Awake mapping for low-grade gliomas involving the left sagittal stratum: anatomofunctional and surgical considerations

2014 ◽  
Vol 120 (5) ◽  
pp. 1069-1077 ◽  
Author(s):  
Emilie Chan-Seng ◽  
Sylvie Moritz-Gasser ◽  
Hugues Duffau
Keyword(s):  
Quality Of Life ◽  
White Matter ◽  
Functional Anatomy ◽  
Awake Surgery ◽  
Cortical Mapping ◽  
Subtotal Resection ◽  
Low Grade ◽  
Temporal Part ◽  
Who Grade

Object Preserving function while optimizing the extent of resection is the main goal in surgery for diffuse low-grade glioma (DLGG). This is particularly relevant for DLGG involving the sagittal stratum (SS), where damage can have severe consequences. Indeed, this structure is a major crossroad in which several important fascicles run. Thus, its complex functional anatomy is still poorly understood. Subcortical electrical stimulation during awake surgery provides a unique opportunity to investigate white matter pathways. This study reports the findings on anatomofunctional correlations evoked by stimulation during resection for gliomas involving the left SS. Surgical outcomes are also detailed. Methods The authors performed a review of patients who underwent awake surgery for histopathologically confirmed WHO Grade II glioma involving the left SS in the neurosurgery department between August 2008 and August 2012. Information regarding clinicoradiological features, surgical procedures, and outcomes was collected and analyzed. Intraoperative electrostimulation was used to map the eloquent structures within the SS. Results Eight consecutive patients were included in this study. There were 6 men and 2 women, whose mean age was 41.7 years (range 32–61 years). Diagnosis was made because of seizures in 7 cases and slight language disorders in 1 case. After cortical mapping, subcortical stimulation detected functional fibers running in the SS in all patients: semantic paraphasia was generated by stimulating the inferior frontooccipital fascicle in 8 cases; alexia was elicited by stimulating the inferior longitudinal fascicle in 3 cases; visual disorders were induced by stimulating the optic radiations in 5 cases. Moreover, in front of the SS, phonemic paraphasia was evoked by stimulating the temporal part of the arcuate fascicle in 5 patients. The resection was stopped according to these functional limits in the 8 patients. After a transient postsurgical worsening, all patients recovered to normal results on examination, except for the persistence of a right superior quadrantanopia in 5 cases, with no consequences for quality of life. The 8 patients returned to a normal social and professional life. Total or subtotal resection was achieved in all cases but one. Conclusions The authors suggest that the use of intrasurgical electrical mapping of the white matter pathways in awake patients opens the door to extensive resection of DLGG within the left SS while preserving the quality of life. Further anatomical, clinical, radiological, and electrophysiological studies are needed for a better understanding of the functional anatomy of this complex region.

Surgery for low-grade glioma infiltrating the central cerebral region: location as a predictive factor for neurological deficit, epileptological outcome, and quality of life

2013 ◽  
Vol 119 (2) ◽  
pp. 318-323 ◽  
Author(s):  
Philippe Schucht ◽  
Fadi Ghareeb ◽  
Hugues Duffau
Keyword(s):  
Quality Of Life ◽  
Return To Work ◽  
Seizure Control ◽  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Neurological Deficits ◽  
Main Concern ◽  
Low Grade ◽  
Who Grade

Object A main concern with regard to surgery for low-grade glioma (LGG, WHO Grade II) is maintenance of the patient's functional integrity. This concern is particularly relevant for gliomas in the central region, where damage can have grave repercussions. The authors evaluated postsurgical outcomes with regard to neurological deficits, seizures, and quality of life. Methods Outcomes were compared for 33 patients with central LGG (central cohort) and a control cohort of 31 patients with frontal LGG (frontal cohort), all of whom had had medically intractable seizures before undergoing surgery with mapping while awake. All surgeries were performed in the period from February 2007 through April 2010 at the same institution. Results For the central cohort, the median extent of resection was 92% (range 80%–97%), and for the frontal cohort, the median extent of resection was 93% (range 83%–98%; p = 1.0). Although the rate of mild neurological deficits was similar for both groups, seizure freedom (Engel Class I) was achieved for only 4 (12.1%) of 33 patients in the central cohort compared with 26 (83.9%) of 31 patients in the frontal cohort (p < 0.0001). The rate of return to work was lower for patients in the central cohort (4 [12.1%] of 33) than for the patients in the frontal cohort (28 [90.3%] of 31; p < 0.0001). Conclusions Resection of central LGG is feasible and safe when appropriate intraoperative mapping is used. However, seizure control for these patients remains poor, a finding that contrasts markedly with seizure control for patients in the frontal cohort and with that reported in the literature. For patients with central LGG, poor seizure control ultimately determines quality of life because most will not be able to return to work.

