Right parietal cortex and calculation processing: intraoperative functional mapping of multiplication and addition in patients affected by a brain tumor

2013 ◽  
Vol 119 (5) ◽  
pp. 1107-1111 ◽  
Author(s):  
Alessandro Della Puppa ◽  
Serena De Pellegrin ◽  
Elena d'Avella ◽  
Giorgio Gioffrè ◽  
Marina Munari ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Parietal Cortex ◽  
Parietal Lobe ◽  
Tumor Resection ◽  
Functional Mapping ◽  
Awake Surgery ◽  
Intraparietal Sulcus ◽  
Functional Sites ◽  
Parietal Area ◽  
The Right

Object The role of parietal areas in number processing is well known. The significance of intraoperative functional mapping of these areas has been only partially explored, however, and only a few discordant data are available in the surgical literature with regard to the right parietal lobe. The purpose of this study was to evaluate the clinical impact of simple calculation in cortical electrostimulation of right-handed patients affected by a right parietal brain tumor. Methods Calculation mapping in awake surgery was performed in 3 right-handed patients affected by high-grade gliomas located in the right parietal lobe. Preoperatively, none of the patients presented with calculation deficits. In all 3 cases, after sensorimotor and language mapping, cortical and intraparietal sulcus areas involved in single-digit multiplication and addition calculations were mapped using bipolar electrostimulation. Results In all patients, different sites of the right parietal cortex, mainly in the inferior lobule, were detected as being specifically related to calculation (multiplication or addition). In 2 patients the intraparietal sulcus was functionally specific for multiplication. No functional sites for language were detected. All sites functional for calculation were spared during tumor resection, which was complete in all cases without postoperative neurological deficits. Conclusions These findings provide intraoperative data in support of an anatomofunctional organization for multiplication and addition within the right parietal area. Furthermore, the study shows the potential clinical relevance of intraoperative mapping of calculation in patients undergoing surgery in the right parietal area. Further and larger studies are needed to confirm these data and assess whether mapped areas are effectively essential for function.

scholarly journals Subcortical mapping of calculation processing in the right parietal lobe

2015 ◽  
Vol 122 (5) ◽  
pp. 1038-1041 ◽  
Author(s):  
Alessandro Della Puppa ◽  
Serena De Pellegrin ◽  
Anna Lazzarini ◽  
Giorgio Gioffrè ◽  
Oriela Rustemi ◽  
...  
Keyword(s):  
Parietal Lobe ◽  
Current Knowledge ◽  
Tumor Resection ◽  
Preoperative Assessment ◽  
Cortical Mapping ◽  
Functional Sites ◽  
Postoperative Mri ◽  
The Right ◽  
Subcortical Mapping ◽  
Calculation Processing

Preservation of calculation processing in brain surgery is crucial for patients' quality of life. Over the last decade, surgical electrostimulation was used to identify and preserve the cortical areas involved in such processing. Conversely, subcortical connectivity among different areas implicated in this function remains unclear, and the role of surgery in this domain has not been explored so far. The authors present the first 2 cases in which the subcortical functional sites involved in calculation were identified during right parietal lobe surgery. Two patients affected by a glioma located in the right parietal lobe underwent surgery with the aid of MRI neuronavigation. No calculation deficits were detected during preoperative assessment. Cortical and subcortical mapping were performed using a bipolar stimulator. The current intensity was determined by progressively increasing the amplitude by 0.5-mA increments (from a baseline of 1 mA) until a sensorimotor response was elicited. Then, addition and multiplication calculation tasks were administered. Corticectomy was performed according to both the MRI neuronavigation data and the functional findings obtained through cortical mapping. Direct subcortical electrostimulation was repeatedly performed during tumor resection. Subcortical functional sites for multiplication and addition were detected in both patients. Electrostimulation interfered with calculation processing during cortical mapping as well. Functional sites were spared during tumor removal. The postoperative course was uneventful, and calculation processing was preserved. Postoperative MRI showed complete resection of the tumor. The present preliminary study shows for the first time how functional mapping can be a promising method to intraoperatively identify the subcortical functional sites involved in calculation processing. This report therefore supports direct electrical stimulation as a promising tool to improve the current knowledge on calculation processing connectivity.

scholarly journals Intelligence Deficits in Chinese Patients with Brain Tumor: The Impact of Tumor Resection

