scholarly journals Preserving executive functions in nondominant frontal lobe glioma surgery: an intraoperative tool

2019 ◽  
Vol 131 (2) ◽  
pp. 474-480 ◽  
Author(s):  
Guglielmo Puglisi ◽  
Tommaso Sciortino ◽  
Marco Rossi ◽  
Antonella Leonetti ◽  
Luca Fornia ◽  
...  
Keyword(s):  
Executive Functions ◽  
Frontal Lobe ◽  
Brain Mapping ◽  
Tumor Resection ◽  
Awake Surgery ◽  
Tumor Removal ◽  
Motor Functions ◽  
Inferior Margin ◽  
Functional Integrity ◽  
The Impact

OBJECTIVEThe goal of surgery for gliomas is maximal tumor removal while preserving the patient’s full functional integrity. At present during frontal tumor removal, this goal is mostly achieved, although the risk of impairing the executive functions (EFs), and thus the quality of life, remains significant. The authors investigated the accuracy of an intraoperative version of the Stroop task (iST), adapted for intraoperative mapping, to detect EF-related brain sites by evaluating the impact of the iST brain mapping on preserving functional integrity following a maximal tumor resection.METHODSForty-five patients with nondominant frontal gliomas underwent awake surgery; brain mapping was used to establish the functional boundaries for the resection. In 18 patients language, praxis, and motor functions, but not EFs (control group), were mapped intraoperatively at the cortical-subcortical level. In 27 patients, in addition to language, praxis, and motor functions, EFs were mapped with the iST at the cortical-subcortical level (Stroop group). In both groups the EF performance was evaluated preoperatively, at 7 days and 3 months after surgery.RESULTSThe iST was successfully administered in all patients. Consistent interferences, such as color-word inversion/latency, were obtained by stimulating precise white matter sites below the inferior and middle frontal gyri, anterior to the insula and over the putamen, and these were used to establish the posterior functional limit of the resection. Procedures implemented with iST dramatically reduced the EF deficits at 3 months. The EOR was similar in Stroop and control groups.CONCLUSIONSBrain mapping with the iST allows identification and preservation of the frontal lobe structures involved in inhibition of automatic responses, reducing the incidence of postoperative EF deficits and enhancing the further posterior and inferior margin of tumor resection.

The Clinical Significance of Molecular Markers — BRAF V600E Mutations and CDKN2A Deletions — in Low-Grade Pediatric Gliomas: Cohort Study

2019 ◽  
Vol 6 (1) ◽  
pp. 34-44
Author(s):  
Taisiya M. Mikhaleuskaya ◽  
Alena V. Valochnik ◽  
Natalya E. Konoplya ◽  
Oleg I. Bydanov
Keyword(s):  
Cohort Study ◽  
Molecular Markers ◽  
Tumor Resection ◽  
Morphological Characteristics ◽  
Braf V600e ◽  
Molecular Characteristics ◽  
Repeated Treatment ◽  
Low Grade ◽  
Tumor Removal ◽  
The Impact

Background. Low-grade gliomas are the most common brain tumors in children. Gliomas have a favorable prognosis, but in some cases relapses or continued tumor growth occur. With relatively similar clinical and morphological characteristics of tumors, it is rather difficult to select a group of patients who may have progression. Objective. Our aim was to study the impact of certain clinical, histological and molecular characteristics of tumors on the progression/recurrence. Methods. A retrospective cohort study was carried out. Clinical data, histological features and molecular markers (overexpression of phosphorylated ERK1/2 (pERK1/2), mutation of B-Raf kinase (BRAF V600E), deletion of CDKN2A gene (delCDKN2A) were studied in 90 patients with low-grade pediatric gliomas, who were treated in the Center for Pediatric Oncology, Hematology and Immunology during 2010–2018. In gliomas with signs of anaplasia expression of gene of the X-linked alpha-thalassemia syndrome (ATRX), a trymethylated form of histone 3 (H3K27me), p53, and mutation of the dehydrogenase 1 isocitrate 1 gene (IDH1R132H) were also evaluated. Immunohistochemistry and the hybridization in situ (FISH) was performed to evaluate the molecular markers. Results. Statistical analysis confirmed the importance of such factors as non-radical tumor removal (p<0.0001), repeated treatment (p<0.0025), overexpression of pERK1/2 (p<0.0001), histological signs of anaplasia (p<0.0022), areas of diffuse growth (p<0.001), BRAF V600E (p<0.0001), delCDKN2A (p<0.0099). In tissue of gliomas with anaplasia overexpression of pERK1/2, mutation BRAF V600E, delCDKN2A and ATRX loss were more common. When conducting multivariate analysis, non-radical tumor removal and the presence of one of the molecular markers significantly influenced the prognosis (p<0.0001). Conclusion. The definition of molecular markers and the simultaneous assessment of the degree of tumor resection allows us to distinguish a group of patients with a high risk of tumor recurrence / progression.

