Intraoperative subcortical stimulation mapping of language pathways in a consecutive series of 115 patients with Grade II glioma in the left dominant hemisphere

Duffau, Hugues; Gatignol, S T Peggy; Mandonnet, Emmanuel; Laurent, Césari; Taillandier, Luc

doi:10.3171/jns/2008/109/9/0461

Cited by 438 publications

(362 citation statements)

References 76 publications

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“…However, even in cases of maximal resection, the percentage of patients who obtain seizure control has been described as ranging from 65% to 80%. 9,13,16,18 Beyond the oncological benefit of extensive resection, these data suggest that the EOR is a strong predictor of postoperative seizure outcome in insular LGGs patients.…”

Section: Discussionmentioning

confidence: 98%

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: 98%

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

Ius

Pauletto

Isola

et al. 2014

JNS

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“…Indeed, it was previously shown that the AF, which connects the middle and inferior temporal gyri with the precentral gyrus and posterior portion of the inferior and middle frontal gyri, 39 subserved phonological processing-thus generating phonemic disturbances when stimulated. 14,19,33 This fascicle represents the anterior limit of resection for glioma within the SS.…”

Section: Surgical and Functional Considerationsmentioning

confidence: 99%

“…At the subcortical level, axonal mapping detected functional fibers in all patients: semantic paraphasia was generated by the stimulation of the upper part of the cavity in all cases, corresponding to the IFOF; alexia was elicited during the stimulation of the basal part of the cavity in 3 cases, corresponding to the ILF; in between, in the depth of the cavity, visual disorders were induced by stimulating the ORs in 5 cases; and phonemic paraphasia was evoked by stimulating the anterior part of the cav- . Before resection (left), cortical mapping allowed the detection of eloquent areas as follows: ventral premotor cortex that elicited speech arrest when stimulated (10), midpart of superior temporal gyrus that provoked anomia (15) and phonemic paraphasia (11) when stimulated, and posterior part of superior temporal gyrus that elicited semantic paraphasia during stimulation (12)(13)(14). After resection (right), the deep functional boundaries have been identified by subcortical electrical mapping as follows: in the SS, ILF that provoked alexia (46), OR that evoked visual disturbances (phosphenes) (48), and IFOF that generated semantic paraphasia (49); in addition, in the anterior part of the cavity (in front of SS) the AF that induced phonemic paraphasia (47).…”

Section: Intraoperative Brain Mappingmentioning

confidence: 99%

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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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“…Intraoperative direct electrostimulation under awake anesthesia is the best technique to locate eloquent domains as well as to distinguish functional area from nonfunctional area. In 2008, Duffau and colleagues, reported the largest experience with cortical and subcortical mapping of gliomas affecting the language area 19 . They performed resection using awake craniotomy and direct electrical stimulation in 115 patients.…”

Section: Functional Mappingmentioning

confidence: 99%

Innovative Surgical Management of Glioma

Seecharan¹,

Pollack²,

Farassati³

2012

Novel Therapeutic Concepts in Targeting Glioma

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Intraoperative subcortical stimulation mapping of language pathways in a consecutive series of 115 patients with Grade II glioma in the left dominant hemisphere

Cited by 438 publications

References 76 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

Innovative Surgical Management of Glioma

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