scholarly journals Preoperative Repetitive Navigated TMS and Functional White Matter Tractography in a Bilingual Patient with a Brain Tumor in Wernike Area

2021 ◽  
Vol 11 (5) ◽  
pp. 557
Author(s):  
Valentina Baro ◽  
Samuel Caliri ◽  
Luca Sartori ◽  
Silvia Facchini ◽  
Brando Guarrera ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Anterior Part ◽  
Awake Surgery ◽  
Language Abilities ◽  
Eloquent Areas ◽  
Mapping Tool ◽  
Preoperative Mapping ◽  
Neurosurgical Patients ◽  
White Matter Tractography ◽  
And Function

Awake surgery and intraoperative neuromonitoring represent the gold standard for surgery of lesion located in language-eloquent areas of the dominant hemisphere, enabling the maximal safe resection while preserving language function. Nevertheless, this functional mapping is invasive; it can be executed only during surgery and in selected patients. Moreover, the number of neuro-oncological bilingual patients is constantly growing, and performing awake surgery in this group of patients can be difficult. In this scenario, the application of accurate, repeatable and non-invasive preoperative mapping procedures is needed, in order to define the anatomical distribution of both languages. Repetitive navigated transcranial magnetic stimulation (rnTMS) associated with functional subcortical fiber tracking (nTMS-based DTI-FT) represents a promising and comprehensive mapping tool to display language pathway and function reorganization in neurosurgical patients. Herein we report a case of a bilingual patient affected by brain tumor in the left temporal lobe, who underwent rnTMS mapping for both languages (Romanian and Italian), disclosing the true eloquence of the anterior part of the lesion in both tests. After surgery, language abilities were intact at follow-up in both languages. This case represents a preliminary application of nTMS-based DTI-FT in neurosurgery for brain tumor in eloquent areas in a bilingual patient.

scholarly journals HOUT-12. RETURN TO WORK FOLLOWING AWAKE SURGERY FOR GLIOMAS IN SPEECH-ELOQUENT AREAS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi114-vi114
Author(s):  
Marie-Therese Forster ◽  
Irina Lortz ◽  
Volker Seifert ◽  
Christian Senft
Keyword(s):  
Return To Work ◽  
Awake Surgery ◽  
Professional Status ◽  
Functional Evaluation ◽  
Structured Interviews ◽  
Who Grade ◽  
Eloquent Areas ◽  
Human Happiness ◽  
Grade Ii

Abstract OBJECTIVE Pursuing a profession is an indispensable component of human happiness. The aim of this study was to analyze patients′ professional, socio-economic and psychological outcomes besides their neuro-oncological and functional evaluation after awake surgery for gliomas in eloquent areas. METHODS The neuro-oncological and functional outcomes of patients with gliomas other than glioblastoma undergoing awake surgery during a period of 5 years were prospectively assessed within our routine oncological follow-up. Repercussions of the disease on their professional status, socio-economic situation, and neurocognitive function were evaluated retrospectively with structured interviews. RESULTS We analyzed data of 37 patients with gliomas (3 WHO Grade I, 6 WHO grade II, 28 WHO grade III). Gross total and subtotal tumor resections were performed in 20 (54.1%) and 11 (29.7%) patients, respectively, whereas in 7 patients (16.2%) resection had to remain partial. Median follow up was 24.1 months (range: 5–61 months). 31 patients (83.8%) had stable disease, 2 (5.4%) patients suffered from tumor progression and 4 (10.8%) patients died. Prior to surgery, all but one patient were employed. At the time of analysis, 24 (72.7%) of 33 alive patients had resumed their profession. 5 patients (15.2%) were on incapacity pension, 2 patients were on sick leave, and 2 had retired. The median time until return to work following surgery was 5.9 ±4.6 months. Young age (< 40 years) was the only factor statistically significantly associated with the ability to return to work (p< 0.001). CONCLUSION Despite brain tumor surgery in eloquent regions, the majority of patients with WHO grade II or III gliomas are able to return to work. Employing awake techniques in order to preserve neurological function is of utmost relevance for individual patients′ quality of life and may also decrease the economic burden due to work loss frequently encountered in glioma patients.

scholarly journals Impairment of preoperative language mapping by lesion location: a functional magnetic resonance imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation study

