scholarly journals A focal brain-cooling device as an alternative to electrical stimulation for language mapping during awake craniotomy: patient series

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Sadahiro Nomura ◽  
Takao Inoue ◽  
Hirochika Imoto ◽  
Hirokazu Sadahiro ◽  
Kazutaka Sugimoto ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Functional Mapping ◽  
Awake Craniotomy ◽  
Mapping Technique ◽  
Broca’S Area ◽  
Brain Cooling ◽  
Broca's Area ◽  
Cooling Device ◽  
Language Mapping ◽  
Patient Series

BACKGROUND Functional mapping in awake craniotomy has the potential risk of electrical stimulation-related seizure. The authors have developed a novel mapping technique using a brain-cooling device. The cooling probe is cylindrical in shape with a thermoelectric cooling plate (10 × 10 mm) at the bottom. A proportional integration and differentiation-controlled system adjusts the temperature accurately (Japan patent no. P5688666). The authors used it in two patients with glioblastoma. Broca’s area was identified by electrical stimulation, and then the cooling probe set at 5°C was attempted on it. OBSERVATIONS Electrocorticogram was suppressed, and the temperature dropped to 8°C in 50 sec. A positive aphasic reaction was reproduced on Broca’s area at a latency of 7 sec. A negative reaction appeared on the adjacent cortices despite the temperature decrease. The sensitivity and specificity were 60% and 100%, respectively. No seizures or other adverse events related to the cooling were recognized, and no histological damage to the cooled cortex was observed. LESSONS The cooling probe suppressed topographical brain function selectively and reversibly. Awake functional mapping based on thermal neuromodulation technology could substitute or compensate for the conventional electrical mapping.

scholarly journals Intraoperative subcortical mapping of a language-associated deep frontal tract connecting the superior frontal gyrus to Broca's area in the dominant hemisphere of patients with glioma

2015 ◽  
Vol 122 (6) ◽  
pp. 1390-1396 ◽  
Author(s):  
Masazumi Fujii ◽  
Satoshi Maesawa ◽  
Kazuya Motomura ◽  
Miyako Futamura ◽  
Yuichiro Hayashi ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
White Matter ◽  
Frontal Lobe ◽  
Navigation System ◽  
Broca’S Area ◽  
Language Function ◽  
Broca's Area ◽  
Mr Images ◽  
Language Functions ◽  
Subcortical Mapping

OBJECT The deep frontal pathway connecting the superior frontal gyrus to Broca's area, recently named the frontal aslant tract (FAT), is assumed to be associated with language functions, especially speech initiation and spontaneity. Injury to the deep frontal lobe is known to cause aphasia that mimics the aphasia caused by damage to the supplementary motor area. Although fiber dissection and tractography have revealed the existence of the tract, little is known about its function. The aim of this study was to determine the function of the FAT via electrical stimulation in patients with glioma who underwent awake surgery. METHODS The authors analyzed the data from subcortical mapping with electrical stimulation in 5 consecutive cases (3 males and 2 females, age range 40–54 years) with gliomas in the left frontal lobe. Diffusion tensor imaging (DTI) and tractography of the FAT were performed in all cases. A navigation system and intraoperative MRI were used in all cases. During the awake phase of the surgery, cortical mapping was performed to find the precentral gyrus and Broca's area, followed by tumor resection. After the cortical layer was removed, subcortical mapping was performed to assess language-associated fibers in the white matter. RESULTS In all 5 cases, positive responses were obtained at the stimulation sites in the subcortical area adjacent to the FAT, which was visualized by the navigation system. Speech arrest was observed in 4 cases, and remarkably slow speech and conversation was observed in 1 case. The location of these sites was also determined on intraoperative MR images and estimated on preoperative MR images with DTI tractography, confirming the spatial relationships among the stimulation sites and white matter tracts. Tumor removal was successfully performed without damage to this tract, and language function did not deteriorate in any of the cases postoperatively. CONCLUSIONS The authors identified the left FAT and confirmed that it was associated with language functions. This tract should be recognized by clinicians to preserve language function during brain tumor surgery, especially for tumors located in the deep frontal lobe on the language-dominant side.

scholarly journals SURG-19. REORGANIZATION OF LANGUAGE ENABLES SAFE RESECTION OF TUMORS IN AND AROUND BROCA’S AREA

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi243-vi243
Author(s):  
Emma Holmes ◽  
Keith Kerr ◽  
Cihan Kadipasaoglu ◽  
Nitin Tandon
Keyword(s):  
Language Production ◽  
Senior Author ◽  
Broca’S Area ◽  
Broca's Area ◽  
Language Mapping ◽  
Pathological Evaluation ◽  
Pars Opercularis ◽  
Grade 3 ◽  
Slow Growing

