the right frontal lobe is a highly eloquent area and highlighting the importance of operating these patients in awake conditions.

Disrupting the right pars opercularis with electrical stimulation frees the song: case report

2015 ◽  
Vol 123 (6) ◽  
pp. 1401-1404 ◽  
Author(s):  
Guillaume Herbet ◽  
Gilles Lafargue ◽  
Fabien Almairac ◽  
Sylvie Moritz-Gasser ◽  
François Bonnetblanc ◽  
...  
Keyword(s):  
Language Production ◽  
Inferior Frontal Gyrus ◽  
Awake Surgery ◽  
Low Grade ◽  
Speech Impairment ◽  
First Case ◽  
Pars Opercularis ◽  
The Right

The authors report the first case of a strikingly unusual speech impairment evoked by intraoperative electrostimulation in a 36-year-old right-handed patient, a well-trained singer, who underwent awake surgery for a right fronto-temporo-insular low-grade glioma. Functionally disrupting the pars opercularis of the right inferior frontal gyrus led the patient to automatically switch from a speaking to a singing mode of language production. Given the central role of the right pars opercularis in the inhibitory control network, the authors propose that this finding may be interpreted as possible evidence for a competitive and independent neurocognitive subnetwork devoted to the melodically intoned articulation of words (normal language-based vs singing-based) in subjects with high expertise. From a more clinical perspective, such data may have implications for awake neurosurgery, especially to preserve the quality of life for singers.

Involvement of the right inferior longitudinal fascicle in visual hemiagnosia: a brain stimulation mapping study

2013 ◽  
Vol 118 (1) ◽  
pp. 202-205 ◽  
Author(s):  
Alejandro Fernández Coello ◽  
Sophie Duvaux ◽  
Alessandro De Benedictis ◽  
Ryosuke Matsuda ◽  
Hugues Duffau
Keyword(s):  
Brain Stimulation ◽  
Brain Mapping ◽  
Visual Recognition ◽  
Awake Surgery ◽  
Low Grade ◽  
Mapping Study ◽  
Visual Agnosia ◽  
The Right ◽  
Tractography Data

Neural foundations underlying visual agnosia are poorly understood. The authors present the case of a patient who underwent awake surgery for a right basal temporooccipital low-grade glioma in which direct electrostimulation was used both at the cortical and subcortical level. Brain mapping over the inferior longitudinal fascicle generated contralateral visual hemiagnosia. These original findings are in agreement with recent tractography data that have confirmed the existence of an occipitotemporal pathway connecting occipital visual input to higher-level processing in temporal lobe structures. This is the first report of a true transient visual hemiagnosia elicited through electrostimulation, supporting the crucial role of inferior longitudinal fascicle in visual recognition.

scholarly journals Neuropsychological assessments before and after awake surgery for incidental low-grade gliomas

2020 ◽  
pp. 1-10
Author(s):  
Sam Ng ◽  
Guillaume Herbet ◽  
Anne-Laure Lemaitre ◽  
Jérôme Cochereau ◽  
Sylvie Moritz-Gasser ◽  
...  
Keyword(s):  
Cognitive Domain ◽  
Awake Surgery ◽  
Consecutive Series ◽  
Low Grade ◽  
Asymptomatic Patients ◽  
Z Scores ◽  
Neuropsychological Assessments ◽  
Neuropsychological Outcomes ◽  
The Impact

OBJECTIVEEarly surgery in presumed asymptomatic patients with incidental low-grade glioma (ILGG) has been suggested to improve maximal resection rates and overall survival. However, no study has reported on the impact of such preventive treatment on cognitive functioning. The aim of this study was to investigate neuropsychological outcomes in patients with ILGG who underwent preventive surgery.METHODSThis was a retrospective analysis of a consecutive series of patients with ILGG who underwent awake surgery and who had presurgical and 3-month postsurgical neuropsychological assessments. Data were normalized into z-scores and regrouped by cognitive domains. Clinicoradiological data, histomolecular profile, and differences in z-scores (Δz-scores) were analyzed.RESULTSForty-seven patients were included (mean age 39.2 ± 11.3 years). Twenty-eight patients (59.6%) underwent supratotal or total resections. All patients were still alive after a mean follow-up of 33.0 ± 30.8 months. Forty-one patients (87.2%) had stable (n = 34, 72.3%) or improved (Δz-score > 1; n = 7, 14.9%) neurocognitive outcomes after surgery. Six patients (12.8%) presented a slight impairment (Δz-score < −1) in at least one cognitive domain. The mean presurgical and postsurgical z-scores were comparable except in the psychomotor speed and attention domain. A significant correlation between presurgical executive functioning and tumor volume was reported, whereas the extent of resection and histomolecular profile did not impact neuropsychological outcomes.CONCLUSIONSEarly surgical treatment in presumed asymptomatic patients with ILGG was associated with stable or improved neuropsychological outcomes in 87.2% of patients at 3 months, with only mild cognitive decline observed in 6 patients. In return, supratotal or total resections were achieved in most patients, and all patients were still alive at the end of the follow-up.

