Precentral Glioma Location Determines the Displacement of Cortical Hand Representation

Wunderlich, Gilbert; Knorr, U.; Herzog, Hans; Kiwit, J. C. W.; Freund, Hans‐Joachim; Seitz, Rüdiger J.

doi:10.1097/00006123-199801000-00005

Cited by 136 publications

(63 citation statements)

References 48 publications

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“…71,95,121 A consistent finding of language stimulation studies has been the identification of significant individual variability among patients. 64 Speech arrest is variably located and can go well beyond the classic anatomical boundaries of the Broca area for motor speech.…”

Section: Variability In Cortical Language Localizationmentioning

confidence: 83%

Intraoperative stimulation techniques for functional pathway preservation and glioma resection

Sanai¹,

Berger²

2010

FOC

173

119

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Although a primary tenet of neurosurgical oncology is that survival can improve with greater tumor resection, this principle must be tempered by the potential for functional loss following a radical removal. Preoperative planning with functional and physiological imaging paradigms, combined with intraoperative strategies such as cortical and subcortical stimulation mapping, can effectively reduce the risks associated with operating in eloquent territory. In addition to identifying critical motor pathways, these techniques can be adapted to identify language function reliably. The authors review the technical nuances of intraoperative mapping for low- and high-grade gliomas, demonstrating their efficacy in optimizing resection even in patients with negative mapping data. Collectively, these surgical strategies represent the cornerstone for operating on gliomas in and around functional pathways.

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Section: Variability In Cortical Language Localizationmentioning

confidence: 83%

Intraoperative stimulation techniques for functional pathway preservation and glioma resection

Sanai¹,

Berger²

2010

FOC

173

119

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“…In patients with brain tumors, functionally activated areas along the precentral gyrus that exceed displacement due to mass effects have been observed. When cortical lesions causing contralateral spastic paresis abolish activation of motor cortex, more intense activation of secondary motor areas and of motor cortex ipsilateral to the paretic limbs is observed (107).…”

Section: Effects On Surrounding and Remote Brain Areas Petmentioning

confidence: 99%

Multimodality Assessment of Brain Tumors and Tumor Recurrence

Heiss¹,

Raab²,

Lanfermann³

2011

J Nucl Med

126

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the differences in the information obtained by various MRI and PET modalities and (2) the best combination of imaging procedures to detect brain tumors, to define the biologic activity or malignancy of a tumor, to validate therapeutic effects, and to differentiate between recurrent tumor and tissue necrosis.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNM designates each JNM continuing education article for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only credit commensurate with the extent of their participation in the activity.For CE credit, participants can access this activity through the SNM Web site (http://www.snm.org/ce_online) through October 2012.Neuroimaging plays a significant role in the diagnosis of intracranial tumors, especially brain gliomas, and must consist of an assessment of location and extent of the tumor and of its biologic activity. Therefore, morphologic imaging modalities and functional, metabolic, or molecular imaging modalities should be combined for primary diagnosis and for following the course and evaluating therapeutic effects. MRI is the gold standard for providing detailed morphologic information and can supply some additional insights into metabolism (MR spectroscopy) and perfusion (perfusion-weighted imaging) but still has limitations in identifying tumor grade, invasive growth into neighboring tissue, and treatment-induced changes, as well as recurrences. These insights can be obtained by various PET modalities, including imaging of glucose metabolism, amino acid uptake, nucleoside uptake, and hypoxia. Diagnostic accuracy can benefit from coregistration of PET results and MRI, combining the high-resolution morphologic images with the biologic information. These procedures are optimized by the newly developed combination of PET and MRI modalities, permitting the simultaneous assessment of morphologic, functional, metabolic, and molecular information on the human brain. Brai n tumors are newly formed alterations of morphology, and for their diagnosis, therefore, CT or MRI is mandatory. These imaging modalities are essential for delineating the normal and pathologic anatomy and also for assessing vascular supply and impairment of the blood-brain barrier (BBB) (perfusion-weighted imaging; contrast enhancement). Additionally, MRI is capable of giving functional information on microstructural (diffusion-weighted imaging [DWI]), physiologic, and metabolic (MR spectroscopy [MRS]) changes of tumor tissues. PET and MRI provide physiologic, biochemical, and molecular information related to tumor metabolism, proliferation rate, invasiveness, and interaction with surrounding and remote areas-informati...

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“…43 Furthermore, both intraoperative stimulation and functional imaging techniques have provided evidence for redistribution of functional neural networks in cases of stroke, 13,44,45 congenital malformations, 46,47 brain injury, 48 and tumor progression. 13,14,49 Not surprisingly, it has been hypothesized that brain infiltration by gliomas leads to reshaping or local reorganization of functional networks as well as neosynaptogenesis. 50,51 This would explain the frequent lack of clinical deficit despite glioma growth into eloquent brain areas, 13,49,52 as well as the transient nature of many postoperative deficits.…”

Section: Tailored Craniotomies and The Value Of Negative Language Mapmentioning

confidence: 99%

Operative Techniques for Gliomas and the Value of Extent of Resection

2009

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Summary:Refinement of neurosurgical technique has enabled safer operations with more aggressive outcomes. One cornerstone of modern-day practice is the utilization of intraoperative stimulation mapping. In addition to identifying critical motor pathways, this technique can be adapted to reliably identify language pathways. Given the individual variability of cortical language localization, such awake language mapping is essential to minimize language deficits following tumor resection. Our experience suggests that cortical language mapping is a safe and efficient adjunct to optimize tumor resection while preserving essential language sites, even in the setting of negative mapping data. However, the value of maximizing glioma resections remains surprisingly unclear, as there is no general consensus in the literature regarding the efficacy of extent of glioma resection in improving patient outcome. While the importance of resection in obtaining tissue diagnosis and alleviating symptoms is clear, a lack of Class I evidence prevents similar certainty in assessing the influence of extent of resection. Beyond an analysis of modern intraoperative mapping techniques, we examine every major clinical publication since 1990 on the role of extent of resection in glioma outcome. The mounting evidence suggests that, despite persistent limitations in the quality of available studies, a more extensive surgical resection is associated with longer life expectancy for both low-grade and high-grade gliomas.

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Precentral Glioma Location Determines the Displacement of Cortical Hand Representation

Abstract: Our data provide evidence for the reorganization of the human motor cortex to allow for preserved hand function in Grade II astrocytomas.

Cited by 136 publications

References 48 publications

Intraoperative stimulation techniques for functional pathway preservation and glioma resection

Intraoperative stimulation techniques for functional pathway preservation and glioma resection

Multimodality Assessment of Brain Tumors and Tumor Recurrence

Operative Techniques for Gliomas and the Value of Extent of Resection

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