Abstract INTRODUCTION Since its discovery in the 1800s, Broca’s area has been viewed as a critical node for language production. Previously, pathologies in this area have been considered unresectable due to concern for producing iatrogenic language production deficits. Emerging literature suggests that although acute lesions in this area can cause widespread deficits, slow growing lesions are less correlated with these deficits due to cortical language reorganization. Based on this data, we managed a cohort with Broca’s area lesions with surgical resection using awake intra-operative language mapping. METHODS All 150 awake craniotomies performed by the senior author over a twelve-year period (2006–2017) at a single institution were reviewed. For each patient the imaging was carefully evaluated to localize the neoplasm relative to pars triangularis or pars opercularis in the language dominant hemisphere. Language dominance was confirmed using WADA testing or fMRI. All patients underwent cortical language mapping using a battery of tasks coupled with cortical stimulation. RESULTS A total of 31 surgeries in 29 patients (65.5% male, 86.2% righthanded) were identified. The average age was 41. Patients presented with seizures (64.5%), speech difficulties (35.5%) or headaches (19.4%). A gross or near total resection was achieved in 26/29 (89.7%) of patients. Pathological evaluation revealed grade 2 gliomas (8), grade 3 gliomas (13) and glioblastoma (9). Post-operatively, 8 (25.8%) patients had new or worsening speech deficits, all of which resolved to baseline at follow-up. CONCLUSION Broca’s area lesions can be safely resected in patients using an awake craniotomy technique with language mapping. In our series, the majority of patients had gross or near total resections, few patients had new deficits, and none had permanent new deficits. Considering the increasing evidence in favor of cytoreduction to manage glial neoplasms, this technique should be employed routinely for pathologies in this area to optimize patient outcomes.

Comprehension deficits elicited by electrical stimulation of Broca's area

Brain ◽  
1993 ◽  
Vol 116 (3) ◽  
pp. 695-715 ◽  
Author(s):  
Leonard Schäffler ◽  
Hans O. Lüders ◽  
Dudley S. Dinner ◽  
Ronald P. Lesser ◽  
Gordon J. Chelune
Keyword(s):  
Electrical Stimulation ◽  
Broca’S Area ◽  
Broca's Area ◽  
Stimulation Of

Functional mapping of motor in and near Broca's area

NeuroImage ◽  
1996 ◽  
Vol 3 (3) ◽  
pp. S367 ◽  
Author(s):  
P. Erhard ◽  
T. Kato ◽  
J.P. Strupp ◽  
P. Andersen ◽  
G. Adriany ◽  
...  
Keyword(s):  
Functional Mapping ◽  
Broca’S Area ◽  
Broca's Area

scholarly journals Difficulty in identification of the frontal language area in patients with dominant frontal gliomas that involve the pars triangularis

2016 ◽  
Vol 125 (4) ◽  
pp. 803-811 ◽  
Author(s):  
Taiichi Saito ◽  
Yoshihiro Muragaki ◽  
Takashi Maruyama ◽  
Manabu Tamura ◽  
Masayuki Nitta ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Brain Mapping ◽  
Awake Craniotomy ◽  
Language Function ◽  
Language Mapping ◽  
Positive Mapping ◽  
Language Area ◽  
Pars Triangularis ◽  
Language Areas ◽  
Dominant Side

