glioma surgery
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Author(s):  
Nicholas B. Dadario ◽  
Ashraf Zaman ◽  
Madhavi Pandya ◽  
Brian J. Dlouhy ◽  
Manuri P. Gunawardena ◽  
...  

2022 ◽  
Vol 6 (1) ◽  
pp. V5

Maximal safe resection is the primary goal of glioma surgery. By incorporating improved intraoperative visualization with the 3D exoscope combined with 5-ALA fluorescence, in addition to neuronavigation and diffusion tensor imaging (DTI) fiber tracking, the safety of resection of tumors in eloquent brain regions can be maximized. This video highlights some of the various intraoperative adjuncts used in brain tumor surgery for high-grade glioma. In this case, the authors highlight the resection of a left posterior temporal lobe high-grade glioma in a 33-year-old patient, who initially presented with seizures, word-finding difficulty, and right-sided weakness. They demonstrate the multiple surgical adjuncts used both before and during surgical resection, and how multiple adjuncts can be effectively orchestrated to make surgery in eloquent brain areas safer for patients. Patient consent was obtained for publication. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21174


2022 ◽  
Vol 224 ◽  
pp. 105057
Author(s):  
Andrey Zyryanov ◽  
Ekaterina Stupina ◽  
Elizaveta Gordeyeva ◽  
Olga Buivolova ◽  
Evdokiia Novozhilova ◽  
...  

2022 ◽  
Vol 6 (1) ◽  
pp. V10

Maximal safe resection is the goal of insular glioma surgery. The combination of intraoperative augmented reality (AR) diffusion tensor imaging (DTI) fiber tracking with fluorescein dye (F) helps achieve this goal throughout a microscope-based visualization of the tumor and white matter fiber tracts. The aim of the present video article was to show the technical key aspects of DTI-F microscope-based AR-assisted surgery during the gross-total resection of an insular Berger-Sanai type I+IV high-grade glioma in a 63-year-old patient, performed through a pterional transsylvian approach. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID2157


Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 6127
Author(s):  
Nardin Samuel ◽  
Artur Vetkas ◽  
Aditya Pancholi ◽  
Can Sarica ◽  
Aaron Loh ◽  
...  

The evaluation and manipulation of structural and functional networks, which has been integral to advancing functional neurosurgery, is beginning to transcend classical subspecialty boundaries. Notably, its application in neuro-oncologic surgery has stimulated an exciting paradigm shift from the traditional localizationist approach, which is lacking in nuance and optimization. This manuscript reviews the existing literature and explores how structural and functional connectivity analyses have been leveraged to revolutionize and individualize pre-operative tumor evaluation and surgical planning. We describe how this novel approach may improve cognitive and neurologic preservation after surgery and attenuate tumor spread. Furthermore, we demonstrate how connectivity analysis combined with neuromodulation techniques can be employed to induce post-operative neuroplasticity and personalize neurorehabilitation. While the landscape of functional neuro-oncology is still evolving and requires further study to encourage more widespread adoption, this functional approach can transform the practice of neuro-oncologic surgery and improve the care and outcomes of patients with intra-axial tumors.


2021 ◽  
pp. 341-347
Author(s):  
Giovanni Muscas ◽  
Simone Orlandini ◽  
Eleonora Becattini ◽  
Francesca Battista ◽  
Victor E. Staartjes ◽  
...  

2021 ◽  
pp. 173-180
Author(s):  
Manabu Tamura ◽  
Ikuma Sato ◽  
Yoshihiro Muragaki

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi13-vi13
Author(s):  
Kuniaki Saito ◽  
Nobuyoshi Sasaki ◽  
Yosuke Seiya ◽  
Ryo Onoda ◽  
Keiichi Kobayashi ◽  
...  

Abstract INTRODUCTION: Maximal safe glioma resection should be achieved using neuronavigation, electrophysiological monitoring, fluorescence visual system, and so on. Heads-up surgery with exoscope is suitable for the multimodal glioma surgery because multi-monitors come in our sights simultaneously. We introduce our glioma surgery using a latest exoscope and neuronavigation system. METHODS: We attempted maximal safe resection for the patients with high grade glioma using 3D/4K exoscope with 5-ALA-induced fluorescence, neuronavigation, and electrophysiological monitoring or awake mapping. An extent of resection, morbidity, and postoperative infarction were retrospectively reviewed. RESULTS: Twenty-one patients (age 26–79, male 11/female 10, glioblastoma 10/lower grade glioma 11, general anesthesia 16/awake craniotomy 5) underwent exoscopic tumor removal. Neuronavigation and electrophysiological monitoring were displayed in sub-monitors close to the main screen. Navigation could be recognized continuously using electromagnetic navigation technology. Intraoperative fluorescence was observed in 100% of the tumor with gadolinium enhancement. Surrounding structures such as white matter, vessels and nerves were clearly visualized under blue light. Supra-total resection or gross total resection was achieved in 8 (80%) of the patients with glioblastoma. Surgical morbidity included hemiparesis in 1 (4.8%) patient, hemianopsia in 1 (4.8%) patient. Postoperative infarction was observed in 2 (9.5%) patients, which was significantly lower compared to 23 of 77 (29.9%) patients with glioblastoma who underwent tumor resection with fluorescence-equipped microscope (p<0.05). CONCLUSION: High resolution exoscope surgery is effective for patients undergoing glioma surgery with respect to higher extent of resection and lower ischemic complication. Further studies are needed to assess direct comparisons between exoscope and microscope glioma resection.


2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi21-vi21
Author(s):  
Tomoyuki Kawataki ◽  
Mitsuto Hanihara ◽  
Masakazu Ogiwara ◽  
Hiroyuki Kinouchi

Abstract OBJECTIVE: In motor eloquent glioma surgery, the value of intraoperative diffusion tensor (iDT) imaging was not established to preserve motor function. This study aimed to investigate a relationship between postoperative motor function and iDT imaging parameters, including fractional anisotropy (FA), mean diffusivity (MD), and shortest distance (SD) from resected tumor margin to the corticospinal tract (CST) of gliomas in motor eloquent areas. METHODS: This retrospective study enrolled 20 patients with newly diagnosed supratentorial glioma who underwent surgery and intraoperative magnetic resonance imaging at our hospital. Patients were divided into two groups (i.e., worsening and non-worsening groups) based on their manual muscle test scores before and three months after surgery. We obtained the mean FA and MD values bilaterally, along with identification of the CST and determined the ratios (the affected side / the contralateral side). The SD was measured between the CST and the resected margin of the tumor. We evaluated the quantitative analysis of these parameters related to motor functional outcomes. Moreover the correlation was measured between these parameters and the maximum reduction rate of cortical motor evoked potentials (MEPs) during surgery. RESULTS: In the worsening group (n = 5), the mean FA ratio was lower and the mean MD ratio was higher compared with the non-worsening group (n = 15; P < 0.001 and P < 0.01, respectively). Cut-off values were 0.87 for FA and 1.08 for MD. SD was 7.95 mm in the non-worsening group and 0.44 mm in the worsening group (P < 0.01). These iDT based parameters, the mean FA ratio and the SD, were well correlated with the maximum reduction rate in MEP (R = 0.72 and 0.80, respectively). CONCLUSIONS: The mean ratio of FA, MD, and SD using iDT imagings predict postoperative motor function and help in optimal surgical planning in patients with motor eloquent glioma.


Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S167-S167
Author(s):  
David Pitskhelauri ◽  
Andrey Bykanov ◽  
Alexander Konovalov ◽  
Gleb Danilov ◽  
Svetlana Buklina ◽  
...  

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