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Chabert S, Salas R, Cantor E, Veloz A, Cancino A, González M, Torres F, Bennett C. Hemodynamic response function description in patients with glioma. J Neuroradiol 2024; 51:101156. [PMID: 37805126 DOI: 10.1016/j.neurad.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Functional magnetic resonance imaging is a powerful tool that has provided many insights into cognitive sciences. Yet, as its analysis is mostly based on the knowledge of an a priori canonical hemodynamic response function (HRF), its reliability in patients' applications has been questioned. There have been reports of neurovascular uncoupling in patients with glioma, but no specific description of the Hemodynamic Response Function (HRF) in glioma has been reported so far. The aim of this work is to describe the HRF in patients with glioma. METHODS Forty patients were included. MR images were acquired on a 1.5T scanner. Activated clusters were identified using a fuzzy general linear model; HRFs were adjusted with a double-gamma function. Analyses were undertaken considering the tumor grade, age, sex, tumor location, and activated location. RESULTS Differences are found in the occipital, limbic, insular, and sub-lobar areas, but not in the frontal, temporal, and parietal lobes. The presence of a glioma slows the time-to-peak and onset times by 5.2 and 3.8 % respectively; high-grade gliomas present 8.1 % smaller HRF widths than low-grade gliomas. DISCUSSION AND CONCLUSION There is significant HRF variation due to the presence of glioma, but the magnitudes of the observed differences are small. Most processing pipelines should be robust enough for this magnitude of variation and little if any impact should be visible on functional maps. The differences that have been observed in the literature between functional mapping obtained with magnetic resonance vs. that obtained with direct electrostimulation during awake surgery are more probably due to the intrinsic difference in the mapping process: fMRI mapping detects all recruited areas while intra-surgical mapping indicates only the areas indispensable for the realization of a certain task. Surgical mapping might not be the gold standard to use when trying to validate the fMRI mapping process.
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Affiliation(s)
- Stéren Chabert
- School of Biomedical Engineering, Universidad de Valparaiso, General Cruz 222, Valparaiso, Chile; Millennium Science Initiative Intelligent Healthcare Engineering, Santiago, Chile.
| | - Rodrigo Salas
- School of Biomedical Engineering, Universidad de Valparaiso, General Cruz 222, Valparaiso, Chile; Millennium Science Initiative Intelligent Healthcare Engineering, Santiago, Chile
| | - Erika Cantor
- Institute of Statistics, Universidad de Valparaíso, Valparaíso, Chile
| | - Alejandro Veloz
- School of Biomedical Engineering, Universidad de Valparaiso, General Cruz 222, Valparaiso, Chile
| | - Astrid Cancino
- Millennium Science Initiative Intelligent Healthcare Engineering, Santiago, Chile; Doctorado en Ciencias e Ingeniería para la Salud, Universidad de Valparaiso, Valparaiso, Chile
| | - Matías González
- Neurosurgery Department, Hospital Carlos van Buren, Valparaiso, Chile
| | - Francisco Torres
- Millennium Science Initiative Intelligent Healthcare Engineering, Santiago, Chile; Radiology Department, Hospital Carlos van Buren, Valparaiso, Chile
| | - Carlos Bennett
- Neurosurgery Department, Hospital Carlos van Buren, Valparaiso, Chile
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Elmer S, Schmitt R, Giroud N, Meyer M. The neuroanatomical hallmarks of chronic tinnitus in comorbidity with pure-tone hearing loss. Brain Struct Funct 2023; 228:1511-1534. [PMID: 37349539 PMCID: PMC10335971 DOI: 10.1007/s00429-023-02669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
Tinnitus is one of the main hearing impairments often associated with pure-tone hearing loss, and typically manifested in the perception of phantom sounds. Nevertheless, tinnitus has traditionally been studied in isolation without necessarily considering auditory ghosting and hearing loss as part of the same syndrome. Hence, in the present neuroanatomical study, we attempted to pave the way toward a better understanding of the tinnitus syndrome, and compared two groups of almost perfectly matched individuals with (TIHL) and without (NTHL) pure-tone tinnitus, but both characterized by pure-tone hearing loss. The two groups were homogenized in terms of sample size, age, gender, handedness, education, and hearing loss. Furthermore, since the assessment of pure-tone hearing thresholds alone is not sufficient to describe the full spectrum of hearing abilities, the two groups were also harmonized for supra-threshold hearing estimates which were collected using temporal compression, frequency selectivity und speech-in-noise tasks. Regions-of-interest (ROI) analyses based on key brain structures identified in previous neuroimaging studies showed that the TIHL group exhibited increased cortical volume (CV) and surface area (CSA) of the right supramarginal gyrus and posterior planum temporale (PT) as well as CSA of the left middle-anterior part of the superior temporal sulcus (STS). The TIHL group also demonstrated larger volumes of the left amygdala and of the left head and body of the hippocampus. Notably, vertex-wise multiple linear regression analyses additionally brought to light that CSA of a specific cluster, which was located in the left middle-anterior part of the STS and overlapped with the one found to be significant in the between-group analyses, was positively associated with tinnitus distress level. Furthermore, distress also positively correlated with CSA of gray matter vertices in the right dorsal prefrontal cortex and the right posterior STS, whereas tinnitus duration was positively associated with CSA and CV of the right angular gyrus (AG) and posterior part of the STS. These results provide new insights into the critical gray matter architecture of the tinnitus syndrome matrix responsible for the emergence, maintenance and distress of auditory phantom sensations.