Unilateral spatial neglect due to a haemorrhagic contusion in the right frontal lobe

1995 ◽  
Vol 242 (10) ◽  
pp. 613-617 ◽  
Author(s):  
Shinichiro Maeshima ◽  
Tomoaki Terada ◽  
Kunio Nakai ◽  
Hiroki Nishibayashi ◽  
Fuminori Ozaki ◽  
...  
Keyword(s):  
Frontal Lobe ◽  
Spatial Neglect ◽  
Unilateral Spatial Neglect ◽  
The Right

scholarly journals Mapping visuospatial and self-motion perception functions in the left parietal lobe

2018 ◽  
Vol 45 (VideoSuppl2) ◽  
pp. V8 ◽  
Author(s):  
Carlos Velásquez ◽  
Elsa Goméz ◽  
Juan Martino
Keyword(s):  
Motion Perception ◽  
Parietal Lobe ◽  
Spatial Neglect ◽  
Low Grade ◽  
Language Mapping ◽  
Subcortical Stimulation ◽  
The Right ◽  
Glioma Resection ◽  
Self Motion ◽  
Stimulation Of

Parietal lobe functions include somesthesia, language, calculation, self-motion perception, and visuospatial awareness. In this video, the authors show the intraoperative mapping of a left parietal lobe for a low-grade glioma resection. Standard sensory and language mapping were performed. Interestingly, by using the “Line Bisection” task, subcortical stimulation of the gyrus angularis was repeatedly associated with ipsilateral spatial neglect, often described in the right parietal lobe. In a similar way, subcortical stimulation in a more posterior point elicited episodes of vertigo, probably due to stimulation of the superior longitudinal fasciculus. Both findings were useful to define the functional limit of the resection.The video can be found here: https://youtu.be/qgGDRW_6u0A.

scholarly journals Impaired Set-Shifting from Dorsal Stream Disconnection: Insights from a European Series of Right Parietal Lower-Grade Glioma Resection

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3337
Author(s):  
Suzanne L. Hartung ◽  
Emmanuel Mandonnet ◽  
Philip de Witt Hamer ◽  
Martin Klein ◽  
Michel Wager ◽  
...  
Keyword(s):  
Stroop Task ◽  
Right Hemisphere ◽  
Parietal Lobe ◽  
Dorsal Stream ◽  
Awake Surgery ◽  
Lateral Part ◽  
Low Grade ◽  
Lower Grade ◽  
Set Shifting ◽  
The Right

Awake surgery with cognitive monitoring has increasingly been implemented to preserve brain networks and functionality. More recently, not only surgery in the left but also in the right hemisphere, i.c., the parietal lobe, was associated with potential risk for deficits in cognitive functions, such as cognitive flexibility. In this explorative pilot study, we compare cognitive performance more than three months after surgery with baseline measurements and explore the association between cognitive decline and subcortical tracts that may have been severed during surgery in the right hemisphere. Twenty-two patients who underwent surgery for a right parietal low-grade glioma were assessed pre- and postoperatively using the Trail Making Test and the Stroop task to administer set-shifting abilities and inhibition. Volume measurements and lesion–symptom mapping analyses were performed on postoperative MRI scans. Careful interpretation of the results shows a change in TMT performance and not on the Stroop Task when the lateral part of the arcuate fasciculus is damaged, indicating that disconnection of the lateral part of the dorsal stream might be correlated specifically with impaired set-shifting and not with inhibition. More importantly, this study underlines the need for international concertation to allow larger studies to increase power and perform more detailed analyses.

scholarly journals Executive functional deficits during electrical stimulation of the right frontal aslant tract

2021 ◽  
Author(s):  
Geert-Jan M. Rutten ◽  
Maud J. F. Landers ◽  
Wouter De Baene ◽  
Tessa Meijerink ◽  
Stephanie van der Hek ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Clinical Practice ◽  
Executive Functions ◽  
Tumor Resection ◽  
Awake Surgery ◽  
Low Grade ◽  
Functional Deficits ◽  
Frontal Aslant Tract ◽  
The Right ◽  
Stimulation Of