OBJECTIVE Identification of language areas using functional brain mapping is sometimes impossible using current methods but essential to preserve language function in patients with gliomas located within or near the frontal language area (FLA). However, the factors that influence the failure to detect language areas have not been elucidated. The present study evaluated the difficulty in identifying the FLA in dominant-side frontal gliomas that involve the pars triangularis (PT) to determine the factors that influenced failed positive language mapping. METHODS Awake craniotomy was performed on 301 patients from April 2000 to October 2013 at Tokyo Women's Medical University. Recurrent cases were excluded, and patients were also excluded if motor mapping indicated their glioma was in or around the motor area on the dominant or nondominant side. Eighty-two consecutive cases of primary frontal glioma on the dominant side were analyzed for the present study. MRI was used for all patients to evaluate whether tumors involved the PT and to perform language functional mapping with a bipolar electrical stimulator. Eighteen of 82 patients (mean age 39 ± 13 years) had tumors that showed involvement of the PT, and the detailed characteristics of these 18 patients were examined. RESULTS The FLA could not be identified with intraoperative brain mapping in 14 (17%) of 82 patients; 11 (79%) of these 14 patients had a tumor involving the PT. The negative response rate in language mapping was only 5% in patients without involvement of the PT, whereas this rate was 61% in patients with involvement of the PT. Univariate analyses showed no significant correlation between identification of the FLA and sex, age, histology, or WHO grade. However, failure to identify the FLA was significantly correlated with involvement of the PT (p < 0.0001). Similarly, multivariate analyses with the logistic regression model showed that only involvement of the PT was significantly correlated with failure to identify the FLA (p < 0.0001). In 18 patients whose tumors involved the PT, only 1 patient had mild preoperative dysphasia. One week after surgery, language function worsened in 4 (22%) of 18 patients. Six months after surgery, 1 (5.6%) of 18 patients had a persistent mild speech deficit. The mean extent of resection was 90% ± 7.1%. Conclusions Identification of the FLA can be difficult in patients with frontal gliomas on the dominant side that involve the PT, but the positive mapping rate of the FLA was 95% in patients without involvement of the PT. These findings are useful for establishing a positive mapping strategy for patients undergoing awake craniotomy for the treatment of frontal gliomas on the dominant side. Thoroughly positive language mapping with subcortical electrical stimulation should be performed in patients without involvement of the PT. More careful continuous neurological monitoring combined with subcortical electrical stimulation is needed when removing dominant-side frontal gliomas that involve the PT.

scholarly journals Awake craniotomy for a cavernous angioma in the Broca’s area

2018 ◽  
Vol 45 (VideoSuppl2) ◽  
pp. V4 ◽  
Author(s):  
Lucas Alverne F. Albuquerque ◽  
Fátima C. Pessoa ◽  
Gabryella S. Diógenes ◽  
Felipe S. Borges ◽  
Stélio C. Araújo Filho
Keyword(s):  
Brain Mri ◽  
Cavernous Angioma ◽  
Awake Craniotomy ◽  
Neurological Deficits ◽  
Broca’S Area ◽  
Broca's Area ◽  
Motor Mapping ◽  
History Of ◽  
Pars Opercularis ◽  
History Of Epilepsy

Cavernous angiomas constitute 5%–10% of cerebrovascular malformations and may cause seizure and neurological deficits from bleeding.4 The authors present a case of a 44-year-old man with a 3.5-year history of epilepsy without complete seizure control despite anticonvulsants. Brain MRI showed a 2.8 cm cavernous angioma at the left pars opercularis, also known as the Broca’s area.3 The patient underwent an awake craniotomy for intraoperative cortical–subcortical language and sensory-motor mapping for a complete resection of the cavernous angioma and the hemosiderin rim.1–6 The procedure was uneventful, and the patient evolved seizure free and with no deficits.The video can be found here: https://youtu.be/QajbLIsr_vg.

scholarly journals Language Localization in Multilingual Patients—Evidence From Direct Electrical Stimulation: A Systematic Review and Single Institution Case Series

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Colin Teo Kok Ann ◽  
Djaina Satoer ◽  
Hui Minn Chan ◽  
Marco Rossi ◽  
Tseng Tsai Yeo ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Standardized Test ◽  
Case Series ◽  
Awake Craniotomy ◽  
Direct Electrical Stimulation ◽  
Language Function ◽  
Language Mapping ◽  
Second Languages ◽  
First Languages ◽  
L1 And L2

Abstract INTRODUCTION To enable the safe mapping of language function in multilinguals, we need to understand how language organization in multilinguals differ from well-described organizations in monolingual patients. The development and appropriate administration of standardized test batteries intraoperatively is important to ensure accuracy of mapping, as interlanguage differences cannot be accounted by accurate translations alone. Individual or linguistic factors affects language organization. This study aims to review the published literature on language organization in multilinguals and illustrate intraoperative findings from a case series of multilingual patients who underwent language mapping during awake craniotomy at an Asian institution. METHODS This PRISMA guided review included studies on multilingual patients undergoing awake craniotomy utilizing direct electrical stimulation (DES) to localize language sites during awake craniotomy. Similar details from case series of multilingual individuals with more than one language mapped at our center, and strategies used to develop intraoperative tasks for non-English languages are also presented. RESULTS A total of 142 patients in 21 studies were included. These studies included 80.9% bilinguals, 10.5% trilinguals, 6.3% tetralinguals, 2.8% pentalinguals. Most common first languages (L1) are French (26.7%), English (16.9%), Spanish (14.0%), second languages (L2) are English (38%), Spanish (19.7%), Mandarin (7.7%). Our study noted large variation in fluency definition and evaluation methods for language and cognitive evaluation. Stimulation protocols, error definitions were similar. Naming and counting tasks most commonly used. Majority of studies (76.1%) found distinct cortical sites for L1 and L2, and shared sites as well (66.7%). There was no clear relationship between pattern of distribution and age of acquisition, proficiency or nature of language. Sites for specific tasks such as voluntary and involuntary switching, translation, and reading were identified. CONCLUSION There are distinct differences language organization between multilinguals and monolinguals. It is crucial for understanding of these differences for maximal preservation of each mapped language function to achieve maximal quality of life.

