Evidence for potentials and limitations of brain plasticity using an atlas of functional resectability of WHO grade II gliomas: Towards a “minimal common brain”

Ius, Tamara; Angelini, Elsa D.; Schotten, Michel Thiebaut de; Mandonnet, Emmanuel; Duffau, Hugues

doi:10.1016/j.neuroimage.2011.03.022

Cited by 329 publications

(245 citation statements)

References 83 publications

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“…[22][23][24]27,28,30,37,43 Indeed, LGGs have a clear propensity for the insular lobe, spreading along the intricate network of afferent and efferent connections. 15,16,19 Moreover, due to the surrounding functional and vascular structures, the resection of insular tumors is risky and challenging.…”

Section: Discussionmentioning

confidence: 99%

“…27,28,46,55 The extent of tumor resection was calculated, by using pre-and postoperative T2-weighted MR images, on the basis of the methodology described by Smith et al: (preoperative tumor volume -postoperative tumor volume)/preoperative tumor volume. 56 For the postoperative volume reconstructions, we used MR images in DICOM format (Digital Imaging and Communications in Medicine) from MRI studies performed 4 months after surgery.…”

Section: Volumetric Analysismentioning

confidence: 99%

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Surgery for insular low-grade glioma: predictors of postoperative seizure outcome

Ius

Pauletto

Isola

et al. 2014

JNS

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Object. Although a number of recent studies on the surgical treatment of insular low-grade glioma (LOG) have demonstrated that aggressive resection leads to increased overall patient survival and decreased malignant progression, less attention has been given to the results with respect to tumor-related epilepsy. The aim of this investigation was to evaluate the impact of volumetric, histological, and intraoperative neurophysiological factors on seizure outcome in patients with insular LGG. \ud Methods. The authors evaluated predictors of seizure outcome with special emphasis on both the extent of tumor resection (EOR) and the tumor's infiltrative pattern quantified by computing the difference between the preoperative T2- and Ti-weighted MR images (Delta VT2T1) in 52 patients with preoperative drug-resistant epilepsy. \ud Results. The 12-month postoperative seizure outcome (Engel class) was as follows: seizure free (Class I), 67.31%; rare seizures (Class II), 7.69%; meaningful seizure improvement (Class III), 15.38%; and no improvement or worsening (Class IV), 9.62%. Poor seizure control was more common in patients with a longer preoperative seizure history (p < 0.002) and higher frequency of seizures (p = 0.008). Better seizure control was achieved in cases with EOR >= 90% (p < 0.001) and Delta VT2T1 < 30 cm(3) (p < 0.001). In the final model, Delta VT2T1 proved to be the strongest independent predictor of seizure outcome in insular LGG patients (p < 0.0001). \ud Conclusions. No or little postoperative seizure improvement occurs mainly in cases with a prevalent infiltrative tumor growth pattern, expressed by high Delta VT2T1 values, which consequently reflects a smaller BOR

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Section: Discussionmentioning

confidence: 99%

Section: Volumetric Analysismentioning

confidence: 99%

Surgery for insular low-grade glioma: predictors of postoperative seizure outcome

Ius

Pauletto

Isola

et al. 2014

JNS

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“…4,6,9,24 Intrasurgical electrical mapping is particularly useful to identify the white matter tracts, because the brain's plastic potential is low at the subcortical level: any damage of the neural connectivity will generate permanent deficits. 7,28 In this study we used intraoperative axonal electrostimulation in awake patients to map the different pathways running in the SS. Thanks to this method, original anatomofunctional correlations have been performed, enabling a better understanding of the role of this cerebral structure.…”

Section: Surgical and Functional Considerationsmentioning

confidence: 99%

Awake mapping for low-grade gliomas involving the left sagittal stratum: anatomofunctional and surgical considerations

Chan-Seng¹,

Moritz‐Gasser

Duffau

2014

JNS

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P atients with diffuse low-grade glioma ([DLGG]; that is, Grade II glioma according the WHO classification) tend to live many years after diagnosis, with surgery helping to further extend survival time. 2,29,49,50,53 Indeed, despite the lack of Class I evidence demonstrating that DLGG surgery improved survival, Jakola et al. 29 recently investigated survival in population-based parallel cohorts of patients with DLGGs from 2 Norwegian university hospitals with different surgical treatment strategies. They demonstrated that treatment at a center that favored early resection was associated with better overall survival (median survival not reached) than treat- Object. Preserving function while optimizing the extent of resection is the main goal in surgery for diffuse lowgrade glioma (DLGG). This is particularly relevant for DLGG involving the sagittal stratum (SS), where damage can have severe consequences. Indeed, this structure is a major crossroad in which several important fascicles run. Thus, its complex functional anatomy is still poorly understood. Subcortical electrical stimulation during awake surgery provides a unique opportunity to investigate white matter pathways. This study reports the findings on anatomofunctional correlations evoked by stimulation during resection for gliomas involving the left SS. Surgical outcomes are also detailed.Methods. The authors performed a review of patients who underwent awake surgery for histopathologically confirmed WHO Grade II glioma involving the left SS in the neurosurgery department between August 2008 and August 2012. Information regarding clinicoradiological features, surgical procedures, and outcomes was collected and analyzed. Intraoperative electrostimulation was used to map the eloquent structures within the SS.Results. Eight consecutive patients were included in this study. There were 6 men and 2 women, whose mean age was 41.7 years (range 32-61 years). Diagnosis was made because of seizures in 7 cases and slight language disorders in 1 case. After cortical mapping, subcortical stimulation detected functional fibers running in the SS in all patients: semantic paraphasia was generated by stimulating the inferior frontooccipital fascicle in 8 cases; alexia was elicited by stimulating the inferior longitudinal fascicle in 3 cases; visual disorders were induced by stimulating the optic radiations in 5 cases. Moreover, in front of the SS, phonemic paraphasia was evoked by stimulating the temporal part of the arcuate fascicle in 5 patients. The resection was stopped according to these functional limits in the 8 patients. After a transient postsurgical worsening, all patients recovered to normal results on examination, except for the persistence of a right superior quadrantanopia in 5 cases, with no consequences for quality of life. The 8 patients returned to a normal social and professional life. Total or subtotal resection was achieved in all cases but one.Conclusions. The authors suggest that the use of intrasurgical electrical mapping of the white matter pathway...

