scholarly journals Asleep Speech Mapping Using Orofacial Muscles as Surrogates for Motor Speech in Patients Who Cannot Tolerate Awake Surgery: A Case Series

Cureus ◽  
2021 ◽  
Author(s):  
David Bonda ◽  
Justin W Silverstein ◽  
Joshua Katz ◽  
Jason A Ellis ◽  
John Boockvar ◽  
...  
Keyword(s):  
Case Series ◽  
Awake Surgery ◽  
Motor Speech ◽  
Speech Mapping

A Preliminary Look Into the Clinical Evolution of Motor Speech Characteristics in Primary Progressive Apraxia of Speech in Québec French

2021 ◽  
pp. 1-18
Author(s):  
Liziane Bouvier ◽  
Laura Monetta ◽  
Paolo Vitali ◽  
Robert Laforce ◽  
Vincent Martel-Sauvageau
Keyword(s):  
Multiple Testing ◽  
Case Series ◽  
Cognitive Screening ◽  
Apraxia Of Speech ◽  
Motor Speech ◽  
Primary Progressive ◽  
Speech Characteristics ◽  
Quebec French ◽  
Language Assessments ◽  
Almost All

Purpose This study aimed to track changes in acoustical and perceptual features of motor speech in patients with phonetic and prosodic primary progressive apraxia of speech (PPAOS) in Québec French over an 18-month period. Method A prospective multiple-case series with multiple testing periods, including four participants with a diagnosis of PPAOS, was conducted. Participants were 0.5–4 years postonset of disease at baseline. They underwent comprehensive motor speech and language assessments and cognitive screening every 6 months for up to 18 months. Acoustical and perceptual analyses of motor speech were conducted. Results Results showed a considerable impairment in motor speech abilities for patients with PPAOS at all time points and a significant decrease in performance for almost all articulatory and prosodic measures over time. Passage reading and diadochokinesis seemed particularly promising for the tracking of changes in PPAOS motor speech characteristics and PPAOS classification. Quantifying length of speech runs made it possible to distinguish phonetic from prosodic PPAOS. Finally, the patients who evolved to phonetic PPAOS developed aphasia, and the two with prosodic PPAOS showed greater motor symptoms such as unequivocal dysarthria. Conclusion This study extends the growing literature on PPAOS and its subtypes by describing specific changes in articulatory and prosodic abilities over a period of at least 6 months, which are important for the diagnosis and management of PPAOS.

Digital revascularization and replantation using the wide-awake hand surgery technique

2017 ◽  
Vol 42 (6) ◽  
pp. 621-625 ◽  
Author(s):  
JKF Wong ◽  
CH Lin ◽  
NJ Chang ◽  
HC Chen ◽  
YT Lin ◽  
...  
Keyword(s):  
Local Anaesthesia ◽  
Case Series ◽  
Hand Surgery ◽  
Awake Surgery ◽  
Tissue Necrosis ◽  
Level Of Evidence ◽  
Operator Experience ◽  
Soft Tissue Necrosis ◽  
Wide Awake ◽  
Superficial Soft Tissue

The use of local anaesthesia and adrenaline for hand surgery is gaining popularity; however, where vascularity is impaired, wide-awake surgery is considered a contraindication. We present our case series of five digital devascularizations and eight amputations that underwent surgery using the ‘wide-awake’ anaesthetic technique. A temporary digital tourniquet (< 20 min) was used in three cases to identify structures quickly. The anastomoses were performed under local anaesthesia without a tourniquet. All cases had successful re-establishment of blood flow with good perfusion to the digital tips; no cases were re-explored because of vascular crisis. Four cases had minor superficial soft tissue necrosis that healed secondarily. We conclude that digital revascularization and replantation can be performed under local anaesthesia with use of adrenaline and without detriment to the traumatized digit provided careful patient selection and adequate operator experience are available. Level of evidence: IV

scholarly journals Synchronized presentation of a language task to the electrical stimulation of cortical regions during speech mapping in an awake surgery

2018 ◽  
Vol 4 (1) ◽  
pp. 547-550
Author(s):  
Laura Hansmeyer ◽  
Thilo B. Krueger
Keyword(s):  
Electrical Stimulation ◽  
Image Display ◽  
Awake Surgery ◽  
Line Drawings ◽  
Cortical Areas ◽  
Trigger Signal ◽  
Speech Mapping ◽  
Picture Presentation ◽  
Cortical Regions ◽  
Stimulation Of