scholarly journals NCOG-07. FEATURES OF EPILEPTOGENIC BRAIN METASTASES AND THEIR TREATMENT

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii130-ii130
Author(s):  
Nicholas Musgrave ◽  
Kristin Huntoon ◽  
Joshua Wang ◽  
Douglas Hardesty ◽  
Daniel Prevedello ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Frontal Lobe ◽  
Surgical Resection ◽  
Seizure Control ◽  
Tumor Resection ◽  
Surgical Patients ◽  
Treatment Modalities ◽  
Categorical Variables ◽  
Systemic Treatments ◽  
The Impact

Abstract Patients with brain metastases (BM) may experience seizures at diagnosis or during their treatment. Seizures are associated with decreased overall survival (OS) and poorer quality of life. Therapeutic options may include surgical resection of epileptogenic BM. This study evaluated features of epileptogenic BM and whether surgical resection of these tumors improved seizure control and OS. A retrospective single-center review between 2006-2016 identified 1581 patients with BM. Data analyzed included demographics, primary cancer, systemic treatments, radiographic features of BM, BM treatment modalities, anti-epileptic drugs (AEDs), and seizure characteristics before and after intervention for BM. Chi-squared tests were used for categorical variables. Kaplan-Meier curves and Breslow values were used to assess OS following seizure. Of 1581 patients with BM, 136 (9%) experienced one or more seizures. Seizure was the presenting symptom of BM in 74 (54.4%) patients. Melanoma metastases were most epileptogenic, causing seizure in 38 of 216 (17.6%) patients (p&lt; 0.001). Frontal lobe metastases were most common in patients with seizures (100, 73.5% p=0.033). After median follow-up of 23 months, 48 of 80 (60%) surgical patients were seizure free compared with 27 of 56 (48.2%) non-surgical patients. OS from first seizure was improved in surgical patients versus non-surgical patients (735±133 vs 447±74 days, p=0.043). Frontal lobe tumor resection (n=61) conferred improved survival compared with non-frontal lobe tumor resections (n=19) (698±323 vs 344±132 days, p=0.044). Variables such as demographics, number of BM, tumor histology, and dose of AED were not significantly different between surgical and non-surgical groups. Seizures due to BM cause significant morbidity and mortality. Frontal lobe location and melanoma histology increase seizure risk. Resection of BM was associated with improved seizure control and prolonged OS from the time of first seizure. Further studies should delineate the impact of surgery and determine if a specific constellation of variables warrants prophylactic AEDs.

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.

Intraoperative Monitoring of an Aspect of Executive Functions: Administration of the Stroop Test in 9 Adult Patients During Awake Surgery for Resection of Frontal Glioma

2012 ◽  
Vol 72 (2) ◽  
pp. ons169-ons181 ◽  
Author(s):  
Michel Wager ◽  
Foucaud Du Boisgueheneuc ◽  
Claudette Pluchon ◽  
Coline Bouyer ◽  
Veronique Stal ◽  
...  
Keyword(s):  
Executive Functions ◽  
Stroop Effect ◽  
Intraoperative Monitoring ◽  
Tumor Resection ◽  
Stroop Test ◽  
Adult Patients ◽  
Anterior Cingulate ◽  
Awake Surgery ◽  
Surgical Data ◽  
Stimulation Of