AbstractDirect electrical stimulation mapping was used to map executive functions during awake surgery of a patient with a right frontal low-grade glioma. We specifically targeted the frontal aslant tract, as this pathway had been infiltrated by the tumor. The right frontal aslant tract has been implicated in executive functions in the neuroscientific literature, but is yet of unknown relevance for clinical practice. Guided by tractography, electrical stimulation of the frontal aslant tract disrupted working memory and inhibitory functions. In this report we illustrate the dilemmas that neurosurgeons face when balancing maximal tumor resection against optimal cognitive performance. In particular, we emphasize that intraoperative tasks that target cognitive functions should be carefully introduced in clinical practice to prevent clinically irrelevant responses and too early termination of the resection.

scholarly journals Intraoperative cortical mapping of visuospatial functions in parietal low-grade tumors: changing perspectives of neurophysiological mapping

2013 ◽  
Vol 34 (2) ◽  
pp. E4 ◽  
Author(s):  
Andrea Talacchi ◽  
Giovanna Maddalena Squintani ◽  
Barbara Emanuele ◽  
Vincenzo Tramontano ◽  
Barbara Santini ◽  
...  
Keyword(s):  
Parietal Lobe ◽  
Spatial Neglect ◽  
Cortical Mapping ◽  
Neurophysiological Monitoring ◽  
Low Grade ◽  
Language Functions ◽  
First Case ◽  
Visuospatial Functions ◽  
The Right ◽  
Language Areas

Object The aim of this study was to explore the feasibility of intraoperative visuospatial mapping with the same criteria currently used to define essential language areas. Methods The authors compared surgical procedures in 2 patients with similar tumors (Grade II oligodendroglioma in the right parietal lobe) undergoing awake, image-assisted surgery for lesion removal with intraoperative neurophysiological monitoring. The line bisection task was used in both patients but with different criteria. Results In the first case, the authors respected any area, even within the tumor, where significant interference was found (a stimulation-induced error in 2 of 3 applications defined an essential area). In the second case, they removed 1 essential area located in the tumor and recorded an uneventful clinical response soon thereafter. They continued to monitor the patient without stimulation and stopped the resection when the patient was close to the criteria valid for defining spatial neglect. The signs of spatial neglect were present for 3 days postoperatively and then cleared spontaneously. Subtotal tumor removal was achieved in both cases. Conclusions Evidence in the present study reveals that areas for visuospatial functions cannot be assessed with the same criteria used for language functions, since essential areas located in the tumor can be safely removed.

scholarly journals Combining Electrostimulation With Fiber Tracking to Stratify the Inferior Fronto-Occipital Fasciculus

2021 ◽  
Vol 15 ◽  
Author(s):  
Alexandre Roux ◽  
Anne-Laure Lemaitre ◽  
Jeremy Deverdun ◽  
Sam Ng ◽  
Hugues Duffau ◽  
...  
Keyword(s):  
Awake Surgery ◽  
Low Grade ◽  
Network Organization ◽  
Hemispheric Differences ◽  
Interindividual Variations ◽  
Fiber Tracts ◽  
The Right ◽  
Subcortical Mapping ◽  
High Degree

The inferior fronto-occipital fasciculus (IFOF) is one of the longest association fiber tracts of the brain. According to the most recent anatomical studies, it may be formed by several layers, suggesting a role in multiple cognitive functions. However, to date, no attempt has been made to dissociate the functional contribution of the IFOF subpathways. In this study, real-time, cortico-subcortical mapping with direct electrostimulation was performed in 111 patients operated on in wide-awake surgery for a right low-grade glioma. Patients performed two behavioral tasks during stimulation, tapping, respectively, mentalizing and visual semantic cognition—two functions supposed to be partly mediated by the IFOF. Responsive white matter sites were first subjected to a clustering analysis to assess potential topological differences in network organization. Then they were used as seeds to generate streamline tractograms based on the HC1021 diffusion dataset (template-based approach). The tractograms obtained for each function were overlapped and contrasted to determine whether some fiber pathways were more frequently involved in one or the other function. The obtained results not only provided strong evidence for a role of the right IFOF in both functions, but also revealed that the tract is dissociable into two functional strata according to a ventral (semantic) and dorsal (mentalizing) compartmentalization. Besides, they showed a high degree of anatomo-functionnal variability across patients in the functional implication of the IFOF, possibly related to symmetrical/hemispheric differences in network organization. Collectively, these findings support the view that the right IFOF is a functionally multi-layered structure, with nevertheless interindividual variations.

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