Specificities of Awake Craniotomy and Brain Mapping in Children for Resection of Supratentorial Tumors in the Language Area

Delion, Matthieu; Terminassian, A.; Lehousse, T.; Aubin, Ghislaine; Malka, Jean; N’Guyen, Sylvie; Mercier, Philippe; Menei, Philippe

doi:10.1016/j.wneu.2015.06.073

Cited by 54 publications

(57 citation statements)

References 21 publications

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“…They mostly consisted of technical notes or case reports of a few patients (Delion et al, 2015;Kamran et al, 2014;Lee, Smyser, & Shimony, 2013;Shimony et al, 2009;Zhang et al, 2009). They mostly consisted of technical notes or case reports of a few patients (Delion et al, 2015;Kamran et al, 2014;Lee, Smyser, & Shimony, 2013;Shimony et al, 2009;Zhang et al, 2009).…”

Section: Rsfmri Versus Task-based Fmri For the Preoperative Identifmentioning

confidence: 99%

“…Transient language disturbances (aphasic, arrest, paraphasia) were consigned. During surgical removal of the tumor, subcortical stimulation was also used to identify white matter tracts, alternated with ultrasonic hover resection in a back-and-forth fashion, as described in a previous study (Delion et al, 2015).…”

Section: Surgical Procedures and Intraoperative Cortical Mappingmentioning

confidence: 99%

“…There are few studies in the literature on presurgical motor and language mapping by rsfMRI. They mostly consisted of technical notes or case reports of a few patients (Delion et al, 2015;Kamran et al, 2014;Lee, Smyser, & Shimony, 2013;Shimony et al, 2009;Zhang et al, 2009). The only studies reporting the comparison of task fMRI and rsfMRI to direct intraoperative stimulation were a series of 13 patients from Mitchell et al, where rsfMRI showed a good sensibility in the identification of motor and language functional brain areas (Mitchell et al, 2013).…”

Section: Rsfmri Versus Task-based Fmri For the Preoperative Identifmentioning

confidence: 99%

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Resting‐state functional magnetic resonance imaging versus task‐based activity for language mapping and correlation with perioperative cortical mapping

et al. 2019

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Introduction Preoperative language mapping using functional magnetic resonance imaging (fMRI) aims to identify eloquent areas in the vicinity of surgically resectable brain lesions. fMRI methodology relies on the blood‐oxygen‐level‐dependent (BOLD) analysis to identify brain language areas. Task‐based fMRI studies the BOLD signal increase in brain areas during a language task to identify brain language areas, which requires patients' cooperation, whereas resting‐state fMRI (rsfMRI) allows identification of functional networks without performing any explicit task through the analysis of the synchronicity of spontaneous BOLD signal oscillation between brain areas. The aim of this study was to compare preoperative language mapping using rsfMRI and task fMRI to cortical mapping (CM) during awake craniotomies. Methods Fifty adult patients surgically treated for a brain lesion were enrolled. All patients had a presurgical language mapping with both task fMRI and rsfMRI. Identified language networks were compared to perioperative language mapping using electric cortical stimulation. Results Resting‐state fMRI was able to detect brain language areas during CM with a sensitivity of 100% compared to 65.6% with task fMRI. However, we were not able to perform a specificity analysis and compare task‐based and rest fMRI with our perioperative setting in the current study. In second‐order analysis, task fMRI imaging included main nodes of the SN and main areas involved in semantics were identified in rsfMRI. Conclusion Resting‐state fMRI for presurgical language mapping is easy to implement, allowing the identification of functional brain language network with a greater sensitivity than task‐based fMRI, at the cost of some precautions and a lower specificity. Further study is required to compare both the sensitivity and the specificity of the two methods and to evaluate the clinical value of rsfMRI as an alternative tool for the presurgical identification of brain language areas.

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Section: Rsfmri Versus Task-based Fmri For the Preoperative Identifmentioning

confidence: 99%

Section: Surgical Procedures and Intraoperative Cortical Mappingmentioning

confidence: 99%

Section: Rsfmri Versus Task-based Fmri For the Preoperative Identifmentioning

confidence: 99%

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Resting‐state functional magnetic resonance imaging versus task‐based activity for language mapping and correlation with perioperative cortical mapping

et al. 2019

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“…Moreover, only 30%‐40% of brain tumors in childhood are supratentorial, and they are most frequently diagnosed in the first 2 years of life, where awake craniotomy is not viable . Besides, ethical concerns regarding negative psychological experience and possible emotional distress have also been raised . Due to these limitations, only small series of awake craniotomy have been conducted in children, in contrast to the larger cohorts within the adult population .…”

