Impact of Intraoperative Stimulation Brain Mapping on Glioma Surgery Outcome: A Meta-Analysis

Hamer, Philip C. De Witt; Robles, Santiago Gil; Zwinderman, Aeilko H.; Duffau, Hugues; Berger, Mitchel S.

doi:10.1200/jco.2011.38.4818

Cited by 885 publications

(552 citation statements)

References 33 publications

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“…18,21 To this end, functional mapping for guided resection performed using intraoperative direct stimulation was extensively demonstrated as representing a reliable and efficient technique to maximize the benefit/risk ratio of DLGG in eloquent areas. 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.…”

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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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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“…Preoperative and intraoperative care should be taken to avoid surgical sequelae in the management of gliomas. 24,25 Accurate real-time positioning of intraoperative brain function is among the most important issues for neurosurgeons. In recent studies, R-fMRI was found to be well-correlated with the pre-and postoperative clinical condition of patients.…”

Section: Discussionmentioning

confidence: 99%

Real-Time Motor Cortex Mapping for the Safe Resection of Glioma: An Intraoperative Resting-State fMRI Study

Qiu

Gong

et al. 2017

AJNR Am J Neuroradiol

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“…Improving access to these resources may improve care, optimize resection, and reduce morbidity. 9 Our study does not establish which specific strategies or aspects of high-volume care are associated with improved outcomes. Additional study of clinical and practice barriers to selective referral, such as the distance from low-to high-volume hospitals, and the implications for patients remaining at low-volume hospitals is needed.…”

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confidence: 94%

Surgery for primary supratentorial brain tumors in the United States, 2000–2009: effect of provider and hospital caseload on complication rates

Trinh¹,

Davies²,

Berger³

2015

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OBJECT The object of this study was to examine how procedural volume and patient demographics impact complication rates and value of care in those who underwent biopsy or craniotomy for supratentorial primary brain tumors. METHODS The authors conducted a retrospective cohort study using data from the Nationwide Inpatient Sample (NIS) on 62,514 admissions for biopsy or resection of supratentorial primary brain tumors for the period from 2000 to 2009. The main outcome measures were in-hospital mortality, routine discharge proportion, length of hospital stay, and perioperative complications. Associations between these outcomes and hospital or surgeon case volumes were examined in logistic regression models stratified across patient characteristics to control for presentation of disease and comorbid risk factors. The authors further computed value of care, defined as the ratio of functional outcome to hospital charges. RESULTS High-case-volume surgeons and hospitals had superior outcomes. After adjusting for patient characteristics, high-volume surgeon correlated with reduced complication rates (OR 0.91, p = 0.04) and lower in-hospital mortality (OR 0.43, p < 0.0001). High-volume hospitals were associated with reduced in-hospital mortality (OR 0.76, p = 0.003), higher routine discharge proportion (OR 1.29, p < 0.0001), and lower complication rates (OR 0.93, p = 0.04). Patients treated by high-volume surgeons were less likely to experience postoperative hematoma, hydrocephalus, or wound complications. Patients treated at high-volume hospitals were less likely to experience mechanical ventilation, pulmonary complications, or infectious complications. Worse outcomes tended to occur in African American and Hispanic patients and in those without private insurance, and these demographic groups tended to underutilize high-volume providers. CONCLUSIONS A high-volume status for hospitals and surgeons correlates with superior value of care, as well as reduced in-hospital mortality and complications. These findings suggest that regionalization of care may enhance patient outcomes and improve value of care for patients with primary supratentorial brain tumors.

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Impact of Intraoperative Stimulation Brain Mapping on Glioma Surgery Outcome: A Meta-Analysis

Abstract: Glioma resections using ISM are associated with fewer late severe neurologic deficits and more extensive resection, and they involve eloquent locations more frequently. This indicates that ISM should be universally implemented as standard of care for glioma surgery.

Cited by 885 publications

References 33 publications

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

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

Real-Time Motor Cortex Mapping for the Safe Resection of Glioma: An Intraoperative Resting-State fMRI Study

Surgery for primary supratentorial brain tumors in the United States, 2000–2009: effect of provider and hospital caseload on complication rates

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