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Chao Shen ◽  
Rong Xie ◽  
Xiaoyun Cao ◽  
Weimin Bao ◽  
Bojie Yang ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Pituitary Adenoma ◽  
Tumor Resection ◽  
Chinese Patients ◽  
Adult Intelligence Scale ◽  
Wechsler Adult Intelligence Scale ◽  
Significant Difference ◽  
And Performance ◽  
The Right ◽  
The Impact

Background. Intelligence is much important for brain tumor patients after their operation, while the reports about surgical related intelligence deficits are not frequent. It is not only theoretically important but also meaningful for clinical practice.Methods. Wechsler Adult Intelligence Scale was employed to evaluate the intelligence of 103 patients with intracranial tumor and to compare the intelligence quotient (IQ), verbal IQ (VIQ), and performance IQ (PIQ) between the intracerebral and extracerebral subgroups.Results. Although preoperative intelligence deficits appeared in all subgroups, IQ, VIQ, and PIQ were not found to have any significant difference between the intracerebral and extracerebral subgroups, but with VIQ lower than PIQ in all the subgroups. An immediate postoperative follow-up demonstrated a decline of IQ and PIQ in the extracerebral subgroup, but an improvement of VIQ in the right intracerebral subgroup. Pituitary adenoma resection exerted no effect on intelligence. In addition, age, years of education, and tumor size were found to play important roles.Conclusions. Brain tumors will impair IQ, VIQ, and PIQ. The extracerebral tumor resection can deteriorate IQ and PIQ. However, right intracerebral tumor resection is beneficial to VIQ, and transsphenoidal pituitary adenoma resection performs no effect on intelligence.

scholarly journals Intraoperative Motor Symptoms during Brain Tumor Resection in the Supplementary Motor Area (SMA) without Positive Mapping during Awake Surgery

2015 ◽  
Vol 55 (5) ◽  
pp. 442-450 ◽  
Author(s):  
Riho NAKAJIMA ◽  
Mitsutoshi NAKADA ◽  
Katsuyoshi MIYASHITA ◽  
Masashi KINOSHITA ◽  
Hirokazu OKITA ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Supplementary Motor Area ◽  
Tumor Resection ◽  
Motor Area ◽  
Awake Surgery ◽  
Motor Symptoms ◽  
Positive Mapping ◽  
Brain Tumor Resection

scholarly journals Preoperative functional MRI use in neurooncology patients: a clinician survey

2020 ◽  
Vol 48 (2) ◽  
pp. E11 ◽  
Author(s):  
Brittany M. Stopa ◽  
Joeky T. Senders ◽  
Marike L. D. Broekman ◽  
Mark Vangel ◽  
Alexandra J. Golby
Keyword(s):  
Brain Tumor ◽  
Functional Mri ◽  
Preoperative Planning ◽  
Adult Population ◽  
Tumor Resection ◽  
Final Analysis ◽  
High Grade Glioma ◽  
Awake Surgery ◽  
Planning Tool ◽  
Intraoperative Mapping

OBJECTIVEFunctional MRI (fMRI) is increasingly being investigated for use in neurosurgical patient care. In the current study, the authors characterize the clinical use of fMRI by surveying neurosurgeons’ use of and attitudes toward fMRI as a surgical planning tool in neurooncology patients.METHODSA survey was developed to inquire about clinicians’ use of and experiences with preoperative fMRI in the neurooncology patient population, including example case images. The survey was distributed to all neurosurgical departments with a residency program in the US.RESULTSAfter excluding incomplete surveys and responders that do not use fMRI (n = 11), 50 complete responses were included in the final analysis. Responders were predominantly from academic programs (88%), with 20 years or more in practice (40%), with a main area of practice in neurooncology (48%) and treating an adult population (90%). All 50 responders currently use fMRI in neurooncology patients, mostly for low- (94%) and high-grade glioma (82%). The leading decision factors for ordering fMRI were location of mass in dominant hemisphere, location in a functional area, motor symptoms, and aphasia. Across 10 cases, language fMRI yielded the highest interrater reliability agreement (Fleiss’ kappa 0.437). The most common reasons for ordering fMRI were to identify language laterality, plan extent of resection, and discuss neurological risks with patients. Clinicians reported that fMRI results were not obtained when ordered a median 10% of the time and were suboptimal a median 27% of the time. Of responders, 70% reported that they had ever resected an fMRI-positive functional site, of whom 77% did so because the site was “cleared” by cortical stimulation. Responders reported disagreement between fMRI and awake surgery 30% of the time. Overall, 98% of responders reported that if results of fMRI and intraoperative mapping disagreed, they would rely on intraoperative mapping.CONCLUSIONSAlthough fMRI is increasingly being adopted as a practical preoperative planning tool for brain tumor resection, there remains a substantial degree of discrepancy with regard to its current use and presumed utility. There is a need for further research to evaluate the use of preoperative fMRI in neurooncology patients. As fMRI continues to gain prominence, it will be important for clinicians to collectively share best practices and develop guidelines for the use of fMRI in the preoperative planning phase of brain tumor patients.