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Affiliation(s)
- Stefan Elmer
- Department of Computational Linguistics, Computational Neuroscience of Speech & Hearing, University of Zurich, Zurich, Switzerland
- Competence Center Language & Medicine, University of Zurich, Zurich, Switzerland
| | - Raffael Schmitt
- Department of Computational Linguistics, Computational Neuroscience of Speech & Hearing, University of Zurich, Zurich, Switzerland
| | - Nathalie Giroud
- Department of Computational Linguistics, Computational Neuroscience of Speech & Hearing, University of Zurich, Zurich, Switzerland
- Center for Neuroscience Zurich, University and ETH of Zurich, Zurich, Switzerland
- Competence Center Language & Medicine, University of Zurich, Zurich, Switzerland
| | - Martin Meyer
- Department of Comparative Language Science, University of Zurich, Zurich, Switzerland
- Center for Neuroscience Zurich, University and ETH of Zurich, Zurich, Switzerland
- Center for the Interdisciplinary Study of Language Evolution (ISLE), University of Zurich, Zurich, Switzerland
- Cognitive Psychology Unit, Alpen-Adria University, Klagenfurt, Austria
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Al-Arfaj HK, Al-Sharydah AM, AlSuhaibani SS, Alaqeel S, Yousry T. Task-Based and Resting-State Functional MRI in Observing Eloquent Cerebral Areas Personalized for Epilepsy and Surgical Oncology Patients: A Review of the Current Evidence. J Pers Med 2023; 13:jpm13020370. [PMID: 36836604 PMCID: PMC9964201 DOI: 10.3390/jpm13020370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/23/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Functional magnetic resonance imaging (fMRI) is among the newest techniques of advanced neuroimaging that offer the opportunity for neuroradiologists, neurophysiologists, neuro-oncologists, and neurosurgeons to pre-operatively plan and manage different types of brain lesions. Furthermore, it plays a fundamental role in the personalized evaluation of patients with brain tumors or patients with an epileptic focus for preoperative planning. While the implementation of task-based fMRI has increased in recent years, the existing resources and evidence related to this technique are limited. We have, therefore, conducted a comprehensive review of the available resources to compile a detailed resource for physicians who specialize in managing patients with brain tumors and seizure disorders. This review contributes to the existing literature because it highlights the lack of studies on fMRI and its precise role and applicability in observing eloquent cerebral areas in surgical oncology and epilepsy patients, which we believe is underreported. Taking these considerations into account would help to better understand the role of this advanced neuroimaging technique and, ultimately, improve patient life expectancy and quality of life.
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Affiliation(s)
| | - Abdulaziz Mohammad Al-Sharydah
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
- Correspondence: ; Fax: +966-013-8676697
| | - Sari Saleh AlSuhaibani
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
| | - Soliman Alaqeel
- Medical Imaging Department, Dammam Medical Complex, Ministry of Health, Dammam 11176, Saudi Arabia
| | - Tarek Yousry
- Division of Neuroradiology and Neurophysics, Lysholm Department of Neuroradiology, UCL IoN, UCLH, London NW1 2BU, UK
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Jiang S, Chai H, Tang Q. Advances in the intraoperative delineation of malignant glioma margin. Front Oncol 2023; 13:1114450. [PMID: 36776293 PMCID: PMC9909013 DOI: 10.3389/fonc.2023.1114450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
Surgery plays a critical role in the treatment of malignant glioma. However, due to the infiltrative growth and brain shift, it is difficult for neurosurgeons to distinguish malignant glioma margins with the naked eye and with preoperative examinations. Therefore, several technologies were developed to determine precise tumor margins intraoperatively. Here, we introduced four intraoperative technologies to delineate malignant glioma margin, namely, magnetic resonance imaging, fluorescence-guided surgery, Raman histology, and mass spectrometry. By tracing their detecting principles and developments, we reviewed their advantages and disadvantages respectively and imagined future trends.