scholarly journals Awake Surgery for Left Posterior Insular Low-Grade Glioma Through the Parietorolandic Operculum: The Need to Preserve the Functional Connectivity. A Case Series

2022 ◽  
Vol 8 ◽  
Author(s):  
Hugues Duffau
Keyword(s):  
White Matter ◽  
Functional Connectivity ◽  
Case Series ◽  
Low Grade Glioma ◽  
Awake Surgery ◽  
Cortical Mapping ◽  
Lateral Part ◽  
Low Grade ◽  
Left Posterior ◽  
Transcortical Approach

Objective: Surgical approach to low-grade glioma (LGG) involving the posterior insula is challenging, especially in the left hemisphere, with a high risk of sensorimotor, language, or visual deterioration. In this study, a case series of 5 right-handed patients harboring a left posterior insular LGG is reported, by detailing a transcorticosubcortical approach.Method: The five surgeries were achieved in awake patients using cortical and axonal electrostimulation mapping. The glioma was removed through the left rolandic and/or parietal opercula, with preservation of the subcortical connectivity.Results: The cortical mapping was positive in the five patients, enabling the selection of an optimal transcortical approach, via the anterolateral supramarginal gyrus in four patients and/or via the lateral retrocentral gyrus in three cases (plus through the left superior temporal gyrus in one case). Moreover, the white matter tracts were identified in all cases, i.e., the lateral part of the superior longitudinal fasciculus (five cases), the arcuate fasciculus (four cases), the thalamocortical somatosensory pathways (four cases), the motor pathway (one case), the semantic pathway (three cases), and the optic tract (one case). Complete resection of the LGG was achieved in two patients and near-total resection in three patients. There were no postoperative permanent sensorimotor, language, or visual deficits.Conclusion: A transcortical approach through the parietorolandic operculum in awake patients represents safe and effective access to the left posterior insular LGG. Detection and preservation of the functional connectivity using direct electrostimulation of the white matter bundles are needed in this cross-road brain region to prevent otherwise predictable postsurgical impairments.

scholarly journals OS10.2 Effectiveness and tolerability of lacosamide as add-on therapy in patients with brain tumor-related epilepsy: results from a prospective, non-interventional study in European clinical practice

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii20-iii21
Author(s):  
R Rudà ◽  
S Hellot ◽  
M De Backer ◽  
J Chan ◽  
L Joeres ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Brain Tumor ◽  
Seizure Frequency ◽  
Retention Rate ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Interventional Study ◽  
Who Grade ◽  
Kaplan Meier

