An update on tests used for intraoperative monitoring of cognition during awake craniotomy

Acta Neurochirurgica, Journal Year: 2024, Volume and Issue: 166(1)

Published: May 7, 2024

Abstract Purpose Mapping higher-order cognitive functions during awake brain surgery is important for preservation which related to postoperative quality of life. A systematic review from 2018 about neuropsychological tests used craniotomy made clear that until 2017 language was most often monitored and the other domains were underexposed (Ruis, J Clin Exp Neuropsychol 40(10):1081–1104, 218). The field monitoring however developing rapidly. aim current therefore, investigate whether there a change in towards incorporation new more complete mapping (higher-order) functions. Methods We replicated search study PubMed Embase February November 2023, yielding 5130 potentially relevant articles. artificial machine learning tool ASReview screening included 272 papers gave detailed description craniotomy. Results Comparable previous 2018, majority studies (90.4%) reported assessing Nevertheless, an increasing number now also describe visuospatial functions, social cognition, executive Conclusions Language remains extensively tested domain. However, broader range are implemented (new developed) received attention. rapid development reflected this review. some (e.g., memory), still need can be surgery.

Language: Английский

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Safety and Efficacy in the Transcortical and Transsylvian Approach in Insular High-Grade Gliomas: A Comparative Series of 58 Patients

Current Oncology, Journal Year: 2025, Volume and Issue: 32(2), P. 98 - 98

Published: Feb. 10, 2025

Gliomas within the insular region represent one of most challenging problems in neurosurgical oncology. There are two main surgical approaches to address complex vascular network and functional areas around insula: transsylvian approach transcortical approach. In literature, there is not a clear consensus on best terms safety efficacy. The purpose this study evaluate effectiveness these analyze prognostic factors natural history gliomas. Patients with newly diagnosed high-grade gliomas who underwent surgery between January 2019 June 2024 were analyzed. series was analyzed according classification Berger-Sanai Yaşargil. Karnofsky performance score (KPS), extent resection (EOR), progression-free survival (PFS), overall (OS) considered outcome measures. A total 58 primary glioma patients enrolled study. IDH mutation found 13/58 (22.4%); specifically, 3/13 (23.1%) grade 4, 10/13 (76.9%) 3. Furthermore, 40/58 (69%) gross (GTR), 15 (26%) subtotal resection, 3 (5%) partial resection. Middle cerebral artery encasement negatively affected OS. GTR, radiotherapy, KPS, autonomous deambulation at month after positively used 11 47 cases, respectively. comparison different did display differences neurological deficits OS (p > 0.05). related greater achievement GTR = 0.031). According classification, has higher EOR postoperative KPS when lesion zone III-IV 0.029). Greater can be achieved an acceptable morbidity profile predictive improved Both corridors insula associated low profiles. intraoperative mapping more favorable for achieving EOR, particularly inferior border Sylvian fissure.

Language: Английский

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Electrostimulation of the white matter of the posterior insula and medial operculum: perception of vibrations, heat, and pain

Pain, Journal Year: 2023, Volume and Issue: unknown

Published: Oct. 20, 2023

Abstract This study aimed to characterize the sensory responses observed when electrically stimulating white matter surrounding posterior insula and medial operculum (PIMO). We reviewed patients operated on under awake conditions for a glioma located in temporoparietal junction. Patients' perceptions were retrieved from operative reports. Stimulation points registered Montreal Neurological Institute template. A total of 12 stimulation 8 analyzed. Painful sensations contralateral leg reported (5 sites 5 patients) close parcel OP2/3 Glasser atlas. Pain had diverse qualities: burning, tingling, crushing, or electric shock. More laterally, OP1, pain heat upper part body described 2 patients). Intermingled with these sites, vibration also (3 Based tractograms 44 subjects Human Connectome Project data set, we built template pathways linking thalamus OP1. thalamo-OP2/3 thalamo-OP1 tracts. Heat tract. In 227 surgeries performed tumor outside PIMO region, no ever matter. Thus, propose that thalamo-PIMO connections constitute main cortical inputs nociception thermoception emphasize preserving fibers is utmost importance prevent postoperative onset debilitating insulo-opercular syndrome.

Language: Английский

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Incidence of ischemic complications and technical nuances of arteries preservation for insular gliomas resection

Frontiers in Surgery, Journal Year: 2022, Volume and Issue: 9

Published: Oct. 14, 2022

Insular gliomas have complex anatomy and microvascular supply that make resection difficult. Furthermore, of insular glioma is associated with a significant risk postoperative ischemic complications. Thus, this study aimed to assess the incidence complications related resection, determine its factors, describe single surgeon's experience artery-preserving tumor resection. We enrolled 75 consecutive patients who underwent transcortical Preoperative demographic, clinical, radiological [including diffusion-weighted imaging (DWI)], intraoperative neurophysiological data, functional outcomes were analyzed. Motor evoked potentials (MEPs) characteristics like relationship between proximal segment lateral lenticulostriate arteries (LLSAs) tumor, flat inner edge sign (the well-defined) or obscure sign, distance lesion posterior limb internal capsule invasion superior limiting sulcus by Strategies such as "residual triangle," "basal ganglia outline reappearance," "sculpting" technique used preserve LLSAs main branches M2 for maximal according Berger-Sinai classification. Postoperative DWI showed acute ischemia in 44 (58.7%). Moreover, nine (12%) had developed new motor deficits, determined treating neurosurgeons. The [odds ratio (OR), 0.144; 95% confidence interval (CI), 0.024-0.876) MEPs (>50%) (OR, 18.182; CI, 3.311-100.00) significantly core ischemia, which affected corona radiata. was high detected DWI, well deficits signs decline >50% higher developing ischemia. With our strategies, safe may be achieved.

