In Reply: Altered Motor Excitability in Patients With Diffuse Gliomas Involving Motor Eloquent Areas: The Impact of Tumor Grading

Lavrador, José Pedro; Gioti, Ifigeneia; Hoppe, Szymon; Jung, Josephine; Patel, Sabina; Gullan, Richard; Ashkan, Keyoumars; Bhangoo, Ranjeev; Vergani, Francesco

doi:10.1093/neuros/nyaa514

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…There is a suggestion of a longer intraoperative distance to the CST in patients where the iRMTr for the upper limb was abnormal. This reflects the understanding of abnormal cortical excitability of the motor cortex as an initial step for motor injury, which requires a more cautious resection towards the M1-CST complex 18,29,30 . For visual outcome, the significance of the CTD supports a need for better intraoperative mapping techniques, though the subdural strip proved to be reliable and predictive of outcome, as a deterioration of the recordings related to postoperative deficit.…”

Section: Discussionmentioning

confidence: 98%

Simultaneous Motor and Visual Intraoperative Neuromonitoring in Asleep Parietal Lobe Surgery: Dual Strip Technique

Rajashekar¹,

Lavrador²,

Ghimire³

et al. 2022

Preprint

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Background: The role played by the non-dominant parietal lobe in motor cognition, attention and spatial awareness networks has potentiated the use of awake surgery. When this is not feasible, asleep monitoring and mapping techniques should be used to achieve an onco-functional balance. Objective: This study aims to assess the feasibility of a dual-strip method to obtain direct cortical stimulation for continuous real-time cortical monitoring and subcortical mapping of motor and visual pathways simultaneously in parietal lobe tumour surgery. Methods: Single-centre prospective study between May’19-November’20 of patients with intrinsic non-dominant parietal-lobe tumours. Two subdural strips were used to simultaneously map and monitor motor and visual pathways. Results: Fifteen patients were included. With regards to motor function, a large proportion of patients had abnormal interhemispheric resting motor threshold ratio (iRMTr) (71.4%), abnormal Cortical Excitability Score (CES) (85.7%), close distance to the corticospinal tract – Lesion-To-Tract Distance (LTD) – 4.2mm, Cavity-To-Tract Distance (CTD) – 7mm and intraoperative subcortical distance - 6.4mm. Concerning visual function, the LTD and CTD for optic radiations (OR) were 0.5mm and 3.4mm, respectively; the mean intensity for positive subcortical stimulation of OR was 12mA±2.3mA and 5/6 patients with deterioration of VEPs>50% had persistent hemianopia and transgression of ORs. 12 patients remained stable, one patient had a de-novo transitory hemiparesis, and two showed improvements in motor symptoms. A higher iRMTr for lower limbs was related with a worse motor outcome (p=0.013) and a longer CTD to OR was directly related with a better visual outcome (p=0.041). At 2 weeks after hospital discharge, all patients were ambulatory at home and all proceeded to have oncological treatment. Conclusion: We propose motor and visual function boundaries for asleep surgery of intrinsic non-dominant parietal tumours. Pre-operative abnormal cortical excitability of the motor cortex, deterioration of the VEP recordings and CTD<2mm from the OR were related to poorer outcomes.

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Section: Discussionmentioning

confidence: 98%

Simultaneous Motor and Visual Intraoperative Neuromonitoring in Asleep Parietal Lobe Surgery: Dual Strip Technique

Rajashekar¹,

Lavrador²,

Ghimire³

et al. 2022

Preprint

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“…We speculate that the above mentioned findings may be related to the fact that the cerebral cortex's language, motor, sensory, and cognitive areas are predominantly located in the frontal and parietal lobes and deep supratentorial region. The current surgical strategy for tumors affecting the cerebral cortex's language, motor, sensory, and cognitive areas is to remove the tumor to the greatest extent possible safely; and to preserve vital neurological function as possible while extending patient survival to improve the postoperative quality of life, rather than pursuing total tumor resection based on neuroimaging (5,43,44). However, the tumor location classification method in this manuscript does not precisely distinguish between eloquent and non-eloquent tumors, and the above conclusions only suggest this potential possibility, which needs to be investigated by further prospective clinical trial data.…”

