scholarly journals Awake craniotomy for a low-grade glioma - a pilot procedure at a public hospital in Trinidad and Tobago

2021 ◽  
Author(s):  
Panduranga Seetahal-Maraj
Keyword(s):  
Public Hospital ◽  
Frozen Section ◽  
Technical Skill ◽  
Low Grade Glioma ◽  
Awake Craniotomy ◽  
Cortical Mapping ◽  
Tumour Resection ◽  
Low Grade ◽  
Successful Performance ◽  
Eloquent Cortex

Awake craniotomies (AC) are proven to reduce the neurological deficit associated with tumour resection in areas of eloquent cortex. Successful performance requires not only technical skill, but the availability of neuronavigation, cortical mapping, intra-operative frozen section and the appropriate anaesthetic support. This case report describes the first fully awake craniotomy done in Trinidad, at a public hospital, for a patient with seizures secondary to a low-grade glioma. It resulted in an excellent patient outcome, with full cessation of seizures and no postoperative deficits.

scholarly journals Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice

2010 ◽  
Vol 28 (2) ◽  
pp. E7 ◽  
Author(s):  
Andrea Szelényi ◽  
Lorenzo Bello ◽  
Hugues Duffau ◽  
Enrica Fava ◽  
Guenther C. Feigl ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Cognitive Function ◽  
Low Grade Glioma ◽  
Awake Craniotomy ◽  
Awake Surgery ◽  
Low Grade ◽  
Glioma Surgery ◽  
Neurological Sequelae ◽  
Intraoperative Electrical Stimulation ◽  
Methodological Aspects

There is increasing evidence that the extent of tumor removal in low-grade glioma surgery is related to patient survival time. Thus, the goal of resecting the largest amount of tumor possible without leading to permanent neurological sequelae is a challenge for the neurosurgeon. Electrical stimulation of the brain to detect cortical and axonal areas involved in motor, language, and cognitive function and located within the tumor or along its boundaries has become an essential tool in combination with awake craniotomy. Based on a literature review, discussions within the European Low-Grade Glioma Group, and illustrative clinical experience, the authors of this paper provide an overview for neurosurgeons, neurophysiologists, linguists, and anesthesiologists as well as those new to the field about the stimulation techniques currently being used for mapping sensorimotor, language, and cognitive function in awake surgery for low-grade glioma. The paper is intended to help the understanding of these techniques and facilitate a comparison of results between users.

Electrophysiological Mapping and Monitoring during an Awake Craniotomy for Low-Grade Glioma: Case Report

2019 ◽  
Vol 59 (3) ◽  
pp. 133-141
Author(s):  
Justin W. Silverstein ◽  
Andrew Rosenthal ◽  
Nitesh V. Patel ◽  
John A. Boockvar
Keyword(s):  
Case Report ◽  
Low Grade Glioma ◽  
Awake Craniotomy ◽  
Low Grade ◽  
Glioma Case

scholarly journals Improving multidisciplinary communication during awake craniotomy: First use of a novel robotic exoscope

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv17-iv18
Author(s):  
Anam Anzak ◽  
Alex Alamri ◽  
Thomas Doke ◽  
Grainne McKenna ◽  
Andrew Elsmore ◽  
...  
Keyword(s):  
Learning Curve ◽  
Inferior Frontal Gyrus ◽  
Structured Interview ◽  
Low Grade Glioma ◽  
Stereoscopic Vision ◽  
Awake Craniotomy ◽  
Low Grade ◽  
Data Generation ◽  
Multidisciplinary Communication ◽  
Team Members

Abstract Background Awake craniotomies require exceptional intra-operative communication between the multidisciplinary team. This is difficult with traditional operating microscopes, where the operative field cannot be visualised by all parties. The Synaptive Modus V is a hands-free, robotic, extracorporeal telescope (exoscope), allowing images to be viewed on multiple large monitors. The Royal London Hospital is the first United Kingdom installation of this device and the first unit in Europe to apply it to awake craniotomies for low-grade glioma. Methods Two consecutive patients with low grade glioma underwent awake craniotomy using the Modus V. Qualitative feedback (semi-structured interview) was received from the MDT including surgeons, occupational/ speech and language/ physio-therapists, neurophysiologists, anaesthetists and scrub team. Optimal device positioning is described. Results Both female patients (38 and 52 years old) underwent surgery between December 2018 and February 2019. Lesions were located in right perisylvian and posterior inferior frontal gyrus locations respectively. Surgical resection was satisfactory. Patient 1 developed a wrist-drop intra-operatively. Patient 2 had transient mild word finding difficulties. Surgeons reported easier surgical flow with hands-free positioning, larger working area and improved ergonomics. Adapting to non-stereoscopic vision increased operating times. Multi-disciplinary team members reported an better communication with the operating surgeon during patient assessment and a more involved educational experience. Conclusion Hands-free exoscopes may provide improved surgical flow and efficiency for awake craniotomy whilst simultaneously improving multidisciplinary communication and education. There is an, as yet, unidentified learning curve for its use that requires learning curve data generation.