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Bennett C, González M, Tapia G, Riveros R, Torres F, Loyola N, Veloz A, Chabert S. Cortical mapping in glioma surgery: correlation of fMRI and direct electrical stimulation with Human Connectome Project parcellations. Neurosurg Focus 2022; 53:E2. [PMID: 36455268 DOI: 10.3171/2022.9.focus2283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/27/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Noninvasive brain mapping with functional MRI (fMRI) and mapping with direct electrical stimulation (DES) are important tools in glioma surgery, but the evidence is inconclusive regarding the sensitivity and specificity of fMRI. The Human Connectome Project (HCP) proposed a new cortical parcellation that has not been thoroughly tested in a clinical setting. The main goal of this study was to evaluate the correlation of fMRI and DES mapping with HCP areas in a clinical setting, and to evaluate the performance of fMRI mapping in motor and language tasks in patients with glioma, using DES as the gold standard. METHODS Forty patients with supratentorial gliomas were examined using preoperative fMRI and underwent awake craniotomy with DES. Functional activation maps were visualized on a 3D representation of the cortex, classified according to HCP areas, and compared with surgical mapping. RESULTS Functional MRI was successful in identifying language and motor HCP areas in most cases, including novel areas such as 55b and the superior longitudinal fasciculus (SLF). Functional MRI had a sensitivity and specificity of 100% and 71%, respectively, for motor function in HCP area 4. Sensitivity and specificity were different according to the area and fMRI protocol; i.e., semantic protocols performed better in Brodmann area (BA) 55b/peri-sylvian language areas with 100% sensitivity and 20% specificity, and word production protocols in BAs 44 and 45 with 70% sensitivity and 80% specificity. Some compensation patterns could be observed, such as motor activation of the postcentral gyrus in precentral gliomas. CONCLUSIONS HCP areas can be detected in clinical scenarios of glioma surgery. These areas appear relatively stable across patients, but compensation patterns seem to differ, allowing occasional resection of activating areas. Newly described areas such as 55b and SLF can act as critical areas in language networks. Surgical planning should account for these parcellations.
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Affiliation(s)
- Carlos Bennett
- 1Department of Neurosurgery, Hospital Carlos van Buren, Valparaíso.,2School of Medicine, Universidad de Valparaíso
| | - Matías González
- 1Department of Neurosurgery, Hospital Carlos van Buren, Valparaíso.,2School of Medicine, Universidad de Valparaíso
| | - Gisella Tapia
- 2School of Medicine, Universidad de Valparaíso.,3Department of Neurology, Hospital Carlos van Buren, Valparaíso
| | - Rodrigo Riveros
- 2School of Medicine, Universidad de Valparaíso.,4Department of Radiology, Hospital Carlos van Buren, Valparaíso
| | - Francisco Torres
- 2School of Medicine, Universidad de Valparaíso.,4Department of Radiology, Hospital Carlos van Buren, Valparaíso
| | - Nicole Loyola
- 1Department of Neurosurgery, Hospital Carlos van Buren, Valparaíso.,2School of Medicine, Universidad de Valparaíso
| | - Alejandro Veloz
- 5School of Biomedical Engineering, Universidad de Valparaíso.,6Centro de Investigación y Desarrollo en Ingeniería en Salud CINGS, Universidad de Valparaíso
| | - Stéren Chabert
- 5School of Biomedical Engineering, Universidad de Valparaíso.,8Instituto Milenio Intelligent Healthcare Engineering, Santiago, Chile
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Chawla P, Misra BK, Udani V, Desai N, Gupta S. Correlation of Preoperative Functional Magnetic Resonance Imaging (fMRI) with Intraoperative Cortical Stimulation in Surgeries of Eloquent Brain Lesions. Neurol India 2022; 70:1534-1539. [PMID: 36076655 DOI: 10.4103/0028-3886.355146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Direct Cortical Stimulation (DCS) represents the gold standard for mapping of eloquent brain cortex. However, DCS is an invasive and time-consuming procedure. fMRI has become a useful tool to delineate motor and sensory eloquent cortex from the areas of planned neurosurgical resection. In our study, we will be studying the reliability of preoperative imaging when compared with the intraoperative DCS. Objectives The aim of this study was to assess the reliability of fMRI by comparing it with DCS. Methods and Materials Thirty patients with eloquent cortex lesions were admitted. Preoperative fMRI sequences were loaded into a neuro-navigational system. Intraoperative motor mapping was done by DCS. The location of all cortical stimulated points was correlated with the cortical functional structures. Based on it, specificity, sensitivity, positive predictive value, negative predictive value of fMRI was calculated. Preoperative and postoperative Karnofsky score and MRC grading was then noted. Results Concordance between fMRI and DCS was noted in 26 cases. Overall mean sensitivity, specificity, positive and negative predictive value of fMRI as compared to DCS was 95%, 92.48%, 85.56%, and 96.08%, respectively. Preoperative and Postoperative Karnofsky score stayed same in most of the cases [25/30]. Conclusions DCS remains the gold standard for mapping eloquent cortex in-spite of its invasiveness, side effects such as seizures and cost concerns. Although fMRI cannot replace DCS, it can guide and increase the efficacy in resection, select high-risk patients for intraoperative monitoring, help in preoperative stratification of risk counseling and preservation of neurological status in eloquent brain lesions.
