Safe Removal of Glioblastoma Near the Angular Gyrus by Awake Surgery Preserving Calculation Ability-Case Report-

Kurimoto, Masanori; Asahi, Takashi; Shibata, Takashi; Takahashi, Chiaki; Nagai, Shoichi; Hayashi, Nakamasa; Matsui, Mié; Endo, Shunro

doi:10.2176/nmc.46.46

Cited by 20 publications

(9 citation statements)

References 30 publications

(40 reference statements)

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“…7,19,22,34 Few reports have characterized language morbidity following resection of intrinsic tumors from this brain region. 14,18,20,21,29,31 This study represents the largest reported experience with dominant IPL glioma resection, and it provides evidence that it is safe, but not risk-free, to resect these lesions.…”

Section: Discussionmentioning

confidence: 79%

“…6,9,32 To date, however, only a few case series and case reports have investigated functional language outcomes following tumor resection from the IPL. 15,18,20,21,29 The purpose of this study was to define language outcomes in a series of consecutive patients who underwent glioma resection from the dominant IPL. In the majority of cases, these resections were performed with intraoperative mapping.…”

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confidence: 99%

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Language outcomes after resection of dominant inferior parietal lobule gliomas

Southwell¹,

Riva

Jordan

et al. 2017

Journal of Neurosurgery

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OBJECTIVE The dominant inferior parietal lobule (IPL) contains cortical and subcortical regions essential for language. Although resection of IPL tumors could result in language deficits, little is known about the likelihood of postoperative language morbidity or the risk factors predisposing to this outcome. METHODS The authors retrospectively examined a series of patients who underwent resections of gliomas from the dominant IPL. Postoperative language outcomes were characterized across the patient population. To identify factors associated with postoperative language morbidity, the authors then compared features between those patients who experienced postoperative deficits and those who experienced no postoperative language dysfunction. RESULTS Twenty-four patients were identified for analysis. Long-term language deficits occurred in 29.2% of patients (7 of 24): 3 of these patients had experienced preoperative language deficits, whereas new long-term language deficits occurred in 4 patients (16.7%; 4 of 24). Of those patients who exhibited preoperative language deficits, 62.5% (5 of 8) experienced long-term resolution of their language deficits with surgical treatment. All patients underwent intraoperative brain mapping by direct electrical stimulation. Awake, intraoperative cortical language mapping was performed on 17 patients (70.8%). Positive cortical language sites were identified in 23.5% of these patients (4 of 17). Awake, intraoperative subcortical language mapping was performed in 8 patients (33.3%). Positive subcortical language sites were identified in 62.5% of these patients (5 of 8). Patients with positive cortical language sites exhibited a higher rate of long-term language deficits (3 of 4, 75%), compared with those who did not (1 of 13, 7.7%; p = 0.02). Although patients with positive subcortical language sites exhibited a higher rate of long-term language deficits than those who exhibited only negative sites (40.0% vs 0.0%, respectively), this difference was not statistically significant (p = 0.46). Additionally, patients with long-term language deficits were older than those without deficits (p < 0.05). CONCLUSIONS In a small number of patients with preoperative language deficits, IPL glioma resection resulted in improved language function. However, in patients with intact preoperative language function, resection of IPL gliomas may result in new language deficits, especially if the tumors are diffuse, high-grade lesions. Thus, language-dominant IPL glioma resection is not risk-free, yet it is safe and its morbidity can be reduced by the use of cortical and subcortical stimulation mapping.

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Section: Discussionmentioning

confidence: 79%

mentioning

confidence: 99%

Language outcomes after resection of dominant inferior parietal lobule gliomas

Southwell¹,

Riva

Jordan

et al. 2017

Journal of Neurosurgery

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“…conducted volumetric measurements of pre-and postoperative imaging. For low-grade gliomas, manual segmentation was performed with region-of-interest analysis to measure tumor volumes (cm 3 ) on the basis of FLAIR or T2 axial slices, as previously described. Extent of resection was calculated as (preoperative tumor volume − postoperative tumor volume)/preoperative tumor volume.…”

Section: Volumetric Analysesmentioning

confidence: 99%

Morbidity profile following aggressive resection of parietal lobe gliomas

Sanai

Martino²,

Berger³

2012

JNS

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Object The impact of parietal lobe gliomas is typically studied in the context of parietal lobe syndromes. However, critical language pathways traverse the parietal lobe and are susceptible during tumor resection. The authors of this study reviewed their experience with parietal gliomas to characterize the impact of resection and the morbidity associated with language. Methods The study population included adults who had undergone resection of parietal gliomas of all grades. Tumor location was identified according to a proposed classification system for parietal region gliomas. Low- and high-grade tumors were volumetrically analyzed using FLAIR and T1-weighted contrast-enhanced MR imaging. Results One hundred nineteen patients with parietal gliomas were identified—34 with low-grade gliomas and 85 with high-grade gliomas. The median patient age was 45 years, and most patients (53) presented with seizures, whereas only 4 patients had an appreciable parietal lobe syndrome. The median preoperative tumor volume was 31.3 cm3, the median extent of resection was 96%, and the median postoperative tumor volume was 0.9 cm3. Surprisingly, the most common early postoperative neurological deficit was dysphasia (16 patients), not weakness (12 patients), sensory deficits (14 patients), or parietal lobe syndrome (10 patients). A proposed parietal glioma classification system, based on surgical anatomy, was predictive of language deficits. Conclusions This is the largest reported experience with parietal lobe gliomas. The findings suggested that parietal language pathways are compromised at a surprisingly high rate. The proposed parietal glioma classification system is predictive of postoperative morbidity associated with language and can assist with preoperative planning. Taken together, these data emphasize the value of identifying language pathways when operating within the parietal lobe.

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“…On the other hand, calculation mapping with 5 Hz rTMS was able to induce a maximum error rate (ER) of 30% in the left AG for a single-digit multiplication task (Maurer et al, 2016 ). Similarly, direct cortical stimulation (DCS) close to the left AG in patients with tumors in the left parietal area disrupted the performance in single-digit addition, subtraction, and multiplication (Whalen et al, 1997 ; Duffau et al, 2002 ; Kurimoto et al, 2006 ). In a patient with a low-grade glioma in the right temporal cortex, DCS of the right AG also disrupted single-digit subtraction (Yu et al, 2011 ).…”

Section: Introductionmentioning

confidence: 99%