Role of Intraoperative Neurophysiologic Monitoring in the Resection of Thalamic Astrocytomas

Carrabba, Giorgio; Bertani, Giulio; Cogiamanian, F.; Ardolino, Gianluca; Zarino, Barbara; Cristofori, Andrea Di; Locatelli, Marco; Caroli, Manuela; Rampini, Paolo

doi:10.1016/j.wneu.2016.06.049

Cited by 18 publications

(11 citation statements)

References 25 publications

(38 reference statements)

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“…Nevertheless, all the DTI surgical information has to be verified by IONM and it is nowadays unacceptable to operate close to the main fiber bundles (or eloquent cortical areas) without IONM ( 13 , 34 , 35 , 45 , 54 ). The scientific evidence supporting the use of IONM has been growing in recent years, and many studies have shown that patients’ permanent morbidity is reduced and tumor EOR is increased when IONMs are applied ( 12 , 31 , 55 ). Parallelly, multiple studies have demonstrated that the EOR correlates positively with OS for both LGG and HGG pushing more and more surgeons toward maximal or even supra-maximal tumor resections according to function boundaries ( 56 – 58 ).…”

Section: Discussionmentioning

confidence: 99%

“…The armamentarium used for IONM has already been described elsewhere by our group ( 25 , 31 ). The neurophysiological techniques included transcranial corkscrew electrodes for transcranial (TC) motor-evoked potentials (MEPs); DES with monopolar and bipolar probes for mapping motor and language functions; cortical strip for electrical stimulation of the cortex and cortical MEP monitoring; cortical strip for electrocorticography (ECoG); and electromyography (EMG) for continuous monitoring of motor functions.…”

Section: Methodsmentioning

confidence: 99%

“…The IONM was performed by dedicated neurophysiologists and technicians (FC, GA, LB, MV). The monitoring technique was performed as described previously ( 25 , 31 ).…”

Section: Methodsmentioning

confidence: 99%

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Diffusion tensor imaging, intra-operative neurophysiological monitoring and small craniotomy: Results in a consecutive series of 103 gliomas

et al. 2022

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Diffusion tensor imaging (DTI) allows visualization of the main white matter tracts while intraoperative neurophysiological monitoring (IONM) represents the gold standard for surgical resection of gliomas. In recent years, the use of small craniotomies has gained popularity thanks to neuronavigation and to the low morbidity rates associated with shorter surgical procedures. The aim of this study was to review a series of patients operated for glioma using DTI, IONM, and tumor-targeted craniotomies. The retrospective analysis included patients with supratentorial glioma who met the following inclusion criteria: preoperative DTI, intraoperative IONM, tumor-targeted craniotomy, pre- and postoperative MRI, and complete clinical charts. The DTI was performed on a 3T scanner. The IONM included electroencephalography (EEG), transcranial (TC) and/or cortical motor-evoked potentials (MEP), electrocorticography (ECoG), and direct electrical stimulation (DES). Outcomes included postoperative neurological deficits, volumetric extent of resection (EOR), and overall survival (OS). One hundred and three patients (61 men, 42 women; mean age 54 ± 14 years) were included and presented the following WHO histologies: 65 grade IV, 19 grade III, and 19 grade II gliomas. After 3 months, only three patients had new neurological deficits. The median postoperative volume was 0cc (IQR 3). The median OS for grade IV gliomas was 15 months, while for low-grade gliomas it was not reached. In our experience, a small craniotomy and a tumor resection supported by IONM and DTI permitted to achieve satisfactory results in terms of neurological outcomes, EOR, and OS for glioma patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Diffusion tensor imaging, intra-operative neurophysiological monitoring and small craniotomy: Results in a consecutive series of 103 gliomas

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“…1,2 Several recent studies have shown that aggressive surgical resection is possible because of improved preoperative and intraoperative imaging along with better visualization methods. [3][4][5] Surgical resection through craniotomies with a larger cortical opening is associated with a high risk of brain injury. 4,6 Role of the endoscope for thalamic lesion was limited to biopsy and endoscopic third ventriculostomy (ETV) for hydrocephalus in the majority of studies.…”

Section: Introductionmentioning

confidence: 99%

Endoscope-controlled Access to Thalamic Tumors using Tubular Brain Retractor: An Alternative Approach to Microscopic Excision