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Affiliation(s)
- Pawan Chawla
- Department of Neurosurgery and Gamma Knife Radiosurgery, P. D. Hinduja Hospital and Medical Research Centre, V. S. Marg, Mahim, Mumbai, Maharashtra, India
| | - Basant K Misra
- Department of Neurosurgery and Gamma Knife Radiosurgery, P. D. Hinduja Hospital and Medical Research Centre, V. S. Marg, Mahim, Mumbai, Maharashtra, India
| | - Vrajesh Udani
- Department of Neurology, P. D. Hinduja Hospital and Medical Research Centre, V. S. Marg, Mahim, Mumbai, Maharashtra, India
| | - Neelu Desai
- Department of Neurology, P. D. Hinduja Hospital and Medical Research Centre, V. S. Marg, Mahim, Mumbai, Maharashtra, India
| | - Santosh Gupta
- Department of Imaging, P. D. Hinduja Hospital and Medical Research Centre, V. S. Marg, Mahim, Mumbai, Maharashtra, India
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Bunyaratavej K, Wangsawatwong P. Rolandic Cortex Morphology: Magnetic Resonance Imaging-Based Three-Dimensional Cerebral Reconstruction Study and Intraoperative Usefulness. Asian J Neurosurg 2022; 17:31-37. [PMID: 35873857 PMCID: PMC9298582 DOI: 10.1055/s-0042-1748790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background
During brain surgery, the neurosurgeon must be able to identify and avoid injury to the Rolandic cortex. However, when only a small part of the cortex is exposed, it may be difficult to identify the Rolandic cortex with certainty. Despite various advanced methods to identify it, visual recognition remains an important backup for neurosurgeons. The aim of the study was to find any specific morphology pattern that may help to identify the Rolandic cortex intraoperatively.
Materials and Methods
Magnetic resonance imaging of the brain from patients with various conditions was used to create the three-dimensional cerebral reconstruction images. A total of 216 patients with 371 intact hemispheres were included. Each image was inspected to note the morphology of the Rolandic cortex and the suprasylvian cortex. Additionally, other two evaluators exclusively inspected the morphology of the suprasylvian cortex. Their observation results were compared to find the agreements.
Results
Several distinctive morphology patterns have been identified at the Rolandic cortex and the suprasylvian cortex including a genu, or a knob at the upper precentral gyrus, an angulation of the lower postcentral gyrus, a strip for pars opercularis, a rectangle for the lower precentral gyrus, and a triangle for the lower postcentral gyrus. Combined total and partial agreement of the suprasylvian cortex morphology pattern ranged from 60.4 to 85.2%.
Conclusion
The authors have demonstrated the distinctive morphology of the Rolandic cortex and the suprasylvian cortex. This information can provide visual guidance to identify the Rolandic cortex particularly during surgery with limited exposure.
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Affiliation(s)
- Krishnapundha Bunyaratavej
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Piyanat Wangsawatwong
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Riley SP, Chu DY, Nair VA, Baskaya MK, Kuo JS, Meyerand ME, Prabhakaran V. Characterizing the relationship between lesion-activation distance using fMRI and verbal measures in brain tumor patients. INTERDISCIPLINARY NEUROSURGERY 2022; 27. [PMID: 34950570 PMCID: PMC8691738 DOI: 10.1016/j.inat.2021.101391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
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Rodriguez-Rojas R, Pineda-Pardo JA, Mañez-Miro J, Sanchez-Turel A, Martinez-Fernandez R, Del Alamo M, DeLong M, Obeso JA. Functional Topography of the Human Subthalamic Nucleus: Relevance for Subthalamotomy in Parkinson's Disease. Mov Disord 2021; 37:279-290. [PMID: 34859498 DOI: 10.1002/mds.28862] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The subthalamic nucleus (STN) is considered a key structure in motor, behavioral, and emotional control. Although identification of the functional topography of the STN has therapeutic implications in the treatment of the motor features of Parkinson's disease (PD), the details of its functional and somatotopic organization in humans are not well understood. OBJECTIVE The aim of this study was to characterize the functional organization of the STN and its correlation with the motor outcomes induced by subthalamotomy. METHODS We used diffusion-weighted imaging to assess STN connectivity patterns in 23 healthy control subjects and 86 patients with PD, of whom 39 received unilateral subthalamotomy. Analytical tractography was used to reconstruct structural cortico-subthalamic connectivity. A diffusion-weighted imaging/functional magnetic resonance imaging-driven somatotopic parcellation of the STN was defined to delineate the representation of the upper and lower limb in the STN. RESULTS We confirmed a connectional gradient to sensorimotor, supplementary-motor, associative, and limbic cortical regions, spanning from posterior-dorsal-lateral to anterior-ventral-medial portions of the STN, with intermediate overlapping zones. Functional magnetic resonance imaging-driven parcellation demonstrated dual segregation of motor cortico-subthalamic projections in humans. Moreover, the relationship between lesion topography and functional anatomy of the STN explains specific improvement in bradykinesia, rigidity, and tremor induced by subthalamotomy. CONCLUSIONS Our results support an interplay between segregation and integration of cortico-subthalamic projections, suggesting the coexistence of parallel and convergent information processing. Identifying the functional topography of the STN will facilitate better definition of the optimal location for functional neurosurgical approaches, that is, electrode placement and lesion location, and improve specific cardinal features in PD. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rafael Rodriguez-Rojas
