Application of Awake Craniotomy and Intraoperative Brain Mapping for Surgical Resection of Insular Gliomas of the Dominant Hemisphere

Alimohamadi, Maysam; Shirani, Mohammad; Moharari, Reza Shariat; Pour-Rashidi, Ahmad; Ketabchi, Mehdi; Khajavi, Mohammadreza; Arami, Mohamadali; Amirjamshidi, Abbas

doi:10.1016/j.wneu.2016.04.079

Cited by 57 publications

(31 citation statements)

References 24 publications

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“…Diffuseness was not measured, so it cannot be compared to reports in the literature, but tumor size was measured. The mean tumor size was 61.2 cm 3 in the AC group and 54.6 cm 3 in the GA group, which contrasts with, for example, the mean tumor size of 107.7 cm 3 reported in the study by Alimohamadi et al [23].…”

Section: Discussioncontrasting

confidence: 77%

“…In addition, GBMs with central necrosis are easier to distinguish from normal brain tissue than are low grade gliomas, allowing easier resection without the need to map the region. In the literature, the median EOR for insular gliomas varies from 83.4 to 86.2% [7,10,23]. However, only Lang et al reported the EOR for the non-glioblastoma group separately (median EOR, 86%) [5].…”

Section: Discussionmentioning

confidence: 99%

“…New early deficits were more prevalent in the AC group, and new late deficits were more prevalent in the GA group, but the differences were not significant. allow resection while ensuring clear demarcation of the functional language area in order to preserve this function [23].…”

Section: Choice Of Anesthesia Techniquementioning

confidence: 99%

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Awake craniotomy versus craniotomy under general anesthesia for the surgical treatment of insular glioma: choices and outcomes

Gravesteijn

Keizer

Vincent

et al. 2017

Neurological Research

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Objective: To investigate differences in outcomes in patients who underwent surgery for insular glioma using an awake craniotomy (AC) vs. a craniotomy under general anesthesia (GA). Methods:Data from patients treated at our hospital between 2005 and 2015 were analyzed retrospectively. The preoperative, intraoperative, postoperative, and longer term follow-up characteristics and outcomes of patients who underwent surgery for primary insular glioma using either an AC or GA were compared. Results: Of the 52 identified patients, 24 had surgery using an AC and 28 had surgery under GA. The extent of resection was similar for the two anesthesia techniques: the median extent of resection was 61.4% (IQR: 37.8-74.3%) in the WHO grade <4 AC group vs. 50.5% (IQR: 35.0-71.2%) in the grade <4 GA group and 73.4% (IQR: 54.8-87.2%) in the grade 4 AC group vs. 88.6% (IQR: 61.2-93.0%) in the grade 4 GA group. Consistent with literature, there were more early neurological deficits after an AC, while the GA group showed more new late neurological deficits; however, these trends were not significant. Survival was similar between the two groups, with 100% 1-and 2-year survival in the grade <4 groups. Conclusion: Our results showed that the extent of resection, neurological outcomes, and survival were similar using the two anesthesia techniques. Since AC is more challenging for the patient and for his or her caregiver after surgery, this finding has implications for clinical decision-making.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Awake craniotomy versus craniotomy under general anesthesia for the surgical treatment of insular glioma: choices and outcomes

Gravesteijn

Keizer

Vincent

et al. 2017

Neurological Research

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“…Different from other tumors, the surgery area of glioma must be strictly restricted to the tumor region to avoid impairment of the normal function of the brain. Gross total resection with a low risk of morbidity (i.e., onco-functional balance) is considered as the goal of surgery [34]. Thus, in the current study, AR and SVIP expression in each grade glioma tissue are mostly compared with normal tissues, instead of peritumoral tissues (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

Regulation of p53wt glioma cell proliferation by androgen receptor-mediated inhibition of small VCP/p97-interacting protein expression

et al. 2017

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The incidence of glioma in men is higher than that in women; however, little is known about the expression and basic function of the androgen receptor (AR) in gliomas. AR inhibited the small VCP/p97-interacting protein (SVIP) on the transcriptional level was previously reported. The present study shows that the protein level of AR is highly expressed in cell lines of the nervous system. Moreover, the AR expression is increased while SVIP expression is decreased in tumor tissue of glioma patients, which is in agreement with the progressing WHO grades. A statistically significant increase in serum testosterone level of glioma patients compared with that of non-cancer patients was also detected. Furthermore, it has been proved that SVIP is down-regulated as well as AR is up-regulated in glioma cell lines with R1881 treatment. Interestingly, the depletion of SVIP using siRNA facilitated cell proliferation and decreased p53 expression. In addition, overexpression of SVIP increased cell death only in p53wt cell lines. Moreover, U87MG cells, p53wt cell line was susceptible to AR antagonists in vitro and in vivo. The current study provides insight into the biological role of AR in suppressing SVIP and p53 and promoting the progression of glioma as well as the clinical treatment of glioma patients.

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“…11,25 Recommendations included the following: 1) wide splitting of the sylvian fissure, 2) awake craniotomy with cortical and subcortical mapping to identify the overlying motor cortex tract and the internal capsule subcortically, and 3) meticulous suprasylvian dissection to avoid coagulation of the long perforating M 2 segment and lateral lenticulostriate arteries during tumor resection. 2,9,11,12,25,31,32,37 Long-term 3-month neurological complication rates subsequently dropped to 8%-10%. 11,19,25…”

Section: Surgery For Insular Tumors Prior To the Modern Eramentioning

confidence: 99%

Insular glioma surgery: an evolution of thought and practice

Hervey-Jumper¹,

Berger²

2019

Journal of Neurosurgery

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OBJECTIVEThe goal of this article is to review the history of surgery for low- and high-grade gliomas located within the insula with particular focus on microsurgical technique, anatomical considerations, survival, and postoperative morbidity.METHODSThe authors reviewed the literature for published reports focused on insular region anatomy, neurophysiology, surgical approaches, and outcomes for adults with World Health Organization grade II–IV gliomas.RESULTSWhile originally considered to pose too great a risk, insular glioma surgery can be performed safely due to the collective efforts of many individuals. Similar to resection of gliomas located within other cortical regions, maximal resection of gliomas within the insula offers patients greater survival time and superior seizure control for both newly diagnosed and recurrent tumors in this region. The identification and the preservation of M2 perforating and lateral lenticulostriate arteries are critical steps to preventing internal capsule stroke and hemiparesis. The transcortical approach and intraoperative mapping are useful tools to maximize safety.CONCLUSIONSThe insula’s proximity to middle cerebral and lenticulostriate arteries, primary motor areas, and perisylvian language areas makes accessing and resecting gliomas in this region challenging. Maximal safe resection of insular gliomas not only is possible but also is associated with excellent outcomes and should be considered for all patients with low- and high-grade gliomas in this area.

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Application of Awake Craniotomy and Intraoperative Brain Mapping for Surgical Resection of Insular Gliomas of the Dominant Hemisphere

Cited by 57 publications

References 24 publications

Awake craniotomy versus craniotomy under general anesthesia for the surgical treatment of insular glioma: choices and outcomes

Awake craniotomy versus craniotomy under general anesthesia for the surgical treatment of insular glioma: choices and outcomes

Regulation of p53wt glioma cell proliferation by androgen receptor-mediated inhibition of small VCP/p97-interacting protein expression

Insular glioma surgery: an evolution of thought and practice

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