Abstract BACKGROUND: Awake brain surgery allows extensive intraoperative monitoring of not only motor and sensory functions and language but also executive functions. OBJECTIVE: To administer the Stroop test intraoperatively to avoid dramatic side effects such as akinetic mutism and to monitor executive functions in an attempt to optimize the benefit/risk balance of surgery. METHODS: A series of 9 adult patients with frontal glioma were operated on for gross tumor resection under local anesthesia. All procedures involved the anterior cingulate cortex (ACC). RESULTS: Three types of response to the Stroop test were observed: 3 patients had a Stroop effect only for stimulation of the contralateral ACC; 3 patients had a Stroop effect for stimulation of the ipsilateral ACC; and 3 patients had no Stroop effect. Preoperative and postoperative neuropsychological and surgical results are presented and discussed. Stimulation sites eliciting a Stroop effect are compared with published image-based data, and insight provided by these surgical data regarding ACC function and plasticity is discussed. No operative complication related to intraoperative administration of the Stroop test was observed. CONCLUSION: Administration of the Stroop test during resection of gliomas involving the ACC in adult patients is an option for intraoperative monitoring of executive functions during awake surgery. Globally, these results suggest functional compensation, mediated by plasticity mechanisms, by contralateral homologous regions of the ACC in adult patients with frontal glioma.

scholarly journals SURG-14. AWAKE CRANIOTOMY VS CRANIOTOMY UNDER GENERAL ANESTHESIA FOR GLIOBLASTOMAS: EVALUATING THE IMPACT ON OVERALL SURVIVAL AND RISK OF RECURRENCE

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii206-ii206
Author(s):  
Mario Moro
Keyword(s):  
Overall Survival ◽  
General Anesthesia ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Neurological Deficits ◽  
Awake Surgery ◽  
Tumor Control ◽  
Risk Of Recurrence ◽  
Eloquent Areas ◽  
The Impact

Abstract Maximum safe resection for eloquent glioblastomas (GBMs) is the maximum tumor resection achievable without causing neurological deficits. Although challenging, it must be considered the therapeutic target for GBMs. Indeed, the extension of resection positively correlates with the overall survival and recurrences risk. Awake surgery (AS) has become paramount for achieving maximum safe resection for tumors in eloquent areas. However, there is not a unanimous consensus on the extent of resection of eloquent GBMs, especially for what concerns the so-called supratotal resection (i.e.: resection over the contrast-enhancing limits of the lesion). Recently, several studies focused their attention on the residual tumor volume as estimated from T1-contrast enhanced sequences, but few analyzed the outcomes of patients with a more extended resection. Some authors speculated that increased surgical aggressiveness, thus removing peritumoral edematous area, correlates with improved overall survival and tumor control, without increasing adverse events rates. This study aimed to assess, through quantitative volumetric analysis, the outcomes of a prospectively collected cohort of patients with primary GBM located in eloquent areas. We furtherly subdivided our population into two treatment groups: awake surgery (AS) and general anesthesia (GA) craniotomies. We analyzed the overall outcomes, especially for what concerns MRI T2-Flair signal extent of resection, related to patients’ survival and recurrences formation. Eventually, we stratified our analysis by type of treatment (awake surgery vs. general anesthesia) to rule out any significant differences in survival and postoperative GBMs behaviors. Our data confirmed extensive that T2-Flair resection (EOR≥30%) and AS could improve overall survival and reduce risk of recurrence without, at the same time, causing an increase of surgical and medical complications

scholarly journals Improvement in cognitive function after surgery for low-grade glioma

2019 ◽  
Vol 130 (2) ◽  
pp. 426-434 ◽  
Author(s):  
Ori Barzilai ◽  
Shlomit Ben Moshe ◽  
Razi Sitt ◽  
Gal Sela ◽  
Ben Shofty ◽  
...  
Keyword(s):  
Executive Functions ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Cognitive Outcome ◽  
Positive Staining ◽  
Low Grade ◽  
Related Quality ◽  
Craniotomy For Tumor Resection ◽  
The Impact ◽  
Dominant Side

