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

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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Intraoperative electrical stimulation mapping of the subcortical language pathways during surgery of low-grade glioma: an anatomo-functional study

NeuroImage ◽

10.1016/s1053-8119(01)91868-3 ◽

2001 ◽

Vol 13 (6) ◽

pp. 525 ◽

Cited By ~ 1

Author(s):

Hugues Duffau ◽

Laurent Capelle

Keyword(s):

Electrical Stimulation ◽

Low Grade Glioma ◽

Functional Study ◽

Low Grade ◽

Intraoperative Electrical Stimulation ◽

Language Pathways

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Predictors of subjective versus objective cognitive functioning in patients with stable grades II and III glioma

Neuro-Oncology Practice ◽

10.1093/nop/npu035 ◽

2015 ◽

Vol 2 (1) ◽

pp. 20-31 ◽

Cited By ~ 13

Author(s):

Karin Gehring ◽

Martin J.B. Taphoorn ◽

Margriet M. Sitskoorn ◽

Neil K. Aaronson

Keyword(s):

Mental Health ◽

Cognitive Function ◽

Cognitive Functioning ◽

Well Being ◽

Low Grade Glioma ◽

Motor Dysfunction ◽

Low Grade ◽

Physical And Mental Health ◽

Subjective Cognitive Function ◽

Mental Health Factors

Abstract Background Studies in cancer and noncancer populations demonstrate lower than expected correlations between subjective cognitive symptoms and cognitive functioning as determined by standardized neuropsychological tests. This paper systematically examines the association between subjective and objective cognitive functioning in patients with low-grade glioma and the associations of these indicators of cognitive function with clusters of sociodemographic, clinical, and self-reported physical and mental health factors. Methods Multiple regression analyses with the subjective and 2 objective indicators of cognitive functioning as dependent variables and 4 clusters of predictor variables were conducted in 169 patients with predominantly low-grade glioma. Results Correlations between the subjective and the 2 objective cognitive indicators were negligible (0.04) to low (0.24). Objective cognitive deficits were predominantly associated with sociodemographic (older age, lower education, male sex) and clinical (left hemisphere tumor) variables, while lower ratings of subjective cognitive function were more closely related to self-reported mental health symptoms (fatigue, lower mental well-being), physical (motor) dysfunction and female sex. Self-reported communication deficits were associated significantly with both subjective and objective dysfunction. Conclusions We recommend that both subjective and objective measures of cognitive functioning, together with a measure of psychological distress, be used for comprehensive neuropsychological assessments of patients with glioma to determine which areas are most affected and which specific intervention strategies are most appropriate.

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Intraoperative MRI and FLAIR Analysis: Implications for low-grade glioma surgery

Journal of Neuroradiology ◽

10.1016/j.neurad.2019.08.005 ◽

2019 ◽

Author(s):

Myriam Edjlali ◽

Loïc Ploton ◽

Claude-Alain Maurage ◽

Christine Delmaire ◽

Jean-Pierre Pruvo ◽

...

Keyword(s):

Low Grade Glioma ◽

Intraoperative Mri ◽

Low Grade ◽

Glioma Surgery

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Anesthesia management for low-grade glioma awake surgery: a European Low-Grade Glioma Network survey

Acta Neurochirurgica ◽

10.1007/s00701-020-04274-0 ◽

2020 ◽

Vol 162 (7) ◽

pp. 1701-1707 ◽

Cited By ~ 3

Author(s):

Jeremy Arzoine ◽

◽

Charlotte Levé ◽

Antonio Pérez-Hick ◽

John Goodden ◽

...