JS01.4.A The neurocognitive function changes with awake craniotomy for low-grade glioma in the left hemispheric eloquent regions

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii5-ii5
Author(s):  
Y Wang ◽  
P Ji ◽  
S Guo ◽  
J Liu ◽  
Y Zhai ◽  
...  
Keyword(s):  
Cognitive Performance ◽  
Brain Mapping ◽  
Treatment Strategy ◽  
Cognitive Assessment ◽  
Tumor Resection ◽  
Tumor Location ◽  
Low Grade Glioma ◽  
Awake Craniotomy ◽  
Low Grade ◽  
Eloquent Area

Abstract BACKGROUND Cognitive deficit was frequently observed in glioma patients, especially for those on the eloquent area. Considering the increased life expectancy, brain mapping during awake craniotomy was preferentially applied to exacerbate neurocognitive deficits. The aim of the current study was to evaluate the neurocognitive changes during the perioperative period of resection of low-grade glioma (LGG) in the left side eloquent area with awake craniotomy in a major neurosurgical center in China for 5 years. MATERIAL AND METHODS We retrospectively analyzed patients with left-sided glioma in eloquent areas, who received awake craniotomy during 2016–2020. Montreal Cognitive Assessment Scale, BN-20, and EORTC-QLQ-C30 questionnaire were applied for neurological cognitive assessment. We performed a correlation analysis between changes in cognitive performance and tumor characteristics, including tumor location, pathological grade. Treatment-related factors were also analyzed, such as the extent of resection (EOR), preoperative and postoperative Karnofsky Performance Score (KPS), postoperative treatment strategy (chemo- and radiotherapy), progression-free survival (PFS), overall survival (OS). RESULTS 68 patients were included in our current study. For the language domain, memory domain, and executive functions, 7.4% (5/68) patients presented mild postoperative cognitive performance deterioration compared to preoperative. Tumor location was the only factor that greatly influenced the postoperative cognitive performance, while other features (EOR, KPS, pathological grades) and treatment strategy were found no effect on cognitive change. The extent of tumor resection ranged from 81% to 100%. CONCLUSION Our study underlines the importance of the application of brain mapping during awake craniotomy, which helps to maximize extent of tumor resection while preserving cognitive function in individuals with LGG in eloquent regions.

scholarly journals Awake Craniotomy for Left Insular Low-Grade Glioma Removal on a Patient with Learning Disabilities

2017 ◽  
Vol 06 (01) ◽  
pp. 041-043 ◽  
Author(s):  
Andrej Vranic ◽  
Blaz Koritnik ◽  
Jasmina Markovic-Bozic
Keyword(s):  
Learning Disabilities ◽  
Case Report ◽  
Brain Tumors ◽  
Awake Craniotomy ◽  
Awake Surgery ◽  
Cortical Mapping ◽  
Low Grade ◽  
Low Grade Gliomas ◽  
Eloquent Areas ◽  
Slow Growing

Introduction Low-grade gliomas (LGG) are slow-growing primary brain tumors in adults, with high tropism for eloquent areas. Standard approach in treatment of LGG is awake craniotomy with intraoperative cortical mapping — a method which is usually used on adult and fully cooperative patients. Case Report We present the case of a patient with learning disabilities (PLD) who was operated for left insular LGG awake craniotomy, and intraoperative cortical mapping were performed and the tumor was gross totally removed. Conclusion Awake surgery for left insular LGG removal is challenging; however, it can be performed safely and successfully on PLD.