Radiosurgery-induced brain tumor

2001 ◽  
Vol 95 (4) ◽  
pp. 710-713 ◽  
Author(s):  
Takanobu Kaido ◽  
Tohru Hoshida ◽  
Ryunosuke Uranishi ◽  
Nobuhisa Akita ◽  
Akihira Kotani ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Gamma Knife ◽  
Parietal Lobe ◽  
Radiation Necrosis ◽  
Gamma Knife Radiosurgery ◽  
Clonic Seizure ◽  
Content Type ◽  
One Year ◽  
The Right ◽  
Fine Print

✓ The authors describe a case of glioblastoma multiforme (GBM) associated with previous gamma knife radiosurgery for a cerebral arteriovenous malformation (AVM). A 14-year-old boy had undergone radiosurgery for an AVM, which was performed using a 201-source 60Co gamma knife system at another institution. The maximum and margin radiation doses used in the procedure were 40 and 20 Gy, respectively. One year after radiosurgery, the patient noticed onset of mild left hemiparesis due to radiation necrosis. Six and one-half years after radiosurgery, at the age of 20 years, the patient experienced an attack of generalized tonic—clonic seizure. Magnetic resonance (MR) imaging revealed the existence of a brain tumor in the right parietal lobe. The patient underwent an operation and the histological diagnosis of the lesion was GBM. Ten months following the operation, that is, 99 months postradiosurgery, this patient died. To the best of the authors' knowledge, this is the first reported case of a neoplasm induced by radiosurgery for an AVM and the second case in which it occurred following radiosurgery for intracranial disease.

scholarly journals SURG-05. AN AWAKE SURGERY FOR A CHILD SUFFERING FROM EPILEPSY DUE TO DYSEMBRYPLASTIC NEUROEPITHELIAL TUMOR LOCATED IN THE LEFT PARIETAL LOBE

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii461-iii462
Author(s):  
Juri Kiyokawa ◽  
Shinji Yamamoto ◽  
Yasuhiro Murota ◽  
Mariko Ishikawa ◽  
Hiroto Yamaoka ◽  
...  
Keyword(s):  
Parietal Lobe ◽  
Tumor Resection ◽  
Epileptic Seizures ◽  
Awake Surgery ◽  
Tumor Biopsy ◽  
Eloquent Areas ◽  
Poor Tolerance ◽  
Epileptic Spikes ◽  
Two Stages ◽  
Intracranial Electrodes

Abstract BACKGROUND An awake surgery is a useful measure to remove tumors located close to eloquent areas of the brain to reduce surgical complications and maximize the resection. However, it has some disadvantages compared to surgeries under general anesthesia. Generally speaking, applying it to a child under 15 years-old (y/o) is hesitating because of anxiety, poor tolerance, failure to cooperate in tasks and so forth. Here, we present a case of a 13y/o girl who underwent an awake surgery due to dysembryplastic neuroepithelial tumor (DNT) located in the left parietal lobe. CASE PRESENTATION: She consulted our hospital for epileptic seizures. MRI showed a multilocular mass lesion in the left parietal lobe. The tumor was located in or close to eloquent areas. The epilepsy was refractory even with multiple antiepileptic drugs (AEDs). A Wada examination revealed that her speech area is on the left hemisphere. The operations were performed in two stages. Prior to the operations, we had several thought-out simulations in the operating room and ICU with her, her parents, and our staff including nurses and lab technicians. The first operation was to perform tumor biopsy and place intracranial electrodes. The histological diagnosis was DNT. Video electroencephalogram showed that the epileptogenic lesion was around the tumor. The second operation resulted in total tumor resection and reduction of paroxysmal epileptic spikes without major complications. She is seizure free for more than three years with two AEDs. CONCLUSION Careful preparations may enable an awake surgery even for a child under 15y/o.