Keyword(s):

Low Grade Glioma ◽

Awake Surgery ◽

Low Grade ◽

Anesthesia Management

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Changes in language white matter tract microarchitecture associated with cognitive deficits in patients with presumed low-grade glioma

Journal of Neurosurgery ◽

10.3171/2017.12.jns171681 ◽

2019 ◽

Vol 130 (5) ◽

pp. 1538-1546 ◽

Cited By ~ 6

Author(s):

Fatih Incekara ◽

Djaina Satoer ◽

Evy Visch-Brink ◽

Arnaud Vincent ◽

Marion Smits

Keyword(s):

Executive Function ◽

Diffusion Tensor Imaging ◽

White Matter ◽

Diffusion Tensor ◽

Mean Diffusivity ◽

Low Grade Glioma ◽

Cognitive Domain ◽

Awake Surgery ◽

Low Grade ◽

Linear Regression Models

OBJECTIVEThe authors conducted a study to determine whether cognitive functioning of patients with presumed low-grade glioma is associated with white matter (WM) tract changes.METHODSThe authors included 77 patients with presumed low-grade glioma who underwent awake surgery between 2005 and 2013. Diffusion tensor imaging with deterministic tractography was performed preoperatively to identify the arcuate, inferior frontooccipital, and uncinate fasciculi and to obtain the mean fractional anisotropy (FA) and mean diffusivity per tract. All patients were evaluated preoperatively using an extensive neuropsychological protocol that included assessments of the language, memory, and attention/executive function domains. Linear regression models were used to analyze each cognitive domain and each diffusion tensor imaging metric of the 3 WM tracts.RESULTSSignificant correlations (corrected for multiple testing) were found between FA of the arcuate fasciculus and results of the repetition test for the language domain (β = 0.59, p < 0.0001) and between FA of the inferior frontooccipital fasciculus and results of the imprinting test for the memory domain (β = −0.55, p = 0.002) and the attention test for the attention and executive function domain (β = −0.62, p = 0.006).CONCLUSIONSIn patients with glioma, language deficits in repetition of speech, imprinting, and attention deficits are associated with changes in the microarchitecture of the arcuate and inferior frontooccipital fasciculi.

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P10.01 Epilepsy following low grade glioma surgery

Neuro-Oncology ◽

10.1093/neuonc/nox036.319 ◽

2017 ◽

Vol 19 (suppl_3) ◽

pp. iii85-iii85

Author(s):

E. Agushi ◽

R. Mohanraj

Keyword(s):

Low Grade Glioma ◽

Low Grade ◽

Glioma Surgery

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Awake Mapping Optimizes the Extent of Resection for Low-Grade Gliomas in Eloquent Areas

Neurosurgery ◽

10.1227/01.neu.0000369514.74284.78 ◽

2010 ◽

Vol 66 (6) ◽

pp. 1074-1084 ◽

Cited By ~ 149

Author(s):

Alessandro De Benedictis ◽

Sylvie Moritz-Gasser ◽

Hugues Duffau

Keyword(s):

Extent Of Resection ◽

Low Grade Glioma ◽

Awake Surgery ◽

Low Grade ◽

Functional Sites ◽

Social Lives ◽

Eloquent Areas ◽

Functional Regions ◽

First Time

Abstract BACKGROUND Awake craniotomy with intraoperative electrical mapping is a reliable method to minimize the risk of permanent deficit during surgery for low-grade glioma located within eloquent areas classically considered inoperable. However, it could be argued that preservation of functional sites might lead to a lesser degree of tumor removal. To the best of our knowledge, the extent of resection has never been directly compared between traditional and awake procedures. OBJECTIVE We report for the first time a series of patients who underwent 2 consecutive surgeries without and with awake mapping. METHODS Nine patients underwent surgery for a low-grade glioma in functional sites under general anesthesia in other institutions. The resection was subtotal in 3 cases and partial in 6 cases. There was a postoperative worsening in 3 cases. We performed a second surgery in the awake condition with intraoperative electrostimulation. The resection was performed according to functional boundaries at both the cortical and subcortical levels. RESULTS Postoperative magnetic resonance imaging showed that the resection was complete in 5 cases and subtotal in 4 cases (no partial removal) and that it was improved in all cases compared with the first surgery (P = .04). There was no permanent neurological worsening. Three patients improved compared with the presurgical status. All patients returned to normal professional and social lives. CONCLUSION Our results demonstrate that awake surgery, known to preserve the quality of life in patients with low-grade glioma, is also able to significantly improve the extent of resection for lesions located in functional regions.

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