Abstract BACKGROUND Data on the use of lacosamide (LCM) for the treatment of brain tumor-related epilepsy (BTRE) are limited. The objective of this study was to evaluate the effectiveness and tolerability of LCM added to 1 or 2 antiepileptic drugs (AEDs) in the treatment of patients with epilepsy due to low-grade primary brain tumor. MATERIAL AND METHODS Prospective, multicenter, single-arm, non-interventional study with a 6-month observation period (EP0045; NCT02276053). LCM was added to existing treatment with 1 or 2 AEDs. Patients aged ≥16 years with BTRE secondary to low-grade glioma (WHO Grade I-II) were eligible. Primary endpoints: patients experiencing a ≥50% reduction in seizure frequency from Baseline to Month 6; Patient’s Global Impression of Change (PGIC) rating at Month 6. Secondary endpoints: Kaplan-Meier estimated retention rate and change from Baseline in quality-of-life to Month 6 (EQ-5D-5L and MDASI-BT). Safety variables: occurrence of adverse drug reactions (ADRs) and ADRs leading to discontinuation. The present analysis was performed for the safety set: all patients who took ≥1 dose of lacosamide. RESULTS The study was conducted between November 2014 and December 2017. Patients were enrolled from 24 sites in Italy, the United Kingdom, the Netherlands, Germany, France, and Spain. 93 patients started LCM (mean [SD] age: 44.5 [14.7] years; 50 [53.8%] male); 14 (15.1%) withdrew from the study by 6 months. 85 (91.4%) patients had low-grade glioma, 3 (3.2%) had suspected glioma, 3 (3.2%) had meningioma, 1 (1.1%) had craniopharyngioma, and 1 (1.1%) had a histologically unverified tumor. At 6-months, 66 (71.0%) patients reported a ≥50% reduction in seizure frequency, 30 (32.3%) of whom were seizure-free. Improvements on PGIC were reported by 49 (52.7%) patients. The Kaplan-Meier estimated 6-month retention rate was 86.0%. Quality of life (EQ-5D-5L) and symptoms outcome measures (MDASI-BT) remained stable. ADRs leading to discontinuation occurred in 4 (4.3%) patients, most commonly vertigo (2 [2.2%] patients). CONCLUSION This is the first prospective, multicenter study focusing on epilepsy due to slow-growing tumors (mainly low-grade gliomas), treated with LCM. The results suggest that LCM reduces seizures in patients with resistant BTRE. The majority of patients noticed a clinical improvement with the addition of LCM. Observed ADRs were consistent with the known safety profile of LCM. STUDY SUPPORTED BY: UCB Pharma.

scholarly journals QOLP-16. DISTRESSED (D TYPE) PERSONALITY, PREOPERATIVE PSYCHOLOGICAL DISTRESS, COGNITIVE FUNCTIONING, QUALITY OF LIFE, AND TREATMENT OUTCOMES OF GLIOMA PATIENTS: PROSPECTIVE STUDY

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi201-vi201
Author(s):  
Aiste Pranckeviciene ◽  
Ausra Saudargiene ◽  
Vytenis Deltuva ◽  
Arimantas Tamasauskas ◽  
Adomas Bunevicius
Keyword(s):  
Quality Of Life ◽  
Psychological Distress ◽  
Cognitive Functioning ◽  
Treatment Outcomes ◽  
Neuropsychological Tests ◽  
Low Grade ◽  
Depression And Anxiety ◽  
Who Grade

Abstract BACKGROUND This study aimed to evaluate impact of distressed (D type) personality on preoperative psychological distress, cognitive functioning and quality of life (QoL) as well as short-term and long-term treatment outcomes of glioma patients. METHOD One-hundred and seventy patients (93 men, mean age=51.1±14.5 years) participated in the study. Fifty-four (31.8%) patients were diagnosed with low grade (WHO grade I-II), and 116 (68.2%) with high grade (WHO grade III-IV) tumors. Psychological assessment was performed 2–3 days before surgery using a set of self-report questionnaires (NCCN Distress thermometer, EORTC-QLQ-C30, EORTCQLQ-BN20, HADS, DS-14) and a short battery of neuropsychological tests. Functional status at the discharge was assessed using the GOS. Follow-up period was 40 months. RESULTS Thirty-nine (22.9%) of patients met criteria for D type personality. D-type patients relative to non D-type patients reported significantly worse QoL, higher number tumor related symptoms, greater depression and anxiety symptoms, and demonstrated slowing of psychomotor speed in neuropsychological tests. However, no personality related differences were observed in level of functioning at time of discharge as well as long-term patients’ survival. Path analysis using SEM revealed non-direct impact of D-type personality traits on patients QoL (Chi-square value=16.73, df=13, p=0.212). The model indicated statistically significant indirect effects of D-type Negative Affectivity on QoL (IPC -0.285, 95% CI [-0.386; -0.178], p=0.003) and tumor related symptoms (IPC 0.196, 95% CI [0.117; 0.296], p=0.002) mediated via depression and anxiety. Social Inhibition was also indirectly associated with QoL (IPC -0.047, 95% CI [-0.120; -0.002], p=0.035) and symptoms (IPC 0.033, 95% CI [0.002; 0.097], p=0.032) through depression and anxiety. CONCLUSION D-type personality contributes to impairment of QoL and higher number of reported symptoms in glioma patients via increased susceptibility for depression and anxiety.