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Universidad CEU-San Pablo University, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Carlos III Institute, Madrid, Spain
| | - Jose A Pineda-Pardo
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Universidad CEU-San Pablo University, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Carlos III Institute, Madrid, Spain
| | - Jorge Mañez-Miro
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Alicia Sanchez-Turel
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Raul Martinez-Fernandez
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Universidad CEU-San Pablo University, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Carlos III Institute, Madrid, Spain
| | - Marta Del Alamo
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Mahlon DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jose A Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Universidad CEU-San Pablo University, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Carlos III Institute, Madrid, Spain
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Stockert A, Schwartze M, Poeppel D, Anwander A, Kotz SA. Temporo-cerebellar connectivity underlies timing constraints in audition. eLife 2021; 10:67303. [PMID: 34542407 PMCID: PMC8480974 DOI: 10.7554/elife.67303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 09/09/2021] [Indexed: 12/26/2022] Open
Abstract
The flexible and efficient adaptation to dynamic, rapid changes in the auditory environment likely involves generating and updating of internal models. Such models arguably exploit connections between the neocortex and the cerebellum, supporting proactive adaptation. Here, we tested whether temporo-cerebellar disconnection is associated with the processing of sound at short timescales. First, we identify lesion-specific deficits for the encoding of short timescale spectro-temporal non-speech and speech properties in patients with left posterior temporal cortex stroke. Second, using lesion-guided probabilistic tractography in healthy participants, we revealed bidirectional temporo-cerebellar connectivity with cerebellar dentate nuclei and crura I/II. These findings support the view that the encoding and modeling of rapidly modulated auditory spectro-temporal properties can rely on a temporo-cerebellar interface. We discuss these findings in view of the conjecture that proactive adaptation to a dynamic environment via internal models is a generalizable principle.
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Affiliation(s)
- Anika Stockert
- Language and Aphasia Laboratory, Department of Neurology, Leipzig University Hospital, Leipzig, Germany.,Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Michael Schwartze
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - David Poeppel
- Department of Neuroscience, Max Planck Institute for Empirical Aesthetics, Frankfurt, Germany.,Department of Psychology, New York University, New York, United States
| | - Alfred Anwander
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Sonja A Kotz
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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Daniel AGS, Park KY, Roland JL, Dierker D, Gross J, Humphries JB, Hacker CD, Snyder AZ, Shimony JS, Leuthardt EC. Functional connectivity within glioblastoma impacts overall survival. Neuro Oncol 2021; 23:412-421. [PMID: 32789494 PMCID: PMC7992880 DOI: 10.1093/neuonc/noaa189] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Glioblastoma (GBM; World Health Organization grade IV) assumes a variable appearance on MRI owing to heterogeneous proliferation and infiltration of its cells. As a result, the neurovascular units responsible for functional connectivity (FC) may exist within gross tumor boundaries, albeit with altered magnitude. Therefore, we hypothesize that the strength of FC within GBMs is predictive of overall survival. Methods We used predefined FC regions of interest (ROIs) in de novo GBM patients to characterize the presence of within-tumor FC observable via resting-state functional MRI and its relationship to survival outcomes. Results Fifty-seven GBM patients (mean age, 57.8 ± 13.9 y) were analyzed. Functionally connected voxels, not identifiable on conventional structural images, can be routinely found within the tumor mass and was not significantly correlated to tumor size. In patients with known survival times (n = 31), higher intranetwork FC strength within GBM tumors was associated with better overall survival even after accounting for clinical and demographic covariates. Conclusions These findings suggest the possibility that functionally intact regions may persist within GBMs and that the extent to which FC is maintained may carry prognostic value and inform treatment planning.