The Attentional Role of the Left Parietal Cortex: The Distinct Lateralization and Localization of Motor Attention in the Human Brain

2001 ◽  
Vol 13 (5) ◽  
pp. 698-710 ◽  
Author(s):  
Matthew F. S. Rushworth ◽  
Michael Krams ◽  
Richard E. Passingham
Keyword(s):  
Left Hemisphere ◽  
Parietal Cortex ◽  
Parietal Lobe ◽  
Supramarginal Gyrus ◽  
Related Activity ◽  
Verbal Responses ◽  
Left Hand ◽  
Verbal Rehearsal ◽  
The Right

It is widely agreed that visuospatial orienting attention depends on a network of frontal and parietal areas in the right hemisphere. It is thought that the visuospatial orienting role of the right parietal lobe is related to its role in the production of overt eye movements. The experiments reported here test the possibility that other parietal regions may be important for directing attention in relation to response modalities other than eye movement. Specifically, we used positron emission tomography (PET) to test the hypothesis that a ‘left’ parietal area, the supramarginal gyrus, is important for attention in relation to limb movements (Rushworth et al., 1997; Rushworth, Ellison, & Walsh, in press). We have referred to this process as ‘motor attention’ to distinguish it from orienting attention. In one condition subjects spent most of the scanning period covertly attending to ‘left’ hand movements that they were about to make. Activity in this first condition was compared with a second condition with identical stimuli and movement responses but lacking motor attention periods. Comparison of the conditions revealed that motor attention related activity was almost exclusively restricted to the ‘left’ hemisphere despite the fact that subjects only ever made ipsilateral, left-hand responses. Left parietal activity was prominent in this comparison, within the parietal lobe the critical region for motor attention was the supramarginal gyrus and the adjacent anterior intraparietal sulcus (AIP), a region anterior to the posterior parietal cortex identified with orienting attention. In a second part of the experiment we compared a condition in which subjects covertly rehearsed verbal responses with a condition in which they made verbal responses immediately without rehearsal. A comparison of the two conditions revealed verbal rehearsal-related activity in several anterior left hemisphere areas including Broca's area. The lack of verbal rehearsal-related activity in the left supra-marginal gyrus confirms that this area plays a direct role in motor attention that cannot be attributed to any strategy of verbal mediation. The results also provide evidence concerning the importance of ventral premotor (PMv) and Broca's area in motor attention and language processes.

scholarly journals Combined Functional Mapping using Electrocorticograms and Electrocortical Stimulation for Brain Tumor Resection

2013 ◽  
Vol 22 (10) ◽  
pp. 786-790
Author(s):  
Hiroshi Ogawa ◽  
Naoto Kunii ◽  
Satoru Hiroshima ◽  
Masao Sato ◽  
Ryogo Anei ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Tumor Resection ◽  
Functional Mapping ◽  
Brain Tumor Resection

scholarly journals Impact of Anticipated Awake Surgery on Psychooncological Distress in Brain Tumor Patients

2022 ◽  
Vol 11 ◽  
Author(s):  
Franziska Staub-Bartelt ◽  
Oliver Radtke ◽  
Daniel Hänggi ◽  
Michael Sabel ◽  
Marion Rapp
Keyword(s):  
Brain Tumor ◽  
Significant Influence ◽  
Tumor Resection ◽  
Statistical Analyses ◽  
Distress Thermometer ◽  
Awake Surgery ◽  
Anxiety And Depression ◽  
Cerebral Lesions ◽  
Tumor Patients ◽  
Significant Difference