OBJECTIVECognition is a key component in health-related quality of life (HRQoL) and is currently incorporated as a major parameter of outcome assessment in patients treated for brain tumors. The effect of surgery on cognition and HRQoL remains debatable. The authors investigated the impact of resection of low-grade gliomas (LGGs) on cognition and the correlation with various histopathological markers.METHODSA retrospective analysis of patients with LGG who underwent craniotomy for tumor resection at a single institution between 2010 and 2014 was conducted. Of 192 who underwent resective surgery for LGG during this period, 49 had complete pre- and postoperative neurocognitive evaluations and were included in the analysis. These patients completed a full battery of neurocognitive tests (memory, language, attention and working memory, visuomotor organization, and executive functions) pre- and postoperatively. Tumor and surgical characteristics were analyzed, including volumetric measurements and histopathological markers (IDH, p53, GFAP).RESULTSPostoperatively, significant improvement was found in memory and executive functions. A subgroup analysis of patients with dominant-side tumors, most of whom underwent intraoperative awake mapping, revealed significant improvement in the same domains. Patients whose tumors were on the nondominant side displayed significant improvement only in memory functions. Positive staining for p53 testing was associated with improved language function and greater extent of resection in dominant-side tumors. GFAP positivity was associated with improved memory in patients whose tumors were on the nondominant side. No correlation was found between cognitive outcome and preoperative tumor volume, residual volume, extent of resection, or IDH1 status.CONCLUSIONSResection of LGG significantly improves memory and executive function and thus is likely to improve functional outcome in addition to providing oncological benefit. GFAP and pP53 positivity could possibly be associated with improved cognitive outcome. These data support early, aggressive, surgical treatment of LGG.

Neurocognitive and functional outcomes in patients with diffuse frontal lower-grade gliomas undergoing intraoperative awake brain mapping

2020 ◽  
Vol 132 (6) ◽  
pp. 1683-1691 ◽  
Author(s):  
Kazuya Motomura ◽  
Lushun Chalise ◽  
Fumiharu Ohka ◽  
Kosuke Aoki ◽  
Kuniaki Tanahashi ◽  
...  
Keyword(s):  
Working Memory ◽  
Brain Mapping ◽  
Functional Outcomes ◽  
Digit Span ◽  
Awake Surgery ◽  
Motor Deficit ◽  
Lower Grade ◽  
Superior Frontal Gyrus ◽  
Neurocognitive Functions ◽  
Motor Disturbances

OBJECTIVELower-grade gliomas (LGGs) are often observed within eloquent regions, which indicates that tumor resection in these areas carries a potential risk for neurological disturbances, such as motor deficit, language disorder, and/or neurocognitive impairments. Some patients with frontal tumors exhibit severe impairments of neurocognitive function, including working memory and spatial awareness, after tumor removal. The aim of this study was to investigate neurocognitive and functional outcomes of frontal LGGs in both the dominant and nondominant hemispheres after awake brain mapping.METHODSData from 50 consecutive patients with diffuse frontal LGGs in the dominant and nondominant hemispheres who underwent awake brain surgery between December 2012 and September 2018 were retrospectively analyzed. The goal was to map neurocognitive functions such as working memory by using working memory tasks, including digit span testing and N-back tasks.RESULTSDue to awake language mapping, the frontal aslant tract was frequently identified as a functional boundary in patients with left superior frontal gyrus tumors (76.5%). Furthermore, functional boundaries were identified while evaluating verbal and spatial working memory function by stimulating the dorsolateral prefrontal cortex using the digit span and visual N-back tasks in patients with right superior frontal gyrus tumors (7.1%). Comparing the preoperative and postoperative neuropsychological assessments from the Wechsler Adult Intelligence Scale–Third Edition (WAIS-III) and Wechsler Memory Scale–Revised (WMS-R), significant improvement following awake surgery was observed in mean Perceptual Organization (Z = −2.09, p = 0.04) in WAIS-III scores. Postoperative mean WMS-R scores for Visual Memory (Z = −2.12, p = 0.03) and Delayed Recall (Z = −1.98, p = 0.04) were significantly improved compared with preoperative values for every test after awake surgery. No significant deterioration was noted with regard to neurocognitive functions in a comprehensive neuropsychological test battery. In the postoperative course, early transient speech and motor disturbances were observed in 30.0% and 28.0% of patients, respectively. In contrast, late permanent speech and motor disturbances were observed in 0% and 4.0%, respectively.CONCLUSIONSIt is noteworthy that no significant postoperative deterioration was identified compared with preoperative status in a comprehensive neuropsychological assessment. The results demonstrated that awake functional mapping enabled favorable neurocognitive and functional outcomes after surgery in patients with diffuse frontal LGGs.

Sign in / Sign up

Export Citation Format

Share Document