AbstractIntraoperative speech mapping is performed to preserve language function during tumour resections that involve eloquent cortical areas. For this technique the synchronization of the picture presentation to the patient with the electrical stimulation of the cortex is of major importance. During the operative routine images are manually presented by a psychologist or neurologist to the patient and have to be coordinated with the neurosurgeon stimulating the cortex by a neurostimulator, operated by an engineer. To increase the efficiency of this procedure and to minimize the time needed to localize functional cortical areas, images should appear automatically with electrical stimulation. To achieve this synchronization, the potential combination of an existing neurostimulator with commercially available software for image display was studied. A trigger signal was created to induce the presentation of a series of line drawings showing different objects. The software to control the neurostimulator and the software for image displaying were installed on two different computers. A cable was developed to transfer the trigger signal from the neurostimulator to the computer used for picture presentation. It was shown that it is possible to induce the image display via the neurostimulator using square-wave pulses of 5 V and a width of 10 ms. Thus, we present a system that enables the automated picture presentation synchronized to the electrical stimulation of cortical regions.

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 Neural Changes Induced by a Speech Motor Treatment in Childhood Apraxia of Speech: A Case Series

2021 ◽  
pp. 088307382110158
Author(s):  
Simona Fiori ◽  
Kerstin Pannek ◽  
Irina Podda ◽  
Paola Cipriani ◽  
V. Lorenzoni ◽  
...  
Keyword(s):  
Fractional Anisotropy ◽  
Brain Mri ◽  
Case Series ◽  
Mean Diffusivity ◽  
Treated Group ◽  
Apraxia Of Speech ◽  
Childhood Apraxia Of Speech ◽  
Motor Speech ◽  
Corticobulbar Tract ◽  
Speech Motor

We report a case series of children with childhood apraxia of speech, by describing behavioral and white matter microstructural changes following 2 different treatment approaches. Five children with childhood apraxia of speech were assigned to a motor speech treatment (PROMPT) and 5 to a language, nonspeech oral motor treatment. Speech assessment and brain MRI were performed pre- and post-treatment. The ventral (tongue/larynx) and dorsal (lips) corticobulbar tracts were reconstructed in each subject. Mean fractional anisotropy and mean diffusivity were extracted. The hand corticospinal tract was assessed as a control pathway. In both groups speech improvements paralleled changes in the left ventral corticobulbar tract fractional anisotropy. The PROMPT treated group also showed fractional anisotropy increase and mean diffusivity decrease in the left dorsal corticobulbar tract. No changes were detected in the hand tract. Our results may provide preliminary support to the possible neurobiologic effect of a multimodal speech motor treatment in childhood apraxia of speech.

Intraoperative motor speech mapping under general anesthesia using long-latency response from laryngeal muscles

2020 ◽  
Vol 190 ◽  
pp. 105672
Author(s):  
Elif Ilgaz Aydinlar ◽  
Pinar Yalinay Dikmen ◽  
Muge Kocak ◽  
Emre Sahillioğlu ◽  
M Necmettin Pamir
Keyword(s):  
General Anesthesia ◽  
Motor Speech ◽  
Laryngeal Muscles ◽  
Speech Mapping ◽  
Long Latency ◽  
Latency Response

scholarly journals SURG-10. GRADE TWO GLIOMA SURGERY - A LARGE SINGLE CENTRE REVIEW OF CLINICAL, HISTOLOGICAL, GENETIC AND SURGICAL OUTCOMES

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi241-vi242
Author(s):  
Oliver Richards ◽  
Churl-Su Kwon ◽  
William Bolton ◽  
John Goodden ◽  
Paul Chumas
Keyword(s):  
Statistical Analysis ◽  
Survival Data ◽  
Surgical Outcomes ◽  
Case Series ◽  
Extent Of Resection ◽  
Awake Surgery ◽  
Tumour Resection ◽  
Diffuse Astrocytoma ◽  
Repeat Operation ◽  
Significant Difference