2015 ◽  
Vol 123 (2) ◽  
pp. 314-324 ◽  
Author(s):  
Sebastian Ille ◽  
Nico Sollmann ◽  
Theresa Hauck ◽  
Stefanie Maurer ◽  
Noriko Tanigawa ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Magnetic Stimulation ◽  
Cortical Stimulation ◽  
Awake Surgery ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Language Mapping ◽  
Direct Cortical Stimulation ◽  
Neurosurgical Patients

OBJECT Language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) is increasingly used and has already replaced functional MRI (fMRI) in some institutions for preoperative mapping of neurosurgical patients. Yet some factors affect the concordance of both methods with direct cortical stimulation (DCS), most likely by lesions affecting cortical oxygenation levels. Therefore, the impairment of the accuracy of rTMS and fMRI was analyzed and compared with DCS during awake surgery in patients with intraparenchymal lesions. METHODS Language mapping was performed by DCS, rTMS, and fMRI using an object-naming task in 27 patients with left-sided perisylvian lesions, and the induced language errors of each method were assigned to the cortical parcellation system. Subsequently, the receiver operating characteristics were calculated for rTMS and fMRI and compared with DCS as ground truth for regions with (w/) and without (w/o) the lesion in the mapped regions. RESULTS The w/ subgroup revealed a sensitivity of 100% (w/o 100%), a specificity of 8% (w/o 5%), a positive predictive value of 34% (w/o: 53%), and a negative predictive value (NPV) of 100% (w/o: 100%) for the comparison of rTMS versus DCS. Findings for the comparison of fMRI versus DCS within the w/ subgroup revealed a sensitivity of 32% (w/o: 62%), a specificity of 88% (w/o: 60%), a positive predictive value of 56% (w/o: 62%), and a NPV of 73% (w/o: 60%). CONCLUSIONS Although strengths and weaknesses exist for both rTMS and fMRI, the results show that rTMS is less affected by a brain lesion than fMRI, especially when performing mapping of language-negative cortical regions based on sensitivity and NPV.

Stereotactic Brain Biopsy in Eloquent Areas Assisted by Navigated Transcranial Magnetic Stimulation: a Technical Case Report

2018 ◽  
Vol 17 (3) ◽  
pp. E124-E129 ◽  
Author(s):  
Jiri Bartek ◽  
Gerald Cooray ◽  
Mominul Islam ◽  
Margret Jensdottir
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Stereotactic Biopsy ◽  
Brain Biopsy ◽  
Awake Surgery ◽  
Histopathological Diagnosis ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Stereotactic Brain Biopsy ◽  
Eloquent Areas ◽  
The Brain

Abstract BACKGROUND AND IMPORTANCE Stereotactic brain biopsy (SB) is an important part of the neurosurgical armamentarium, with the possibility of achieving histopathological diagnosis in otherwise inaccessible lesions of the brain. Nevertheless, the procedure is not without the risk of morbidity, which is especially true for lesions in eloquent parts of the brain, where even a minor adverse event can result in significant deficits. Navigated transcranial magnetic stimulation (nTMS) is widely used to chart lesions in eloquent areas, successfully guiding maximal safe resection, while its potential role in aiding with the planning of a stereotactic biopsy is so far unexplored. CLINICAL PRESENTATION Magnetic resonance imaging of a 67-yr-old woman presenting with dysphasia revealed a noncontrast enhancing left-sided lesion in the frontal and parietal pars opercularis. Due to the location of the lesion, nTMS was used to chart both primary motor and language cortex, utilizing this information to plan a safe SB trajectory and sampling area according to the initial work-up recommendations from the multidisciplinary neuro-oncology board. The SB was uneventful, with histology revealing a ganglioglioma, WHO I. The patient was discharged the following day, having declined to proceed with tumor resection (awake surgery) due to the non-negligible risk of morbidity. Upon 1- and 3-mo follow-up, she showed no signs of any procedure-related deficits. CONCLUSION nTMS can be implemented to aid with the planning of a stereotactic biopsy procedure in eloquent areas of the brain, and should be considered part of the neurosurgical armamentarium.