Language: Английский

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Development of an educational method to rethink and learn oncological brain surgery in an “a la carte” connectome-based perspective

Acta Neurochirurgica, Journal Year: 2023, Volume and Issue: 165(9), P. 2489 - 2500

Published: May 18, 2023

Language: Английский

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Stereotactic Photodynamic Therapy of Recurrent Malignant Gliomas

Sovremennye tehnologii v medicine, Journal Year: 2024, Volume and Issue: 16(2), P. 58 - 58

Published: April 27, 2024

is to assess the effectiveness and safety of stereotactic photodynamic therapy (sPDT) with 5-aminolevulinic acid (5-ALA) in patients recurrent malignant supratentorial gliomas functionally relevant brain areas.

Language: Английский

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Maximal safe resection of diffuse lower grade gliomas primarily within central lobe using cortical/subcortical direct electrical stimulation under awake craniotomy

Frontiers in Oncology, Journal Year: 2023, Volume and Issue: 13

Published: Feb. 21, 2023

Diffuse lower-grade glioma (DLGG) in the central lobe is a challenge for safe resection procedures. To improve extent of and reduce risk postoperative neurological deficits, we performed an awake craniotomy with cortical-subcortical direct electrical stimulation (DES) mapping patients DLGG located primarily within lobe. We investigated outcomes brain using DES resection.We retrospective analysis clinical data cohort consecutively treated from February 2017 to August 2021 diffuse gliomas All underwent cortical subcortical eloquent areas, neuronavigation, and/or ultrasound identify tumor location. Tumors were removed according functional boundaries. Maximum was surgical objective all patients.Thirteen 15 craniotomies intraoperative cortices fibers DES. achieved boundaries patients. The pre-operative volumes ranged 4.3 cm3 137.3 (median 19.2 cm3). mean 94.6%, eight cases (53.3%) achieving total resection, four (26.7%) subtotal three (20.0%) partial. residue 1.2 cm3. experienced early deficits or worsening conditions. Three late at 3-month follow-up, including one moderate two mild deficits. None onset severe impairments post-operatively. Ten 12 resections (80.0%) had resumed activities daily living follow-up. Among 14 epilepsy, (85.7%) seizure-free after treatment antiepileptic drugs 7 days surgery up last follow-up.DLGG deemed inoperable can be safely resected without permanent sequelae. Patients improved quality life terms seizure control.

Language: Английский

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Photodynamic interstitial stereotactic therapy for recurrent malignant glioma

Asian Journal of Oncology, Journal Year: 2023, Volume and Issue: 9, P. 14 - 14

Published: Oct. 4, 2023

Objectives Stereotactic photodynamic therapy (sPDT) using 5-aminolaevulinic acid (5-ALA) as a cytotoxic photosensitizer may be potentially prospective treatment option for malignant gliomas. Material and Methods We analyzed data from 10 patients with recurrent gliomas of the brain who were treated sPDT at Department Neurosurgery Military-Medical Academy S. M. Kirov, 2020 to November 2021. Three again after 3, 7, 15 months due relapse. Results The median age was 55.5 years, range 30–60 there six men four women. At time sPDT, 7 (70%) tumors diagnosed glioblastomas (WHO grade IV), 3 (30%) anaplastic astrocytomas III). Tumors without IDH mutation in patients; MGMT gene expression status evaluated 9 (90%) patients. A 1p/19q co-deletion not detected any tumor volume 5.85 cm (min. 3.2 , max. 22.5 ). have found that recurrence-free period 435 195 days, respectively. Conclusion This result allows consider one perspective methods high malignancy cases when repeated open surgical intervention has risks new neurological deficit.

Language: Английский

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Intraoperative Nuances of Awake Craniotomy <Surgical Nuances, Awake Craniotomy>

Published: Jan. 1, 2023

Awake craniotomy (AC) with intraoperative brain mapping is a neurosurgical technique used to obtain maximal safe resections in eloquent areas [1]. It commonly employed neuro-oncology and functional neurosurgery [2]. This can also be access deep lesions that require manipulation of more superficial sites [3]. Successful coordination between the neurosurgeon, neuro-anesthesiologist, nurses, patients, other participating personnel during procedure tantamount successful operation [4]. requires practice repetition provide most benefit for patients. There are steps process not only rehearsed but anticipated so mistakes may avoided.

Language: Английский

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Hyperechoic Area Under Insular Gliomas: A Potentially Hazardous Intraoperative Ultrasound Artifact

World Neurosurgery, Journal Year: 2023, Volume and Issue: 182, P. e899 - e904

Published: Dec. 21, 2023

Language: Английский

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