Abstract We analysed the surgical outcomes in a large series of operated grade two glioma patients with emphasis on surgical resection volumes, histology, genetics and survival. All adult glioma patients (200) operated between 2009 and 2016 with histological confirmation of grade two glioma from a single United Kingdom unit were included. Baseline clinical data was obtained along with radiological assessment of the extent of tumour resection, histological diagnosis, mutation status and survival data. Univariate and multivariate statistical analysis was performed. Preliminary analysis of an initial 63 patients had an average follow up of 51 months. A mean tumour resection of 73.9% (Range 14.4–100%), with an average pre-operative tumour volume of 42.2cm3 was achieved. 48 patients underwent awake surgery. There was no significant difference between pre-operative Karnofsky score (93.0) and post-operative (91.6) function. IDH-mutant diffuse astrocytoma (55.5%), IDH-mutant 1p19q co-deleted oligodendroglioma (33.3%) and IDH wildtype diffuse astrocytoma (14.3%) were the commonest histological diagnoses. 32 patients underwent post-operative adjuvant oncology treatment, with 22 requiring repeat operation. Extent of resection in repeat surgeries was 58.6%. Preliminary statistical analysis on this initial sample has demonstrated that every additional year of age at diagnosis however is associated with a 0.5% reduction in resection (p=0.02) and a 0.2% decline in Karnofsky performance (p=&lt; 0.01). Patients with 1p19q co-deletion had a significant increase in progression free survival (PFS) (p=0.04). No significant variables were found to predict the risk of second surgery. Patients with eloquent tumour locations were significantly less likely to suffer post-operative neurological deficits (p&lt; 0.01) Provisional analysis of our case series demonstrates an excellent extent of resection for our cohort of grade two glioma patients. 1p19q co-deletion in this group was significantly associated with improved PFS. Full analysis of the entire patient cohort will be available in time for presenting.

scholarly journals Awake Surgery for Arteriovenous Malformations (AVM) in Eloquent Area: Risk and Outcome Analysis in the Most Complete Case-Collection

2021 ◽  
Author(s):  
Daniele Armocida ◽  
Luca D'Angelo ◽  
Alessandro Pesce ◽  
Veronica Di Palma ◽  
Gaspare Galati ◽  
...  
Keyword(s):  
Performance Status ◽  
Significant Risk ◽  
Case Series ◽  
Neurological Deficits ◽  
Awake Surgery ◽  
Outcome Analysis ◽  
Complete Case ◽  
Increased Risk ◽  
Eloquent Area ◽  
Case Collection

Abstract Background: Artero-venous malformations (AVMs) located in eloquent area are associated with significant risk of neurological deterioration, especially in patients presenting with unruptured AVMs and minimal or no neurological deficits. Awake-surgery allows a better identification of eloquent gyrus, but its feasibility and application in resection of eloquent AVMs is controversial and mostly limited to small case series.Methods: A total of 31 patients suffering from intracranial AVMs have been operated on in our Department. Patients were stratified into two groups: patients submitted to Asleep Surgery and patients submitted to Awake surgery. We implemented the Awake Group with results from the most complete case series reported in the literature to obtain a complete uni and multivariate analysis of surgical risks and outcome.Results: Awake craniotomy was performed in 19,35% of the AVMs treated in our centre. Considering the reported cases from all other series published in the literature, we obtained a comparison between the asleep group of 25 patients derived from our series and the awake group of 34 patients. No statistically significant differences were identified regarding the risk of postoperative complications, surgical radicality, presence of residual, and need for adjuvant treatment. Interestingly, however, improvement in performance status was more rapid and effective during follow-up in patients treated with awake surgery compared with asleep surgery.Conclusions: In contrast to what is commonly believed, applying awake surgery in this type of lesions does not involve increased intra-operative risks, but rather it seems to determine a greater improvement in the outcome of patients from the thirtieth postoperative day. Awake patients allow for more precise brain mapping and superior clinical neurologic monitoring, which facilitates resection by defining the safe margins without an increased risk.

The Labeling Problem in Aphasia

1986 ◽  
Vol 51 (2) ◽  
pp. 176-180 ◽  
Author(s):  
Audrey L. Holland ◽  
Davida Fromm ◽  
Carol S. Swindell
Keyword(s):  
Speech Disorders ◽  
Case Description ◽  
Test Results ◽  
Apraxia Of Speech ◽  
Poor Agreement ◽  
Motor Speech ◽  
Motor Speech Disorders ◽  
Communication Difficulties ◽  
Token Test ◽  
Primary Problem

Twenty-five "experts" on neurogenic motor speech disorders participated in a tutorial exercise. Each was given information on M, a patient who had communication difficulties as the result of stroke, and asked to complete a questionnaire about his problem. The information included a detailed case description, an audiotape of M's speech obtained at 4, 9, 13, and 17 days post-stroke, and test results from the Western Aphasia Battery, the Token Test, and a battery for apraxia of speech. The experts were in excellent agreement on M's primary problem, although it was called by seven different names. The experts were in poor agreement on his secondary problem(s), e.g., the presence and type of aphasia and dysarthria. The results suggest that labeling is difficult, even for "experts." Furthermore, the practicing clinician needs to be sensitive to the likelihood of more than one coexisting problem.

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