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

Who is who: areas of the brain associated with recognizing and naming famous faces

2009 ◽  
Vol 110 (2) ◽  
pp. 289-299 ◽  
Author(s):  
Carlo Giussani ◽  
Franck-Emmanuel Roux ◽  
Lorenzo Bello ◽  
Valérie Lauwers-Cances ◽  
Costanza Papagno ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Right Hemisphere ◽  
Anterior Part ◽  
Final Analysis ◽  
Naming Task ◽  
Brain Regions ◽  
Object Naming ◽  
Language Deficit ◽  
Neurosurgical Patients ◽  
The Brain

Object It has been hypothesized that specific brain regions involved in face naming may exist in the brain. To spare these areas and to gain a better understanding of their organization, the authors studied patients who underwent surgery by using direct electrical stimulation mapping for brain tumors, and they compared an object-naming task to a famous face–naming task. Methods Fifty-six patients with brain tumors (39 and 17 in the left and right hemispheres, respectively) and with no significant preoperative overall language deficit were prospectively studied over a 2-year period. Four patients who had a partially selective famous face anomia and 2 with prosopagnosia were not included in the final analysis. Results Face-naming interferences were exclusively localized in small cortical areas (< 1 cm2). Among 35 patients whose dominant left hemisphere was studied, 26 face-naming specific areas (that is, sites of interference in face naming only and not in object naming) were found. These face naming–specific sites were significantly detected in 2 regions: in the left frontal areas of the superior, middle, and inferior frontal gyri (p < 0.001) and in the anterior part of the superior and middle temporal gyri (p < 0.01). Variable patterns of interference were observed (speech arrest, anomia, phonemic, or semantic paraphasia) probably related to the different stages in famous face processing. Only 4 famous face–naming interferences were found in the right hemisphere. Conclusions Relative anatomical segregation of naming categories within language areas was detected. This study showed that famous face naming was preferentially processed in the left frontal and anterior temporal gyri. The authors think it is necessary to adapt naming tasks in neurosurgical patients to the brain region studied.

scholarly journals P14.51 Brain mapping for mentalizing in GBM patient

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii78-iii79
Author(s):  
D Chung ◽  
W Yoon
Keyword(s):  
Brain Mapping ◽  
Verbal Memory ◽  
Diffusion Tensor ◽  
Anterior Part ◽  
Neuropsychological Test ◽  
Incorrect Response ◽  
Awake Surgery ◽  
Cystic Tumor ◽  
Palm Tree ◽  
Poor Outcome

Abstract BACKGROUND Glioblastoma is a disease with very poor outcome. Most patients underwent maximal safe resection, especially focusing in the preservation of motor and language function. However, many caregivers were suffered from the blockage of emotion communication with patients. So the definition of maximal safe resection must include the preservation of cognition and mentalizing of patients. Here we present the experience of brain mapping in awake surgery to preserve mentalizing. MATERIAL AND METHODS A 61-year-old male patient with headache was transferred to our hospital because of brain tumor on CT scan checked in another hospital. On the initial MRI, multi-septate cystic tumor was shown on left medial prefrontal area. The patient was recommended the surgical resection, but patient discharged with the denial of the operation. Ten days later, patient visited our hospital again with slowness of response by the enlargement of tumor size. The tumor extensively involved left cingulum and corpus callosum at anterior part. On diffusion tensor image, tumor located at mediosuperior part of inferior fronto-occipital fasciculus (IFOF). The patient showed deficit of visual and verbal memory, generative naming ability, and phonemic generative naming ability on preoperative neuropsychological test (SNSB-II). Pyramid and palm tree test (PPTT) and ‘Reading the Mind in the Eyes’ test (RMET) were also performed to evaluate the semantic association function and mentalizing preoperatively. RESULTS The patient underwent awake surgery with asleep-awake-asleep technique. The tumor was resected until identification of incorrect response to PPTT or RMET on subcortical stimulation (Ojeman stimulator, 1.5mA, 60Hz, biphasic). The histopathologic diagnosis was glioblastoma. Small part of tumor was remained on cingulum, but patient was discharged without change of mentalizing. CONCLUSION Although the patients with glioblastomas show poor outcome, we think that it is important to consider the cognition and mentalizing of patients for emotion communication with caregivers. With awake surgery, mentalizing can be preserved in selective patients.