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“…11,16,17,20,42,54,76 Although we are gaining more and more information about the distribution of human language function and the associated networks, mapping is still very complex and has to be further refined. 10,16,30,31,46,54,65 Thus, there is a need to assess functional cortical organization of language function by noninvasive methods. Navigated transcranial magnetic stimulation (nTMS) is one of these noninvasive techniques.…”

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confidence: 99%

Combined noninvasive language mapping by navigated transcranial magnetic stimulation and functional MRI and its comparison with direct cortical stimulation

Ille

Sollmann

Hauck

et al. 2015

JNS

100

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T he resection of tumors within or adjacent to language-eloquent brain regions is still a neurosurgical quest, and a profound presurgical workup is crucial to achieving the best functional and oncological result. 6,71 Today, the most precise way to localize individual language-eloquent regions is direct cortical stimulation (DCS) during awake craniotomy. 9,12,26,44,45,54,62,65,74 Using only DCS, however, we cannot provide the longitudinal abbreviatioNs BOLD = blood oxygen level-dependent; CPS = cortical parcellation system; DCS direct cortical stimulation; ER = error rate; ERT error rate threshold; fMRI = functional MRI; IPI = interpicture interval; NPV = negative predictive value; nTMS navigated TMS; PPV = positive predictive value; PTI = picture-to-trigger interval; RMT = resting motor threshold; ROC = receiver operating characteristic; rTMS repetitive navigated TMS; TMS = transcranial magnetic stimulation. obJect Repetitive navigated transcranial magnetic stimulation (rTMS) is now increasingly used for preoperative language mapping in patients with lesions in language-related areas of the brain. Yet its correlation with intraoperative direct cortical stimulation (DCS) has to be improved. To increase rTMS's specificity and positive predictive value, the authors aim to provide thresholds for rTMS's positive language areas. Moreover, they propose a protocol for combining rTMS with functional MRI (fMRI) to combine the strength of both methods. methods The authors performed multimodal language mapping in 35 patients with left-sided perisylvian lesions by using rTMS, fMRI, and DCS. The rTMS mappings were conducted with a picture-to-trigger interval (PTI, time between stimulus presentation and stimulation onset) of either 0 or 300 msec. The error rates (ERs; that is, the number of errors per number of stimulations) were calculated for each region of the cortical parcellation system (CPS). Subsequently, the rTMS mappings were analyzed through different error rate thresholds (ERT; that is, the ER at which a CPS region was defined as language positive in terms of rTMS), and the 2-out-of-3 rule (a stimulation site was defined as language positive in terms of rTMS if at least 2 out of 3 stimulations caused an error). As a second step, the authors combined the results of fMRI and rTMS in a predefined protocol of combined noninvasive mapping. To validate this noninvasive protocol, they correlated its results to DCS during awake surgery. results The analysis by different rTMS ERTs obtained the highest correlation regarding sensitivity and a low rate of false positives for the ERTs of 15%, 20%, 25%, and the 2-out-of-3 rule. However, when comparing the combined fMRI and rTMS results with DCS, the authors observed an overall specificity of 83%, a positive predictive value of 51%, a sensitivity of 98%, and a negative predictive value of 95%. coNclusioNs In comparison with fMRI, rTMS is a more sensitive but less specific tool for preoperative language mapping than DCS. Moreover, rTMS is most reliable when using ERTs of 15%, 20...

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Evidence for potentials and limitations of brain plasticity using an atlas of functional resectability of WHO grade II gliomas: Towards a “minimal common brain”

Cited by 329 publications

References 83 publications

Surgery for insular low-grade glioma: predictors of postoperative seizure outcome

Surgery for insular low-grade glioma: predictors of postoperative seizure outcome

Awake mapping for low-grade gliomas involving the left sagittal stratum: anatomofunctional and surgical considerations

Combined noninvasive language mapping by navigated transcranial magnetic stimulation and functional MRI and its comparison with direct cortical stimulation

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