Tailoring neurophysiological strategies with clinical context enhances resection and safety and expands indications in gliomas involving motor pathways

Bello, Lorenzo; Riva, Marco; Fava, Enrica; Ferpozzi, Valentina; Castellano, Antonella; Raneri, Fabio; Pessina, Federico; Bizzi, Alberto; Falini, Andrea; Cerri, Gabriella

doi:10.1093/neuonc/not327

Cited by 135 publications

(139 citation statements)

References 37 publications

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“…7 Cortical and subcortical mapping was performed using an Osiris stimulator (Inomed) by adopting 2 distinct stimulation paradigms: 1) LFBS: 60-Hz biphasic pulses, total duration 1 msec, current intensity referring to each phase, interstimulus interval 16.66 msec, trains lasting 1-4 seconds; and 2) HFMS: train-of-five monophasic pulses, pulse duration 0.5 msec, interstimulus interval 2-4 msec (2 msec for language mapping, 2-4 msec for motor mapping), anodal and cathodal stimulation for cortical and subcortical mapping, respectively, train repetition rate 1-3 Hz. Stimulation was applied for language and motor mapping.…”

Section: Neurophysiological Monitoring and Mapping Protocolmentioning

confidence: 99%

“…Neurophysiological recordings of brain and muscle activity were acquired using a poligraphic electroencephalography (EEG) system (Grass Technologies) and multimodal equipment (ISIS IOM system, Inomed). 7 Subcortical mapping was alternated with resection, using the same current threshold applied for cortical mapping.…”

Section: Neurophysiological Monitoring and Mapping Protocolmentioning

confidence: 99%

“…DES delivered in trains of biphasic pulses at 50-60 Hz (low frequency) 6,7,25,29 through a bipolar probe. During testing, DES is applied at both the cortical and subcortical level with the patient awake, allowing identification of the essential sites involved in the various components of language function, schematically classified as articulatory, semantic, phonemic, and syntactic.…”

mentioning

confidence: 99%

“…6,10,13,[17][18][19]34 The incidence of seizures during awake mapping is usually low. 6,13,19 However, in patients with a long history of seizures and poor seizure control, 7,26 low-frequency bipolar stimulation (LFBS) can be associated with a higher risk of seizures on stimulation, even when the modality is used at the lowest useful current intensity. 7,40,42 The likelihood of performing effective functional mapping can thus be hampered.…”

mentioning

confidence: 99%

“…In fact, high-frequency monopolar stimulation (HFMS) was more effective and less epileptogenic than LFBS during motor mapping. 7,23,35,40,42 To the best of our knowledge, a systematic analysis of the effect of HFMS for intraoperative language mapping has not been conducted, and thus its use has been limited. 3,23 In the current study, we explored the use of train-offive HFMS in performing language mapping: the efficacy and safety of this stimulation paradigm were compared with those of the LFBS modality during awake neurosurgical procedures needing language mapping.…”

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Monopolar high-frequency language mapping: can it help in the surgical management of gliomas? A comparative clinical study