Symmetry of the arcuate fasciculus and its impact on language performance of patients with brain tumors in the language-dominant hemisphere

2017 ◽  
Vol 127 (6) ◽  
pp. 1407-1416 ◽  
Author(s):  
Margit Jehna ◽  
Juliane Becker ◽  
Karla Zaar ◽  
Gord von Campe ◽  
Kariem Mahdy Ali ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Fiber Tracking ◽  
Low Grade ◽  
High Grade ◽  
Arcuate Fasciculus ◽  
Language Performance ◽  
Language Deficits ◽  
Tumor Patients ◽  
Eloquent Areas ◽  
The Right

OBJECTIVECerebral damage in frontal, parietal, and temporal brain areas and, probably more importantly, their interconnections can lead to deficits in language. However, neural plasticity and repair allow the brain to partly compensate for neural injury, mediated by both functional and structural changes. In this study, the authors sought to systematically investigate the relationship between language performance in brain tumor patients and structural perisylvian pathways (i.e., the arcuate fasciculus [AF]) using probabilistic fiber tracking on diffusion tensor imaging. The authors used a previously proposed model in which the AF is divided into anterior, long, and posterior segments. The authors hypothesized that right-handed patients with gliomas in the language-dominant (left) hemisphere would benefit from a more symmetrical or right-lateralized language pathway in terms of better preservation of language abilities. Furthermore, they investigated to what extent specific tumor characteristics, including proximity to the AF, affect language outcome in such patients.METHODSTwenty-seven right-handed patients (12 males and 15 females; mean age 52 ± 16 years) with 11 low-grade and 16 high-grade gliomas of the left hemisphere underwent 3-T diffusion-weighted MRI (30 directions) and language assessment as part of presurgical planning. For a systematic quantitative evaluation of the AF, probabilistic fiber tracking with a 2 regions of interest approach was carried out. Volumes of the 3 segments of both hemispheric AFs were evaluated by quantifying normalized and thresholded pathways. Resulting values served to generate the laterality index of the AFs.RESULTSPatients without language deficits tended to have an AF that was symmetric or lateralized to the right, whereas patients with deficits in language significantly more often demonstrated a left-lateralized posterior segment of the AF. Patients with high-grade gliomas had more severe language deficits than those with low-grade gliomas. Backward logistic regression revealed the laterality index of the posterior AF segment and tumor grade as the only independent statistically significant predictors for language deficits in this cohort.CONCLUSIONSIn addition to the well-known fact that tumor entity influences behavioral outcome, the authors' findings suggest that the right homologs of structural language-associated pathways could be supportive for language function and facilitate compensation mechanisms after brain damage in functionally eloquent areas. This further indicates that knowledge about preoperative functional redistribution (identified by neurofunctional imaging) increases the chance for total or near-total resections of tumors in eloquent areas. In the future, longitudinal studies with larger groups are mandatory to overcome the methodological limitations of this cross-sectional study and to map neuroplastic changes associated with language performance and rehabilitation in brain tumor patients.

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

Awake Mapping Optimizes the Extent of Resection for Low-Grade Gliomas in Eloquent Areas

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1074-1084 ◽  
Author(s):  
Alessandro De Benedictis ◽  
Sylvie Moritz-Gasser ◽  
Hugues Duffau
Keyword(s):  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Awake Surgery ◽  
Low Grade ◽  
Functional Sites ◽  
Social Lives ◽  
Eloquent Areas ◽  
Functional Regions ◽  
First Time

Abstract BACKGROUND Awake craniotomy with intraoperative electrical mapping is a reliable method to minimize the risk of permanent deficit during surgery for low-grade glioma located within eloquent areas classically considered inoperable. However, it could be argued that preservation of functional sites might lead to a lesser degree of tumor removal. To the best of our knowledge, the extent of resection has never been directly compared between traditional and awake procedures. OBJECTIVE We report for the first time a series of patients who underwent 2 consecutive surgeries without and with awake mapping. METHODS Nine patients underwent surgery for a low-grade glioma in functional sites under general anesthesia in other institutions. The resection was subtotal in 3 cases and partial in 6 cases. There was a postoperative worsening in 3 cases. We performed a second surgery in the awake condition with intraoperative electrostimulation. The resection was performed according to functional boundaries at both the cortical and subcortical levels. RESULTS Postoperative magnetic resonance imaging showed that the resection was complete in 5 cases and subtotal in 4 cases (no partial removal) and that it was improved in all cases compared with the first surgery (P = .04). There was no permanent neurological worsening. Three patients improved compared with the presurgical status. All patients returned to normal professional and social lives. CONCLUSION Our results demonstrate that awake surgery, known to preserve the quality of life in patients with low-grade glioma, is also able to significantly improve the extent of resection for lesions located in functional regions.

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