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Affiliation(s)
- Andy G S Daniel
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University, St. Louis, Missouri
| | - Ki Yun Park
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Jarod L Roland
- Washington University School of Medicine, St Louis, Missouri.,Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Joseph B Humphries
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University, St. Louis, Missouri
| | - Carl D Hacker
- Department of Neurological Surgery, St Louis, Missouri
| | - Abraham Z Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric C Leuthardt
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University, St. Louis, Missouri.,Washington University School of Medicine, St Louis, Missouri.,Department of Neurological Surgery, St Louis, Missouri.,Department of Neuroscience, St Louis, Missouri.,Department of Mechanical Engineering and Materials Science, St Louis, Missouri.,Center for Innovation in Neuroscience and Technology, St Louis, Missouri.,Brain Laser Center, St Louis, Missouri
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12
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The corticotegmental connectivity as an integral component of the descending extrapyramidal pathway: novel and direct structural evidence stemming from focused fiber dissections. Neurosurg Rev 2021; 44:3283-3296. [PMID: 33564983 DOI: 10.1007/s10143-021-01489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
This study opts to investigate the thus far ill-defined intra-hemispheric topography, morphology, and connectivity of the extrapyramidal fibers that originate from the frontoparietal cortex and project to the tegmental area and to explore structural correlations to the pyramidal pathway. To this end, twenty normal adult, formalin-fixed cerebral hemispheres were studied through the fiber micro-dissection technique. Stepwise and in-tandem medial to lateral and lateral to medial dissections were carried out in all specimens. The cortical termination of the fibers under investigation was carefully defined, and their entry zone at the tegmental area was meticulously recorded. We consistently identified the corticotegmental tract (CTT) as a distinct fiber pathway lying in the white matter of the genu and posterior limb of the internal capsule and travelling medial to the corticospinal tract (CST) and lateral to the thalamic radiations. The CTT exhibits a fan-shaped configuration and can be classified into three discrete segments: a rostral one receiving fibers from BA8 (pre-SMA, frontal eye fields, dorsal prefrontal cortex), a middle one arising from areas BA4 and BA6 (primary motor cortex and premotor cortex), and a caudal one stemming from areas BA1/2/3 (somatosensory cortex). The anatomical location, configuration, trajectory, and axonal connectivity of this tract are attuned to the descending component of the extrapyramidal system, and therefore, it is believed to be implicated in locomotion, postural control, motor inhibition, and motor modification. Our results provide further support on the emerging concept of a dynamic, parallel, and delocalized theory for complex human motor behavior.
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Ellis DG, White ML, Hayasaka S, Warren DE, Wilson TW, Aizenberg MR. Accuracy analysis of fMRI and MEG activations determined by intraoperative mapping. Neurosurg Focus 2021; 48:E13. [PMID: 32006951 DOI: 10.3171/2019.11.focus19784] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE By looking at how the accuracy of preoperative brain mapping methods vary according to differences in the distance from the activation clusters used for the analysis, the present study aimed to elucidate how preoperative functional neuroimaging may be used in such a way that maximizes the mapping accuracy. METHODS The eloquent function of 19 patients with a brain tumor or cavernoma was mapped prior to resection with both functional MRI (fMRI) and magnetoencephalography (MEG). The mapping results were then validated using direct cortical stimulation mapping performed immediately after craniotomy and prior to resection. The subset of patients with equivalent MEG and fMRI tasks performed for motor (n = 14) and language (n = 12) were evaluated as both individual and combined predictions. Furthermore, the distance resulting in the maximum accuracy, as evaluated by the J statistic, was determined by plotting the sensitivities and specificities against a linearly increasing distance threshold. RESULTS fMRI showed a maximum mapping accuracy at 5 mm for both motor and language mapping. MEG showed a maximum mapping accuracy at 40 mm for motor and 15 mm for language mapping. At the standard 10-mm distance used in the literature, MEG showed a greater specificity than fMRI for both motor and language mapping but a lower sensitivity for motor mapping. Combining MEG and fMRI showed a maximum accuracy at 15 mm and 5 mm-MEG and fMRI distances, respectively-for motor mapping and at a 10-mm distance for both MEG and fMRI for language mapping. For motor mapping, combining MEG and fMRI at the optimal distances resulted in a greater accuracy than the maximum accuracy of the individual predictions. CONCLUSIONS This study demonstrates that the accuracy of language and motor mapping for both fMRI and MEG is heavily dependent on the distance threshold used in the analysis. Furthermore, combining MEG and fMRI showed the potential for increased motor mapping accuracy compared to when using the modalities separately.Clinical trial registration no.: NCT01535430 (clinicaltrials.gov).