scholarly journals QOL-36. USE OF CANNABINOIDS IN THE PEDIATRIC CENTRAL NERVOUS SYSTEM TUMOR POPULATION

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii438-iii438
Author(s):  
Kathleen Dorris ◽  
Jessica Channell ◽  
Ashley Mettetal ◽  
Molly Hemenway ◽  
Natalie Briones ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Central Nervous System ◽  
Nervous System ◽  
Cell Activity ◽  
Cns Tumors ◽  
Low Grade ◽  
Tumor Type ◽  
Central Nervous System Tumor ◽  
The Impact

Abstract BACKGROUND Cannabinoids, including cannabidiol (CBD) and tetrahydrocannabinol (THC), are a class of compounds found in marijuana. Numerous studies in adults have examined cannabinoid use in management of cancer-related symptoms such as nausea, anorexia, and pain. Less is known about the use in the pediatric oncology population. METHODS A prospective observational study has been ongoing since 2016 at Children’s Hospital Colorado to evaluate cannabinoids’ impact using PedsQL™ modules on quality of life of pediatric patients with central nervous system (CNS) tumors who are 2–18 years old. Laboratory assessments of T-cell activity and pharmacokinetics of CBD, THC and associated metabolites are in process. Diaries with exploratory information on cannabinoid use patterns are being collected. RESULTS Thirty-three patients (14:19; male:female) have been enrolled with a median age of 6.4 years (range, 2.9–17.7 years). The most common tumor type in enrolled patients is embryonal tumors (13/33; 39%). Nine (27%) patients have low-grade glial/glioneuronal tumors, and eight (24%) had high-grade/diffuse midline gliomas. The remaining patients had ependymoma or craniopharyngioma. The median time on cannabinoids is 9 months. Most (n=20) patients have used oral products with CBD and THC. One patient continues on cannabinoid therapy in follow up. Preliminary immune function analyses identified impaired neutrophil superoxide anion production and chemotaxis in patients taking cannabinoids at early time points on therapy. CONCLUSIONS Families of children with various CNS tumors are pursuing cannabinoid therapy for both antitumor and supportive care purposes. Analysis of the impact of cannabinoids on patients’ quality of life is ongoing.

Mini-review: Childhood-onset Craniopharyngioma

2021 ◽  
Author(s):  
Anna Otte ◽  
Hermann L Müller
Keyword(s):  
Quality Of Life ◽  
Survival Rates ◽  
Residual Tumor ◽  
Tumor Location ◽  
Multidisciplinary Teams ◽  
Low Grade ◽  
Childhood Onset ◽  
Severe Impairment ◽  
Grade Malignancy

Abstract Craniopharyngiomas are rare embryonic malformational tumors of the sellar/parasellar region, classified by the WHO as tumors with low-grade malignancy (WHO I°). The childhood adamantinomatous subtype of craniopharyngioma is usually cystic with calcified areas. At the time of diagnosis, hypothalamic/pituitary deficits, visual disturbances and increased intracranial pressure are major symptoms. The treatment of choice in case of favorable tumor location (without hypothalamic involvement) is complete resection. It is important to ensure that optical and hypothalamic functionality are preserved. In case of unfavorable tumor location, i.e. with hypothalamic involvement, a hypothalamus-sparing surgical strategy with subsequent local irradiation of residual tumor is recommended. In the further course of the disease, recurrences and progression often occur. Nevertheless, overall survival rates are high at 92%. Severe impairment of quality of life and comorbidities such as metabolic syndrome, hypothalamic obesity and neurological consequences can be observed in patients with disease- and/or treatment-related lesions of hypothalamic structures. Childhood-onset craniopharyngioma frequently manifests as a chronic disease so that patients require lifelong, continuous care by experienced multidisciplinary teams to manage clinical and quality of life consequences.For this review, a search for original articles and reviews published between 1986 and 2020 was performed in Pubmed, Science Citation Index Expanded, EMBASE and Scopus. The search terms used were “craniopharyngioma, hypothalamus, pituitary obesity, irradiation, neurosurgery”.

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