Section: Discussionmentioning

confidence: 99%

Fluorescein-guided surgery for high-grade glioma resection: a five-year-long retrospective study at our institute

et al. 2023

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ObjectiveThis study investigates the extent of resection, duration of surgery, intraoperative blood loss, and postoperative complications in patients with high-grade glioma who received surgery with or without sodium fluorescein guidance.MethodsA single-center retrospective cohort study was conducted on 112 patients who visited our department and underwent surgery between July 2017 and June 2022, with 61 in the fluorescein group and 51 in the non-fluorescein group. Baseline characteristics, intraoperative blood loss, surgery duration, resection extent, and postoperative complications were documented.ResultsThe duration of surgery was significantly shorter in the fluorescein group than in the non-fluorescein group (P = 0.022), especially in patients with tumors in the occipital lobes (P = 0.013). More critically, the gross total resection (GTR) rate was significantly higher in the fluorescein group than in the non-fluorescein group (45.9% vs. 19.6%, P = 0.003). The postoperative residual tumor volume (PRTV) was also significantly lower in the fluorescein group than in the non-fluorescein group (0.40 [0.12-7.11] cm3 vs. 4.76 [0.44-11.00] cm3, P = 0.020). Particularly in patients with tumors located in the temporal and occipital lobes (temporal, GTR 47.1% vs. 8.3%, P = 0.026; PRTV 0.23 [0.12-8.97] cm3 vs. 8.35 [4.05-20.59] cm3, P = 0.027; occipital, GTR 75.0% vs. 0.0%, P = 0.005; PRTV 0.15 [0.13-1.50] cm3 vs. 6.58 [3.70-18.79] cm3, P = 0.005). However, the two groups had no significant difference in intraoperative blood loss (P = 0.407) or postoperative complications (P = 0.481).ConclusionsFluorescein-guided resection of high-grade gliomas using a special operating microscope is a feasible, safe, and convenient technique that significantly improves GTR rates and reduces postoperative residual tumor volume when compared to conventional white light surgery without fluorescein guidance. This technique is particularly advantageous for patients with tumors located in non-verbal, sensory, motor, and cognitive areas such as the temporal and occipital lobes, and does not increase the incidence of postoperative complications.

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“…We speculate that the above ndings may be related to the fact that cerebral language and motor areas are mainly located in the frontal and parietal lobes. The current surgical strategy for tumors involving the cerebral language and motor areas is to safely remove the tumor to the maximum extent possible; the aim is to preserve as much vital neurological function as possible while prolonging the patient's survival to improve the patient's postoperative quality of life, rather than to pursue total neuroimaging-based resection of the tumor [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Fluorescein-Guided Surgery for High-Grade Glioma Resection: A five-year long retrospective study in our institute

Chen

Sun

Chen

et al. 2023

Preprint

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Objective: To investigate the outcomes and adverse events of glioma patients received surgery with or without fluorescein sodium guidance. Methods: A total of 136 patients who visited our hospital and underwent surgery from July 2017 to June 2022 were retrospectively analyzed. 75 cases in the fluorescein group, while 61 cases in the non-fluorescein group. Baseline characteristics, intraoperative blood loss, duration of operation and tumor mass resection were documented, adverse events were also recorded. Results: The duration of operation was significantly shorter in the fluorescein group than in the non-fluorescein group (P = 0.008), especially for patients with tumors in the frontal and occipital lobes (frontal, P = 0.036; occipital, P = 0.041). More critically, the rate of gross total resection (GTR) was significantly higher in the fluorescein group than in the non-fluorescein group (42.67% vs. 21.31%, P = 0.005), particularly for patients with tumors located in the temporal lobe, occipital lobe, and deep supratentorial area (temporal, 48.15% vs. 13.04%, P = 0.002; occipital, 53.84% vs. 0.00%, P = 0.026; deep supratentorial region, 15.00% vs. 5.88%, P = 0.016). however, there was no statistically significant difference in intraoperative blood loss (P = 0.094) or incidence of complications (6.67% vs. 4.92%, P = 0.668) between the two groups. Conclusions: Fluorescein-guided resection of high-grade gliomas using a dedicated filter on the operating microscope is feasible, safe, convenient and significantly increases the GTR rate; this is especially advantageous in patients with tumors located in non-verbal and motor areas such as the temporal and occipital lobes and deep supratentorial areas.

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In Reply: Altered Motor Excitability in Patients With Diffuse Gliomas Involving Motor Eloquent Areas: The Impact of Tumor Grading

Cited by 4 publications

References 6 publications

Simultaneous Motor and Visual Intraoperative Neuromonitoring in Asleep Parietal Lobe Surgery: Dual Strip Technique

Simultaneous Motor and Visual Intraoperative Neuromonitoring in Asleep Parietal Lobe Surgery: Dual Strip Technique

Fluorescein-guided surgery for high-grade glioma resection: a five-year-long retrospective study at our institute

Fluorescein-Guided Surgery for High-Grade Glioma Resection: A five-year long retrospective study in our institute

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