BackgroundBrain tumor patients present high rates of distress, anxiety, and depression, in particular perioperatively. For resection of eloquent located cerebral lesions, awake surgery is the gold standard surgical method for the preservation of speech and motor function, which might be accompanied by increased psychological distress. The aim of the present study was to analyze if patients who are undergoing awake craniotomy suffer from increased prevalence or higher scores in distress, anxiety, or depression.MethodsPatients, who were electively admitted for brain tumor surgery at our neurooncological department, were perioperatively screened regarding distress, anxiety, and quality of life using three established self-assessment instruments (Hospital Anxiety and Depression Scale, distress thermometer, and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30-BN20). Screening results were correlated regarding operation technique (awake vs. general anesthesia). Retrospective statistical analyses for nominal variables were conducted using chi-square test. Metric variables were analyzed using the Kruskal–Wallis test, the Mann–Whitney U-test, and independent-samples t-tests.ResultsData from 54 patients (26 male and 28 female) aged 29 to 82 years were available for statistical analyses. A total of 37 patients received primary resection and 17 recurrent tumor resection. Awake surgery was performed in 35 patients. There was no significant difference in awake versus non-awake surgery patients regarding prevalence (of distress (p = 0.465), anxiety (p = 0.223), or depression (p = 0.882). Furthermore, awake surgery had no significant influence on distress thermometer score (p = 0.668), anxiety score (p = 0.682), or depression score (p = 0.630) as well as future uncertainty (p = 0.436) or global health status (p = 0.943). Additionally, analyses revealed that primary or recurrent surgery also did not have any significant influence on the prevalence or scoring of the evaluated items.ConclusionAnalyses of our cohort’s data suggest that planned awake surgery might not have a negative impact on patients concerning the prevalence and severity of manifestation of distress, anxiety, or depression in psychooncological screening. Patients undergoing recurrent surgery tend to demonstrate increased distress, although results were not significant.

scholarly journals Mapping and Preserving the Visuospatial Network by repetitive nTMS and DTI Tractography in Patients With Right Parietal Lobe Tumors

2021 ◽  
Vol 11 ◽  
Author(s):  
Giovanni Raffa ◽  
Maria Catena Quattropani ◽  
Giuseppina Marzano ◽  
Antonello Curcio ◽  
Vincenzo Rizzo ◽  
...  
Keyword(s):  
3D Reconstruction ◽  
Parietal Lobe ◽  
Tumor Resection ◽  
Historical Control ◽  
Control Group ◽  
Cortical Areas ◽  
Group A ◽  
Dti Tractography ◽  
Group B ◽  
The Right

IntroductionThe goal of brain tumor surgery is the maximal resection of neoplastic tissue, while preserving the adjacent functional brain tissues. The identification of functional networks involved in complex brain functions, including visuospatial abilities (VSAs), is usually difficult. We report our preliminary experience using a preoperative planning based on the combination of navigated transcranial magnetic stimulation (nTMS) and DTI tractography to provide the preoperative 3D reconstruction of the visuospatial (VS) cortico-subcortical network in patients with right parietal lobe tumors.Material and MethodsPatients affected by right parietal lobe tumors underwent mapping of both hemispheres using an nTMS-implemented version of the Hooper Visual Organization Test (HVOT) to identify cortical areas involved in the VS network. DTI tractography was used to compute the subcortical component of the network, consisting of the three branches of the superior longitudinal fasciculus (SLF). The 3D reconstruction of the VS network was used to plan and guide the safest surgical approach to resect the tumor and avoid damage to the network. We retrospectively analyzed the cortical distribution of nTMS-induced errors, and assessed the impact of the planning on surgery by analyzing the extent of tumor resection (EOR) and the occurrence of postoperative VSAs deficits in comparison with a matched historical control group of patients operated without using the nTMS-based preoperative reconstruction of the VS network.ResultsTwenty patients were enrolled in the study (Group A). The error rate (ER) induced by nTMS was higher in the right vs. the left hemisphere (p=0.02). In the right hemisphere, the ER was higher in the anterior supramarginal gyrus (aSMG) (1.7%), angular gyrus (1.4%) superior parietal lobule (SPL) (1.3%), and dorsal lateral occipital gyrus (dLoG) (1.2%). The reconstruction of the cortico-subcortical VS network was successfully used to plan and guide tumor resection. A gross total resection (GTR) was achieved in 85% of cases. After surgery no new VSAs deficits were observed and a slightly significant improvement of the HVOT score (p=0.02) was documented. The historical control group (Group B) included 20 patients matched for main clinical characteristics with patients in Group A, operated without the support of the nTMS-based planning. A GTR was achieved in 90% of cases, but the postoperative HVOT score resulted to be worsened as compared to the preoperative period (p=0.03). The comparison between groups showed a significantly improved postoperative HVOT score in Group A vs. Group B (p=0.03).ConclusionsThe nTMS-implemented HVOT is a feasible approach to map cortical areas involved in VSAs. It can be combined with DTI tractography, thus providing a reconstruction of the VS network that could guide neurosurgeons to preserve the VS network during tumor resection, thus reducing the occurrence of postoperative VSAs deficits as compared to standard asleep surgery.

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