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Affiliation(s)
| | - Matthew L White
- 2Radiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Satoru Hayasaka
- 3Department of Psychology, University of Texas at Austin, Texas; and
| | - David E Warren
- 4Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Tony W Wilson
- 4Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
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14
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Fang S, Bai HX, Fan X, Li S, Zhang Z, Jiang T, Wang Y. A Novel Sequence: ZOOMit-Blood Oxygen Level-Dependent for Motor-Cortex Localization. Neurosurgery 2020; 86:E124-E132. [PMID: 31642505 DOI: 10.1093/neuros/nyz441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Use of conventional blood oxygen level-dependent functional magnetic resonance imaging (conventional-BOLD-fMRI) presents challenges in accurately identifying the hand-motor cortex when a glioma involves the ipsilateral hand-knob. Zoomed imaging technique with parallel transmission (ZOOMit)-BOLD is a novel sequence allowing high spatial resolution with a relatively small field of view that may solve this problem. OBJECTIVE To compare the accuracy of ZOOMit-BOLD and conventional-BOLD in hand-motor cortex identification. METHODS A total of 20 patients with gliomas involving the sensorimotor cortex were recruited to identify the hand-motor cortex by both ZOOMit-BOLD and conventional-BOLD. Based on whether the entire or partial glioma directly invaded (was located within) the hand-knob or indirectly affected it by proximity, patients were placed into the involved or uninvolved groups, respectively. Direct cortical stimulation was applied intraoperatively to verify the location of the hand-motor cortex. Overlap indices were used to evaluate the accuracy of the hand-motor cortex identification. An overlap index equal to 0, indicating lack of overlap, was classified as inaccurate classification. RESULTS The accuracy of motor-cortex identification with ZOOMit-BOLD was 100% compared to only 65% with conventional-BOLD. The average overlap index yielded by ZOOMit-BOLD was higher than that of conventional-BOLD, regardless of whether gliomas directly invaded the hand-knob (P = .008) or not (P = .004). The overlap index in the involved group was significantly lower than that in the uninvolved group with both ZOOMit-BOLD (P = .002) and conventional-BOLD (P < .001). CONCLUSION ZOOMit-BOLD may potentially replace conventional-BOLD to identify the hand-motor cortex, particularly in cases in which gliomas directly invade the hand-knob.
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Affiliation(s)
- Shengyu Fang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Harrison X Bai
- Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Xing Fan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Shaowu Li
- Functional Neuroradiology Center, Beijing Neurosurgical Institute, Beijing, China
| | - Zhong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders Brain Tumor Center, Beijing, China
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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15
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Guerin JB, Greiner HM, Mangano FT, Leach JL. Functional MRI in Children: Current Clinical Applications. Semin Pediatr Neurol 2020; 33:100800. [PMID: 32331615 DOI: 10.1016/j.spen.2020.100800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Functional magnetic resonance imaging has become a critical research tool for evaluating brain function during active tasks and resting states. This has improved our understanding of developmental trajectories in children as well as the plasticity of neural networks in disease states. In the clinical setting, functional maps of eloquent cortex in patients with brain lesions and/or epilepsy provides crucial information for presurgical planning. Although children are inherently challenging to scan in this setting, preparing them appropriately and providing adequate resources can help achieve useful clinical data. This article will review the basic underlying physiologic aspects of functional magnetic resonance imaging, review clinically relevant research applications, describe known validation data compared to gold standard techniques and detail future directions of this technology.
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Affiliation(s)
- Julie B Guerin
- Department of Pediatric Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, Mayo Clinic, Rochester, MN
| | - Hansel M Greiner
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, University of Cincinnati College of Medicine Department of Neurosurgery, Cincinnati, OH
| | - James L Leach
- Department of Pediatric Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, Mayo Clinic, Rochester, MN.
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16
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Hui J, Lioumis P, Blumberger DM, Daskalakis ZJ. Non-invasive Central Neuromodulation with Transcranial Magnetic Stimulation. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Neurophysiological examination combined with functional intraoperative navigation using TMS in patients with brain tumor near the central region-a pilot study. Acta Neurochir (Wien) 2019; 161:1853-1864. [PMID: 31297597 DOI: 10.1007/s00701-019-04004-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Feasibility and value of non-invasive transcranial magnetic brain stimulation (TMS MAGVENTURE® MagPro R30 Denmark) for preoperative diagnosis and surgical planning of brain tumor operations in everyday clinical practice. METHODS A prospective monocentric study was conducted, which included preoperative neurological and electrophysiological examination, TMS, and display of functional data in the navigation system (LOCALITE® TMS Navigator Germany). During surgery, the TMS data were correlated with the intraoperative monitoring (IOM). Twenty-four hours to 96 h and after at least 3 months, follow-ups with neurological, electrophysiological examinations and TMS stimulation were performed. RESULTS Twenty-five patients with tumors in or near by the primary motor cortex region were included in the study. Twenty-one patients completed preoperative and first postoperative TMS and the neurological examination. Eight of 21 patients showed slight worsening of primary motor cortex function, 8 patients had an unchanged state, and 4 patients showed an improvement early after surgery. The changes of the electrophysiological examination like significant delay of the latency and/or reduced amplitudes matched well with the postoperative neurological outcome: if patients showed a worsening of the SEP's and MEP's, the postoperative results revealed deterioration. CONCLUSION A preoperatively performed TMS using the MAGVENTURE® MagPro R30 and the LOCALITE® TMS Navigator could be established in our clinical daily practice and allowed a safe and reliable mapping of the primary motor cortex in order to minimize the risk of postoperative neurological deficits and improve the neurological outcome of the patients.