Sihag

Bajaj

Yadav

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background Surgery for thalamic lesions has been considered challenging due to their deep-seated location. Endoscopic excision of deep-seated brain tumors using tubular retractor has been shown to be safe and effective in prior studies; however, there are limited reports regarding its use for thalamic tumors. We present our experience of endoscope-controlled resection of thalamic tumors using a tubular retractor. Material and Methods This was a prospective observational case series done at a tertiary center specialized for endoscopic neurosurgery during the period from 2010 to 2019. Surgeries were performed under the endoscopic control using a silicon tubular retractor. Lesions were approached transcortically or trans-sulcally. Data were collected for the extent of resection, amount of blood loss, operative time, need for conversion to microscopy, and complications. Results Twenty-one patients of thalamic masses of 14- to 60-year age underwent the surgeries. Pathologies ranged from grade I to IV gliomas. Gross total and near-total resection could be done in 42.85% of cases for each group. The average blood loss and operative time were164.04 ± 83.63 mL and 157.14 ± 28.70 minutes, respectively. Complications included a small brain contusion, two transient hemipareses, and one transient speech deficit. Conclusion Endoscopic excision of thalamic tumors using a tubular retractor was found to be a safe and effective alternative to microscopic resection.

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“…Puget et al 31 introduced this term to the nomenclature in 2011, but optimal treatment and appropriate subclassification of these pediatric tumors remains a moving target. 2,5, 7,8,10,11,13,15–17, 20,22, 24–26,28,29,34,38–43,47 While many therapeutic strategies have been considered, we previously reported success in achieving disease control and frequent cure after gross-total resection (GTR) performed via a transcortical approach through the middle temporal gyrus. 4 In conjunction with frameless stereotaxy and contemporary microneurosurgical technique, the use of tractography via diffuse tensor imaging was critical to surgical planning to avoid damaging adjacent white matter structures.…”

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confidence: 99%

Surgical and molecular considerations in the treatment of pediatric thalamopeduncular tumors

Lee

Foster

Lillard

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThalamopeduncular tumors are a group of pediatric low-grade gliomas that arise at the interface of the thalamus and brainstem peduncle. They typically occur within the first 2 decades of life, presenting with progressive spastic hemiparesis. Treatment strategies, including surgical intervention, have varied significantly. The authors present their experience in the treatment of 13 children, ages 2–15 years, with non-neurofibromatosis–related pilocytic astrocytomas located in the thalamopeduncular region.METHODSBetween 2003 and 2016, 13 children presenting with progressive spastic hemiparesis due to a pilocytic astrocytoma at the interface of the thalamus and cerebral peduncles were identified. Medical records were reviewed retrospectively for clinical, radiological, pathological, and surgical data. Formalin-fixed, paraffin-embedded tissue was obtained for 12 cases and tested for KIAA1549-BRAF fusion and BRAF V600E point mutation.RESULTSOn preoperative diffusion tensor imaging tractography (performed in 12 patients), the ipsilateral corticospinal tract was displaced laterally in 1 case (8.3%), medially in 1 case (8.3%), anterolaterally in 10 cases (83%), and posteriorly in no cases. Ten patients underwent resection via a transtemporal, transchoroidal approach, which was chosen to avoid further damage to motor function in cases of tumors that caused anterolateral or medial corticospinal tract displacement. With this approach, complications included hemianopia, oculomotor palsy, and tremor at a rate of 50%. Among the 12 patients with obtainable follow-up (mean 50.9 months), none received adjuvant therapy, and only 2 (17%) experienced recurrence or progression. KIAA1549-BRAF fusions were present in 10 cases (83%), while BRAF V600E was absent (0%). The 2 fusion-negative tumors had clinical features atypical for the series, including multi-focality and infiltration.CONCLUSIONSTranscortical, transchoroidal resection of thalamopeduncular tumors through the middle temporal gyrus allows for a high rate of gross-total resection and cure. Diffuse tensor tractography is a critical component of the preoperative planning process to determine the location of white matter tracts in proximity. Molecular status may correlate with clinical features, and the presence of BRAF lesions offers an additional target for future novel therapeutics.

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Role of Intraoperative Neurophysiologic Monitoring in the Resection of Thalamic Astrocytomas

Cited by 18 publications

References 25 publications

Diffusion tensor imaging, intra-operative neurophysiological monitoring and small craniotomy: Results in a consecutive series of 103 gliomas

Diffusion tensor imaging, intra-operative neurophysiological monitoring and small craniotomy: Results in a consecutive series of 103 gliomas

Endoscope-controlled Access to Thalamic Tumors using Tubular Brain Retractor: An Alternative Approach to Microscopic Excision

Surgical and molecular considerations in the treatment of pediatric thalamopeduncular tumors

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