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 SURG-08. AWAKE CRANIOTOMY WITH BRAIN MAPPING FOR DIFFUSE LOW-GRADE GLIOMA: CASE REPORT OF INSTITUTIONAL EXPERIENCE IN OVERCOMING HURDLES IN A LOW-RESOURCE SETTING

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii204-ii205
Author(s):  
Kirby Manigos ◽  
Kevin Paul Ferraris ◽  
Joseph Erroll Navarro ◽  
Kenny Seng ◽  
Jose Carlos Alcazaren
Keyword(s):  
Brain Mapping ◽  
Diffusion Tensor ◽  
Low Grade Glioma ◽  
Awake Craniotomy ◽  
Limited Resources ◽  
Low Grade ◽  
Low Grade Gliomas ◽  
Neurologic Deficits ◽  
Weighted Sequence ◽  
Low Middle Income Countries

Abstract Maximal safe resection of low-grade gliomas located in functional areas of the cortex while avoiding postsurgical neurologic deficits can be achieved by awake craniotomy with brain mapping. The effectiveness of this surgical technique is fairly established in the developed world, however it remains to be routinely applied in low-middle income countries due to limited resources and lack of equipment. We present the case of a 44 year-old, right-handed male who had a 2-year history of focal aware motor seizures but was otherwise neurologically intact. Neuropsychological testing revealed no cognitive impairment. Cranial magnetic resonance imaging (MRI) revealed a non-enhancing, ill-defined tumor centered on the left insula and extending into the frontotemporal opercula, corona radiata, and posterior limb of the internal capsule—hypointense by T1-weighted sequence and hyperintense by T2-weighted sequence, thus radiographically consistent with diffuse low-grade glioma. Blood-oxygen-level-dependent functional MRI revealed left hemispheric language dominance in the cortex overlying the tumor, but with no motor cortex involvement. The patient underwent a protocol-driven awake craniotomy, intraoperative positive brain mapping using standard cortical stimulator, transsylvian and transcortical transopercular microsurgical approaches to achieve greater than 80% excision of the tumor. Postoperatively, the patient was seizure-free and with similar neurocognitive status prior to the surgery. The patient had been following up for standard adjuvant chemotherapy and radiotherapy. Avoidance of postsurgical neurologic deficits and maximal cytoreduction can still be achieved by awake craniotomy with brain mapping in settings with limited resources. Despite the lack of other perioperative tools and adjuncts such as diffusion tensor imaging, intraoperative ultrasonography, and even intraoperative MRI that are routinely available in high-resource settings, we illustrate in this case that comparable outcomes could be achieved by overcoming hurdles and aiming for the asymptote to the up-to-date and ideal neurosurgical treatment for diffuse low-grade gliomas.

scholarly journals The Merits of Awake Craniotomy for Glioblastoma in the Left Hemispheric Eloquent Area: One Institution Experience

2020 ◽  
Author(s):  
Ying-Ching Li ◽  
Hsiao-Yean Chiu ◽  
Ya-Jui Lin ◽  
Ko-Ting Chen ◽  
Peng-Wei Hsu ◽  
...  
Keyword(s):  
Progression Free Survival ◽  
Extent Of Resection ◽  
Awake Craniotomy ◽  
Treatment Center ◽  
Low Grade ◽  
Karnofsky Performance Score ◽  
Free Survival ◽  
Neurological Outcomes ◽  
Eloquent Cortex ◽  
The Mean

Abstract Background Awake craniotomy (AC) with intraoperative stimulation mapping is the standard treatment for gliomas, especially those on the eloquent cortex. Many studies have reported survival benefits with the use of AC in patients with glioma, however most of these studies have focused on low-grade glioma. The aim of this study was to evaluate the experience of one treatment center over 10 years for resection of left hemispheric eloquent glioblastoma. Methods This retrospective analysis included 48 patients with left hemispheric eloquent glioblastoma who underwent AC and 61 patients who underwent surgery under general anesthesia (GA) between 2008 and 2018. Perioperative risk factors, extent of resection (EOR), preoperative and postoperative Karnofsky Performance Score (KPS), progression-free survival (PFS) and overall survival (OS) were assessed. Results The postoperative KPS was significantly lower in the GA patients compared to the AC patients (p=0.002). The EOR in the GA group was 90.2% compared to 94.9% in the AC group (p=0.003). The mean PFS was 18.9 months in the GA group and 23.2 months in the AC group (p=0.001). The mean OS was 25.5 months in all patients, 23.4 months in the GA group, and 28.1 months in the AC group (p<0.001). In multivariate analysis, the EOR and preoperative KPSindependently predicted better OS. Conclusion The patients with left hemispheric eloquent glioblastoma in this study had better neurological outcomes, maximal tumor removal, and better PFS and OS after AC than surgery under GA. Awake craniotomy should be performed in these patients if the resources are available.

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