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.

scholarly journals Toward a preoperative planning tool for brain tumor resection therapies

2012 ◽  
Vol 8 (1) ◽  
pp. 87-97 ◽  
Author(s):  
Aaron M. Coffey ◽  
Michael I. Miga ◽  
Ishita Chen ◽  
Reid C. Thompson
Keyword(s):  
Brain Tumor ◽  
Preoperative Planning ◽  
Tumor Resection ◽  
Planning Tool ◽  
Brain Tumor Resection

BRMP-01. Awake cranial surgery with intraoperative language mapping for brain tumors. A single-center experience

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi223-vi223
Author(s):  
Andrés Cervio ◽  
Sebastían Giovannini ◽  
Sonia Hasdeu ◽  
Lucía Pertierra ◽  
Blanca Diez
Keyword(s):  
Brain Tumors ◽  
Functional Mri ◽  
Tumor Resection ◽  
Awake Surgery ◽  
Anesthetic Technique ◽  
Low Grade ◽  
Safe Procedure ◽  
Language Mapping ◽  
Cranial Surgery

Abstract BACKGROUND Maximal safe resection of brain tumors affecting language areas has been a matter of increasing interest worldwide in the last decades. Functional MRI, tractography, and awake cranial surgery are standard procedures in our department since 2006. The aim of this study was to describe our experience in a series of 58 patients who underwent awake cranial surgery with intraoperative language mapping. METHODS Retrospective study of 58 adult patients who underwent awake surgery for brain tumors between January 2006 and January 2021. Preoperative neuropsychological assessment served as inclusion criteria. Language was evaluated according to the BDAE (Boston diagnostic aphasia examination) and WAB (Western aphasia battery) and strength according to the MRC (Medical Research Council) motor scale in the preoperative, immediate postoperative, and 3-months follow up. Functional MRI and tractography depicting white-matter tracts, neuronavigation, cortical and subcortical stimulation were performed in all cases. Conscious sedation was the anesthetic technique (propofol, fentanyl, and NSAIDs). Minimum follow-up was 6 months. FINDINGS The average age was 35 years (16–74). The anatomopathological findings were: low-grade glioma in 75,8% (n = 44), high-grade glioma in 15,6% (n = 9) and others in 8,6% (n = 5). No complications were registered during postoperative course. At the immediate postoperative evaluation 65% of patients presented with speech disturbances but at the 3-months follow up speech recovery was observed in all cases. Only 1 patient remained with moderate aphasia. mRS score at 3- months follow up was ≤ 1 in 96% of patients. Two patients had a persistent moderate hemiparesis. CONCLUSION Tumor resection in awake patients showed to be a safe procedure, and well tolerated by the patients. Preoperative planning of anatomical and functional aspects and intraoperative neurophysiological assessment are the cornerstones for pursuing maximal safe resection.

Can Preoperative Mapping with Functional MRI Reduce Morbidity in Brain Tumor Resection? A Systematic Review and Meta-Analysis of 68 Observational Studies

Radiology ◽  
2021 ◽  
pp. 204723
Author(s):  
Licia P. Luna ◽  
Farzaneh Ghazi Sherbaf ◽  
Haris I. Sair ◽  
Debraj Mukherjee ◽  
Isabella Bezerra Oliveira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Tumor ◽  
Functional Mri ◽  
Observational Studies ◽  
Meta Analysis ◽  
Tumor Resection ◽  
Preoperative Mapping ◽  
Brain Tumor Resection

Prophylactic antiepileptic drug administration following brain tumor resection: results of a recent AANS/CNS Section on Tumors survey

2016 ◽  
Vol 126 (6) ◽  
pp. 1772-1778 ◽  
Author(s):  
Michael C. Dewan ◽  
Reid C. Thompson ◽  
Steven N. Kalkanis ◽  
Fred G. Barker ◽  
Constantinos G. Hadjipanayis
Keyword(s):  
Brain Tumor ◽  
Clinical Decision Making ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
Clinical Decision ◽  
Low Grade ◽  
Seizure Prophylaxis ◽  
Tumor Pathology ◽  
Conflicting Evidence ◽  
Brain Tumor Resection

OBJECTIVEAntiepileptic drugs (AEDs) are often administered prophylactically following brain tumor resection. With conflicting evidence and unestablished guidelines, however, the nature of this practice among tumor surgeons is unknown.METHODSOn November 24, 2015, a REDCap (Research Electronic Database Capture) survey was sent to members of the AANS/CNS Section on Tumors to query practice patterns.RESULTSResponses were received from 144 individuals, including 18.8% of board-certified neurosurgeons surveyed (across 86 institutions, 16 countries, and 5 continents). The majority reported practicing in an academic setting (85%) as a tumor specialist (71%). Sixty-three percent reported always or almost always prescribing AED prophylaxis postoperatively in patients with a supratentorial brain tumor without a prior seizure history. Meanwhile, 9% prescribed occasionally and 28% rarely prescribed AED prophylaxis. The most common agent was levetiracetam (85%). The duration of seizure prophylaxis varied widely: 25% of surgeons administered prophylaxis for 7 days, 16% for 2 weeks, 21% for 2 to 6 weeks, and 13% for longer than 6 weeks. Most surgeons (61%) believed that tumor pathology influences epileptogenicity, with high-grade glioma (39%), low-grade glioma (31%), and metastases (24%) carrying the greatest seizure risk. While the majority used prophylaxis, 62% did not believe or were unsure if prophylactic AEDs reduced seizures postoperatively. The vast majority (82%) stated that a well-designed randomized trial would help guide their future clinical decision making.CONCLUSIONSWide knowledge and practice gaps exist regarding the frequency, duration, and setting of AED prophylaxis for seizure-naive patients undergoing brain tumor resection. Acceptance of universal practice guidelines on this topic is unlikely until higher-level evidence supporting or refuting the value of modern seizure prophylaxis is demonstrated.

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

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 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 Performance of Assessment Tool for Preoperative Planning of Brain Tumor Resection

2019 ◽  
pp. 150-164
Author(s):  
V. K. Narendira Kumar ◽  
G. Prabhu ◽  
N. Geetha ◽  
R. Santhosh
Keyword(s):  
Brain Tumor ◽  
Preoperative Planning ◽  
Assessment Tool ◽  
Lateral Displacement ◽  
Tumor Resection ◽  
Head Orientation ◽  
Brain Shift ◽  
Brain Surface ◽  
Brain Tumor Resection ◽  
Displacement Based

A patient precise finite constituent biphasic brain model has be making use of to codify a surgeon's experience by establishing quantifiable biomechanical measures to achieve orientations for optimal preparation of brain tumor resection. When faced by means of evaluating more than a few potential approaches to tumor removal during preoperative planning, the objective of this exertion is to make easy the surgeon’s selection of a patient head orientation such that tumor presentation and resection is help by means of positive brain shift conditions rather than trying to allay confounding ones. Displacement-based procedures consisting of region classification of the brain surface shifting in the craniotomy region and lateral displacement of the tumor center relative to an approach vector distinct by the surgeon were calculated over a variety of orientations and second-hand to form an objective function. For a frontal lobe tumor presentation, the reproduction predicts an perfect orientation that point to s the patient should be positioned in a on the side deceits place on the side contra lateral to the tumor in arrange to minimize unfavorable brain shift.

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