Spontaneous unilateral spatial neglect recovery after brain tumour resection: A multimodal diffusion and rs‐fMRI case report

Zigiotto, Luca; Amorosino, Gabriele; Saviola, Francesca; Jovicich, Jorge; Annicchiarico, Luciano; Rozzanigo, Umberto; Olivetti, Emanuele; Avesani, Paolo; Sarubbo, Silvio

doi:10.1111/jnp.12339

Cited by 3 publications

(2 citation statements)

References 123 publications

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“…Burkhardt et al (2023) showed that three French-speaking people with a left anterior tumour affecting the left inferior longitudinal fasciculus had difficulties retrieving the names of famous people, particularly after tumour removal surgery. Zigiotto et al (2023) presented a case of an Italian speaker with a right parietal tumour and left neglect that recovered after surgery. The authors stressed the importance of fronto-parietal networks relative to neglect.…”

Section: Introduction To the Special Issue On Cognitive Neurosurgerymentioning

confidence: 99%

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Introduction to the special issue on cognitive neurosurgery

Rofes,

Piai

2024

Journal of Neuropsychology

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Section: Introduction To the Special Issue On Cognitive Neurosurgerymentioning

confidence: 99%

“…Zigiotto et al. (2023) presented a case of an Italian speaker with a right parietal tumour and left neglect that recovered after surgery. The authors stressed the importance of fronto‐parietal networks relative to neglect.…”

mentioning

confidence: 99%

Introduction to the special issue on cognitive neurosurgery

Rofes,

Piai

2024

Journal of Neuropsychology

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Changing the Paradigm for Tractography Segmentation in Neurosurgery: Validation of a Streamline-Based Approach

Sarubbo,

Vavassori,

Zigiotto

et al. 2024

Brain Sciences

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In glioma surgery, maximizing the extent of resection while preserving cognitive functions requires an understanding of the unique architecture of the white matter (WM) pathways of the single patient and of their spatial relationship with the tumor. Tractography enables the reconstruction of WM pathways, and bundle segmentation allows the identification of critical connections for functional preservation. This study evaluates the effectiveness of a streamline-based approach for bundle segmentation on a clinical dataset as compared to the traditional ROI-based approach. We performed bundle segmentation of the arcuate fasciculus, of its indirect anterior and posterior segments, and of the inferior fronto-occipital fasciculus in the healthy hemisphere of 25 high-grade glioma patients using both ROI- and streamline-based approaches. ROI-based segmentation involved manually delineating ROIs on MR anatomical images in Trackvis (V0.6.2.1). Streamline-based segmentations were performed in Tractome, which integrates clustering algorithms with the visual inspection and manipulation of streamlines. Shape analysis was conducted on each bundle. A paired t-test was performed on the irregularity measurement to compare segmentations achieved with the two approaches. Qualitative differences were evaluated through visual inspection. Streamline-based segmentation consistently yielded significantly lower irregularity scores (p < 0.001) compared to ROI-based segmentation for all the examined bundles, indicating more compact and accurate bundle reconstructions. Qualitative assessment identified common biases in ROI-based segmentations, such as the inclusion of anatomically implausible streamlines or streamlines with undesired trajectories. Streamline-based bundle segmentation with Tractome provides reliable and more accurate reconstructions compared to the ROI-based approach. By directly manipulating streamlines rather than relying on voxel-based ROI delineations, Tractome allows us to discern and discard implausible or undesired streamlines and to identify the course of WM bundles even when the anatomy is distorted by the lesion. These features make Tractome a robust tool for bundle segmentation in clinical contexts.

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Application of Navigated Transcranial Magnetic Stimulation (nTMS) to Study the Visual–Spatial Network and Prevent Neglect in Brain Tumour Surgery

Bonaudo,

Castaldi,

Pedone

et al. 2024

Cancers

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Objective: Navigated transcranial magnetic stimulation (nTMS) has seldom been used to study visuospatial (VS) circuits so far. Our work studied (I) VS functions in neurosurgical oncological patients by using repetitive nTMS (rnTMS), (II) the possible subcortical circuits underneath, and (III) the correspondence between nTMS and direct cortical stimulation (DCS) during awake procedures. Methods: We designed a monocentric prospective study, adopting a protocol to use rnTMS for preoperative planning, including VS functions for lesions potentially involving the VS network, including neurosurgical awake and asleep procedures. nTMS-based-DTI tractography allowed the visualization of subcortical circuits. Statistical analyses on nTMS/DCS points were performed. Clinical results were collected pre- and postoperatively. Results: Finally, 27 patients with primitive intra-axial brain lesions were enrolled between April 2023 and March 2024. Specific tests and an experimental integrated VS test (VISA) were used. The clinical evaluation (at 5 ± 7, 30 ± 10, 90 ± 10 days after surgery) documented 33% of patients with neglect in the left hemisphere four days after surgery and, during the 3-month follow-up, preservation of visuospatial function/clinical recovery (90.62% in MMSE, 98.86% in the bell test, 80% in the clock test, and 98% in the OCS test). The surgical strategy was modulated according to the nTMS map. Subcortical bundles were traced to identify those most involved in these functions: SFLII > SLFII > SLFI. A comparison of the nTMS and DCS points in awake surgery (n = 10 patients) documented a sensitivity (Se) of 12%, a specificity (Sp) of 91.21%, a positive predictive value (PPV) of 42%, a negative predictive value (NPV) of 66%, and an accuracy of ~63.7%. Conclusions: Based on our preliminary results, nTMS is advantageous for studying cognitive functions, minimising neurological impairment. Further analyses are needed to validate our data.

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Spontaneous unilateral spatial neglect recovery after brain tumour resection: A multimodal diffusion and rs‐fMRI case report

Cited by 3 publications

References 123 publications

Introduction to the special issue on cognitive neurosurgery

Introduction to the special issue on cognitive neurosurgery

Changing the Paradigm for Tractography Segmentation in Neurosurgery: Validation of a Streamline-Based Approach

Application of Navigated Transcranial Magnetic Stimulation (nTMS) to Study the Visual–Spatial Network and Prevent Neglect in Brain Tumour Surgery

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