Section: Introductionmentioning

confidence: 99%

Feasibility of awake craniotomy in the pediatric population

García‐Tejedor

Echániz

Strantzas

et al. 2020

Pediatric Anesthesia

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Background: Awake craniotomy with direct cortical stimulation and mapping is the gold standard for resection of lesions near eloquent brain areas, as it can maximize the extent of resection while minimizing the risk of neurological damage. In contrast to the adult population, only small series of awake craniotomies have been reported in children. Aims:The aim of our study is to establish the feasibility of awake craniotomy in the pediatric population. Methods:We performed a retrospective observational study of children undergoing a supratentorial awake craniotomy between January 2009 and April 2019 in a pediatric tertiary care center. Our primary outcome was feasibility of awake craniotomy, defined as the ability to complete the procedure without conversion to general anesthesia. Our secondary outcomes were the incidence of serious intraoperative complications and the mapping completion rate.Results: Thirty procedures were performed in 28 children: 12 females and 16 males.The median age was 14 years (range 7-17). The primary diagnosis was tumor (83.3%), epilepsy (13.3%), and arterio-venous malformation (3.3%). The anesthetic techniques were asleep-awake-asleep (96.7%) and conscious sedation (3.3%), all cases supplemented with scalp block and pin-site infiltration. Awake craniotomy was feasible in 29 cases (96.7%), one patient converted to general anesthesia due to agitation. Serious complications occurred in six patients: agitation (6.7%), seizures (3.3%), increased intracranial pressure (3.3%), respiratory depression (3.3%), and bradycardia (3.3%).All complications were quickly resolved and without major consequences. Cortical mapping was completed in 96.6% cases. New neurological deficits occurred in six patients (20%)-moderate in one case and mild in 5-being all absent at 6 months of follow-up. Conclusion: Awake craniotomy with intraoperative mapping can be successfully performed in children. Adequate patient selection and close cooperation between neurosurgeons, anesthesiologists, neuropsychologists, and neurophysiologists is paramount. Further studies are needed to determine the best anesthetic technique in this population group. 1. Ojemann GA. Individual variability in cortical localization of language. J Neurosurg. 1979;50:164-169.

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“…However, no differences in the immediate postoperative motor status, extent of resection, or threshold intensity were found between IONM in anaesthetized patients and stimulation during awake craniotomy [46], although a detailed evaluation has not been performed for the different techniques or surgeries.…”

Section: Cortical and Subcortical Surgery In Awake Patientsmentioning

confidence: 99%

Intraoperative Neurophysiological Monitoring in Neuro-oncology

Vega-Zelaya¹,

Sola²,

Pastor³

2016

Neurooncology - Newer Developments

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Neurosurgery can be considered a radical method to treat some illnesses and can seriously damage the nervous system. To avoid deleterious effects, such injuries must be detected during their initial development by means of intraoperative neurophysiological techniques including intraoperative neurophysiological monitoring IONM and functional mapping .In this chapter, we review the most relevant and frequently performed IONM/mapping techniques. Some insight about the electrophysiological basis of stimulation and recording of the nervous system are provided. Intraoperative neurophysiological techniques can be divided into free running or evoked elicited. Among the first we discuss EMG, EEG and ECoG. Evoked potentials discussed include somato-sensory SSEPs , auditory BAEPs , visual VEPs , motor MEPs and stimulated EMG. We are especially interested in the clear and concise exposition of the methodological peculiarities, the fields of application and the flaws associated with the different techniques discussed, with a focus on practical applications. Therefore, we show examples of real operations performed at our institution.We conclude that IONM and mapping are some of the techniques with more relevance during recent decades for oncological neurosurgery. The widespread use and improvement of these techniques have allowed a safer removal of a radical tumour, reducing the risk of permanent postoperative deficits and better functional postsurgical outcomes during neuro-oncological surgery.

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Specificities of Awake Craniotomy and Brain Mapping in Children for Resection of Supratentorial Tumors in the Language Area

Cited by 54 publications

References 21 publications

Resting‐state functional magnetic resonance imaging versus task‐based activity for language mapping and correlation with perioperative cortical mapping

Resting‐state functional magnetic resonance imaging versus task‐based activity for language mapping and correlation with perioperative cortical mapping

Feasibility of awake craniotomy in the pediatric population

Intraoperative Neurophysiological Monitoring in Neuro-oncology

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