scholarly journals High resolution passive speech mapping in dominant hemisphere glioma surgery

2019 ◽  
Vol 21 (3) ◽  
pp. 37-43 ◽  
Author(s):  
M. V. Sinkin ◽  
A. E. Osadchiy ◽  
M. A. Lebedev ◽  
K. V. Volkova ◽  
M. S. Kondratova ◽  
...  
Keyword(s):  
High Resolution ◽  
Gamma Oscillations ◽  
Awake Craniotomy ◽  
Cortical Mapping ◽  
Broca’S Area ◽  
Broca's Area ◽  
Study Objective ◽  
Speech Mapping ◽  
Number Of Patients ◽  
Eloquent Area

Background. Intraoperative brain mapping is one of the most critical stages of neurosurgical intervention in the eloquent area of the cerebral cortex. Traditionally direct cortical electrical stimulation is used for these purposes, but it can lead to seizures and loss of consciousness that makes it impossible to continue the procedure. Moreover, it significantly changes the surgery plan, especially in case of speech mapping during awake craniotomy.The study objective is to create a setup for intraoperative eloquent cortical areas passive mapping, and to compare informativity and safety of passive and active speech mapping.Materials and methods. We have created and tested a mobile device for high-resolution mapping of the Broca’s area that uses the analysis of the desynchronization processes in high-gamma oscillations in 64 micro-contact grid electrode for electrocorticography during awake craniotomy when patient pronounces the objects and actions.Results. We found precise coincidence for localization of the Broca’s area, determined by analyzing of bioelectric signal obtained from the electrocorticography and cortical mapping performed by bipolar direct cortical stimulation using Penfield method.Conclusion. The passive cortical speech mapping expands the potentialities of neurosurgical operations in the eloquent area of the brain and can increase the number of patients for whom this study is achievable. Further studies needed to evolve algorithms and sets of stimuli to expand the list of functional zones that can be mapped passively.

What Makes Surgical Tumor Resection Feasible in Broca's Area? Insights Into Intraoperative Brain Mapping

Neurosurgery ◽  
2010 ◽  
Vol 66 (5) ◽  
pp. 868-875 ◽  
Author(s):  
Vincent Lubrano ◽  
Louisa Draper ◽  
Franck-Emmanuel Roux
Keyword(s):  
Brain Mapping ◽  
Brain Plasticity ◽  
Tumor Resection ◽  
Mass Effect ◽  
Awake Craniotomy ◽  
Short Version ◽  
Broca’S Area ◽  
Broca's Area ◽  
Language Performance ◽  
Mass Lesions

Abstract OBJECTIVE Surgical resection of mass lesions in Broca's area is controversial. To demonstrate that pathology may influence the localization of functional areas and language performance, we reviewed our experience of awake craniotomies in Broca's area. METHODS Sixteen consecutive patients who underwent awake craniotomy and direct brain mapping for resective surgery in Broca's area were analyzed. Six patients had well-circumscribed lesions, whereas 10 patients had infiltrative gliomas. A short version of the Boston Diagnostic Aphasia Examination test was used for language assessment. RESULTS Inferior frontal language sites were found in all but 4 patients. In patients with cavernomas or well-circumscribed tumors, 9 of 9 (100%) of the positive sites were located in the classic Broca's area (BA 44/45). By contrast, in those patients with gliomas, only 5 of 20 (25%) of the positive sites were located in BA 44/45. Patients with infiltrative gliomas demonstrated more deficits in the pre and postoperative periods than those with well-circumscribed mass lesions. All patients returned to their baseline abilities within 6 months. CONCLUSION Intraoperative language maps generated in cases with well-circumscribed lesions are different from those generated in cases with infiltrative gliomas. This supports the view that interindividual language variability and displacement of critical structures by mass effect should first be considered for circumscribed lesions, whereas reshaping should largely be attributed to brain plasticity in gliomas. Surgery in Broca's area can be safely conducted using awake craniotomy and brain mapping.

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