Intraoperative subcortical electrical mapping of optic radiations in awake surgery for glioma involving visual pathways

Gras-Combe, Guillaume; Moritz‐Gasser, Sylvie; Herbet, Guillaume; Duffau, Hugues

doi:10.3171/2012.6.jns111981

Cited by 122 publications

(72 citation statements)

References 40 publications

(44 reference statements)

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“…However, movement is not action. By contrast, EBM in awake patients allows some preservation of high-level visuospatial processing, thanks to mapping of not only motor function but also somatosensory, visual, and vestibular functions, 72,136 as well as mapping of spatial cognition 143 and even of awareness of intending to act.…”

Section: Mapping Of Other (Nonlanguage) Functionsmentioning

confidence: 99%

Selection of intraoperative tasks for awake mapping based on relationships between tumor location and functional networks

Coello

Moritz‐Gasser

Martino

et al. 2013

JNS

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164

122

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Intraoperative electrical brain mapping is currently the most reliable method to identify eloquent cortical and subcortical structures at the individual level and to optimize the extent of resection of intrinsic brain tumors. The technique allows the preservation of quality of life, not only allowing avoidance of severe neurological deficits but also facilitating preservation of high neurocognitive functions. To accomplish this goal, however, it is crucial to optimize the selection of appropriate intraoperative tasks, given the limited intrasurgical awake time frame. In this review, the authors' aim was to propose specific parameters that could be used to build a personalized protocol for each patient. They have focused on lesion location and relationships with functional networks to guide selection of intrasurgical tasks in an effort to increase reproducibility among neurooncological centers.

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Section: Mapping Of Other (Nonlanguage) Functionsmentioning

confidence: 99%

Selection of intraoperative tasks for awake mapping based on relationships between tumor location and functional networks

Coello

Moritz‐Gasser

Martino

et al. 2013

JNS

Self Cite

164

122

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“…We have already reported that this partial visual deficit was well tolerated by patients because they can continue to enjoy a normal social and professional quality of life, including driving (no driverlicense suspension if hemianopia is avoided). 25 Interestingly, even though this is not a component of the SS, the AF has been identified in 5 patients by eliciting phonemic paraphasia during stimulation of the anterior part of the surgical cavity. Indeed, it was previously shown that the AF, which connects the middle and inferior temporal gyri with the precentral gyrus and posterior portion of the inferior and middle frontal gyri, 39 subserved phonological processing-thus generating phonemic disturbances when stimulated.…”

Section: Surgical and Functional Considerationsmentioning

confidence: 99%

“…An image is presented in the quadrant to be saved; that is, in the right inferior quadrant, and another image is presented in the opposite (left superior) quadrant-to serve as a control. 25 Using this protocol, transient visual disturbances have been evoked during stimulation of the depth of the surgical cavity; that is, the deep part of SS, where ORs are running according to the anatomical data. Visual pathways have been totally preserved in 3 cases and partially preserved in 5 cases with a right superior quadrantanopia, but no hemianopia has been generated.…”

Section: Surgical and Functional Considerationsmentioning

confidence: 99%

“…Direct subcortical electrostimulation was repeatedly performed without the patient's knowledge, until ORs were identified by eliciting transient visual disturbances such as blurred vision, shadow, phosphenes, or even visual illusions. 25 Finally, a nonverbal semantic association test (the so-called pyramid and palm trees test [PPTT]) 27 was administered. This task involves 52 blackand-white drawings presented on a computer screen.…”

Section: Surgical Proceduresmentioning

confidence: 99%

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Awake mapping for low-grade gliomas involving the left sagittal stratum: anatomofunctional and surgical considerations