Riva¹,

Fava²,

Gallucci

et al. 2016

JNS

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T he current strategy for addressing intrinsic brain lesions, such as gliomas, is aimed at maximal tumor resection while preserving the patient's functional integrity. 9,31,33,[36][37][38] Achieving these aims can be hampered by the infiltrative nature of gliomas, which can involve essential functional structures. 16 Intraoperative direct electrical stimulation (DES) coupled with neuropsychological testing has been increasingly recognized as an efficient strategy to improve the extent of resection (EOR) and reduce postoperative morbidity. 10,13,18 In fact, DES allows identification and localization (mapping) of eloquent structures, at both the cortical and subcortical level. 5,15,[17][18][19]30,34,39 In addition, a tailored neuropsychological evaluation provides an appropriate cognitive picture of the patient, leading to an objective definition of their cognitive status and guiding resection during language and cognitive mapping. obJective Intraoperative language mapping is traditionally performed with low-frequency bipolar stimulation (LFBS). High-frequency train-of-five stimulation delivered by a monopolar probe (HFMS) is an alternative technique for motor mapping, with a lower reported seizure incidence. The application of HFMS in language mapping is still limited. Authors of this study assessed the efficacy and safety of HFMS for language mapping during awake surgery, exploring its clinical impact compared with that of LFBS. methods Fifty-nine patients underwent awake surgery with neuropsychological testing, and LFBS and HFMS were compared. Frequency, type, and site of evoked interference were recorded. Language was scored preoperatively and 1 week and 3 months after surgery. Extent of resection was calculated as well. results High-frequency monopolar stimulation induced a language disturbance when the repetition rate was set at 3 Hz. Interference with counting (p = 0.17) and naming (p = 0.228) did not vary between HFMS and LFBS. These results held true when preoperative tumor volume, lesion site, histology, and recurrent surgery were considered. Intraoperative responses (1603) in all patients were compared. The error rate for both modalities differed from baseline values (p < 0.001) but not with one another (p = 0.06). Low-frequency bipolar stimulation sensitivity (0.458) and precision (0.665) were slightly higher than the HFMS counterparts (0.367 and 0.582, respectively). The error rate across the 3 types of language errors (articulatory, anomia, paraphasia) did not differ between the 2 stimulation methods (p = 0.279). coNclusioNs With proper setting adjustments, HFMS is a safe and effective technique for language mapping.

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Section: Neurophysiological Monitoring and Mapping Protocolmentioning

confidence: 99%

Section: Neurophysiological Monitoring and Mapping Protocolmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Monopolar high-frequency language mapping: can it help in the surgical management of gliomas? A comparative clinical study

Riva¹,

Fava²,

Gallucci

et al. 2016

JNS

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The mirror neuron system and the strange case of Broca's area

Cerri

Cabinio

Blasi

et al. 2014

Human Brain Mapping

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Mirror neurons, originally described in the monkey premotor area F5, are embedded in a frontoparietal network for action execution and observation. A similar Mirror Neuron System (MNS) exists in humans, including precentral gyrus, inferior parietal lobule, and superior temporal sulcus. Controversial is the inclusion of Broca's area, as homologous to F5, a relevant issue in light of the mirror hypothesis of language evolution, which postulates a key role of Broca's area in action/speech perception/production. We assess "mirror" properties of this area by combining neuroimaging and intraoperative neurophysiological techniques. Our results show that Broca's area is minimally involved in action observation and has no motor output on hand or phonoarticulatory muscles, challenging its inclusion in the MNS. The presence of these functions in premotor BA6 makes this area the likely homologue of F5 suggesting that the MNS may be involved in the representation of articulatory rather than semantic components of speech.

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Mapping the brain network of the phonological loop

Papagno

Comi

Riva

et al. 2017

Human Brain Mapping

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The cortical and subcortical neural correlates underlying item and order information in verbal short-term memory (STM) were investigated by means of digit span in 29 patients with direct electrical stimulation during awake surgery for removal of a neoplastic lesion. Stimulation of left Broca's area interfered with span, producing significantly more item than order errors, as compared to the stimulation of the supramarginal/angular gyrus, which also interfered with span but, conversely, produced more order than item errors. Similarly, stimulation of the third segment of the left superior longitudinal fasciculus (SLF-III), also known as anterior segment of the arcuate fascicle (AF), produced more order than item errors. Therefore, we obtained two crucial results: first, we were able to distinguish between content and order information storage. Second, we demonstrated that the SLF-III is involved in transferring order information from Geschwind's area to Broca's area. In a few patients, we demonstrated that also order information of nonverbal material was disrupted by left supramarginal gyrus stimulation. Order information is thus likely stored in the supramarginal gyrus, possibly independently from the nature of the material. Hum Brain Mapp 38:3011-3024, 2017. © 2017 Wiley Periodicals, Inc.

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Tailoring neurophysiological strategies with clinical context enhances resection and safety and expands indications in gliomas involving motor pathways

Abstract: The integration of stimulation modalities with clinical context enhances the extent and safety of resection and expands the population of patients who could benefit from surgical treatment.

Cited by 135 publications

References 37 publications

Monopolar high-frequency language mapping: can it help in the surgical management of gliomas? A comparative clinical study

Monopolar high-frequency language mapping: can it help in the surgical management of gliomas? A comparative clinical study

The mirror neuron system and the strange case of Broca's area

Mapping the brain network of the phonological loop

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