Chan-Seng¹,

Moritz‐Gasser

Duffau

2014

JNS

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P atients with diffuse low-grade glioma ([DLGG]; that is, Grade II glioma according the WHO classification) tend to live many years after diagnosis, with surgery helping to further extend survival time. 2,29,49,50,53 Indeed, despite the lack of Class I evidence demonstrating that DLGG surgery improved survival, Jakola et al. 29 recently investigated survival in population-based parallel cohorts of patients with DLGGs from 2 Norwegian university hospitals with different surgical treatment strategies. They demonstrated that treatment at a center that favored early resection was associated with better overall survival (median survival not reached) than treat- Object. Preserving function while optimizing the extent of resection is the main goal in surgery for diffuse lowgrade glioma (DLGG). This is particularly relevant for DLGG involving the sagittal stratum (SS), where damage can have severe consequences. Indeed, this structure is a major crossroad in which several important fascicles run. Thus, its complex functional anatomy is still poorly understood. Subcortical electrical stimulation during awake surgery provides a unique opportunity to investigate white matter pathways. This study reports the findings on anatomofunctional correlations evoked by stimulation during resection for gliomas involving the left SS. Surgical outcomes are also detailed.Methods. The authors performed a review of patients who underwent awake surgery for histopathologically confirmed WHO Grade II glioma involving the left SS in the neurosurgery department between August 2008 and August 2012. Information regarding clinicoradiological features, surgical procedures, and outcomes was collected and analyzed. Intraoperative electrostimulation was used to map the eloquent structures within the SS.Results. Eight consecutive patients were included in this study. There were 6 men and 2 women, whose mean age was 41.7 years (range 32-61 years). Diagnosis was made because of seizures in 7 cases and slight language disorders in 1 case. After cortical mapping, subcortical stimulation detected functional fibers running in the SS in all patients: semantic paraphasia was generated by stimulating the inferior frontooccipital fascicle in 8 cases; alexia was elicited by stimulating the inferior longitudinal fascicle in 3 cases; visual disorders were induced by stimulating the optic radiations in 5 cases. Moreover, in front of the SS, phonemic paraphasia was evoked by stimulating the temporal part of the arcuate fascicle in 5 patients. The resection was stopped according to these functional limits in the 8 patients. After a transient postsurgical worsening, all patients recovered to normal results on examination, except for the persistence of a right superior quadrantanopia in 5 cases, with no consequences for quality of life. The 8 patients returned to a normal social and professional life. Total or subtotal resection was achieved in all cases but one.Conclusions. The authors suggest that the use of intrasurgical electrical mapping of the white matter pathway...

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“…DES plays an important role in studies of such higher cognitive functions as hemispheric ignorance, perceptual awareness, music, calculation, memory and category-specific naming (12,(34)(35)(36)(37)(38)(39). In the present study, it was found that the Broca area of a Chinese population undergoing DES was mainly concentrated within a 1-cm range.…”

Section: Discussionmentioning

confidence: 55%

Glioma localization and excision using direct electrical stimulation for language mapping during awake surgery

Bai

Wang

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. The aim of this study was to investigate the method and significance of the application of direct electrical stimulation (DES) to the brain mapping of language functions during glioma surgery. A retrospective analysis of clinical data was performed for 91 cases of brain functional area glioma surgery under DES from January 2003 until January 2012. Following cortical electrical stimulation, 88 patients exhibited seizures involving facial or hand movements and 91 cases experienced language disorders such as counting interruption, naming errors or anomia. The most commonly observed areas of counting interruption were distributed on the posterior part of the left anterior central gyrus (47.7%), the operculum of the left inferior frontal gyrus (24.4%) and the triangular part of the left inferior frontal gyrus (12.8%). Postoperative magnetic resonance imaging demonstrated that overall excision was achieved in 53 cases and sub-overall excision was performed in 31 cases. A total of 42 cases (46.2%) exhibited no postoperative neurological dysfunction, 39 cases (42.9%) exhibited brief language dysfunction, 27 cases (29.7%) experienced brief limb movement disorder, and one case appeared to have permanent neurological dysfunction. DES was indicated to be a reliable and noninvasive method for the intraoperative positioning of language areas, and was able to resect gliomas in the language area with maximal safety.

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Intraoperative subcortical electrical mapping of optic radiations in awake surgery for glioma involving visual pathways

Abstract: Online identification of optic radiations by direct subcortical electrostimulation is a reliable and effective method to avoid permanent hemianopia in surgery for gliomas involving visual pathways.

Cited by 122 publications

References 40 publications

Selection of intraoperative tasks for awake mapping based on relationships between tumor location and functional networks

Selection of intraoperative tasks for awake mapping based on relationships between tumor location and functional networks

Awake mapping for low-grade gliomas involving the left sagittal stratum: anatomofunctional and surgical considerations

Glioma localization and excision using direct electrical stimulation for language mapping during awake surgery

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