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18
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Belkacem AN, Nishio S, Suzuki T, Ishiguro H, Hirata M. Neuromagnetic Decoding of Simultaneous Bilateral Hand Movements for Multidimensional Brain-Machine Interfaces. IEEE Trans Neural Syst Rehabil Eng 2019; 26:1301-1310. [PMID: 29877855 DOI: 10.1109/tnsre.2018.2837003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To provide multidimensional control, we describe the first reported decoding of bilateral hand movements by using single-trial magnetoencephalography signals as a new approach to enhance a user's ability to interact with a complex environment through a multidimensional brain-machine interface. Ten healthy participants performed or imagined four types of bilateral hand movements during neuromagnetic measurements. By applying a support vector machine (SVM) method to classify the four movements regarding the sensor data obtained from the sensorimotor area, we found the mean accuracy of a two-class classification using the amplitudes of neuromagnetic fields to be particularly suitable for real-time applications, with accuracies comparable to those obtained in previous studies involving unilateral movement. The sensor data from over the sensorimotor cortex showed discriminative time-series waveforms and time-frequency maps in the bilateral hemispheres according to the four tasks. Furthermore, we used four-class classification algorithms based on the SVM method to decode all types of bilateral movements. Our results provided further proof that the slow components of neuromagnetic fields carry sufficient neural information to classify even bilateral hand movements and demonstrated the potential utility of decoding bilateral movements for engineering purposes such as multidimensional motor control.
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Wilke C, Grosshans D, Duman J, Brown P, Li J. Radiation-induced cognitive toxicity: pathophysiology and interventions to reduce toxicity in adults. Neuro Oncol 2019; 20:597-607. [PMID: 29045710 DOI: 10.1093/neuonc/nox195] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Radiotherapy is ubiquitous in the treatment of patients with both primary brain tumors as well as disease which is metastatic to the brain. This therapy is not without cost, however, as cognitive decline is frequently associated with cranial radiation, particularly with whole brain radiotherapy (WBRT). The precise mechanisms responsible for radiation-induced morbidity remain incompletely understood and continue to be an active area of ongoing research. In this article, we review the hypothetical means by which cranial radiation induces cognitive decline as well as potential therapeutic approaches to prevent, minimize, or reverse treatment-induced cognitive deterioration. We additionally review advances in imaging modalities that can potentially be used to identify site-specific radiation-induced anatomic or functional changes in the brain and their correlation with clinical outcomes.
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Affiliation(s)
- Christopher Wilke
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (C.W., D.G., J.L.); Department of Neuroscience, Baylor College of Medicine, Houston, Texas (J.D.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (P.B.)
| | - David Grosshans
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (C.W., D.G., J.L.); Department of Neuroscience, Baylor College of Medicine, Houston, Texas (J.D.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (P.B.)
| | - Joseph Duman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (C.W., D.G., J.L.); Department of Neuroscience, Baylor College of Medicine, Houston, Texas (J.D.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (P.B.)
| | - Paul Brown
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (C.W., D.G., J.L.); Department of Neuroscience, Baylor College of Medicine, Houston, Texas (J.D.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (P.B.)
| | - Jing Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (C.W., D.G., J.L.); Department of Neuroscience, Baylor College of Medicine, Houston, Texas (J.D.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (P.B.)
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20
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Gould L, Ekstrand C, Fourney DR, Mickleborough MJ, Ellchuk T, Borowsky R. The Effect of Tumor Neovasculature on Functional Magnetic Resonance Imaging Blood Oxygen Level–Dependent Activation. World Neurosurg 2018; 115:373-383. [DOI: 10.1016/j.wneu.2018.04.200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 11/16/2022]
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21
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Visualization of subcortical language pathways by diffusion tensor imaging fiber tracking based on rTMS language mapping. Brain Imaging Behav 2018; 11:899-914. [PMID: 27323766 DOI: 10.1007/s11682-016-9563-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diffusion tensor imaging fiber tracking (DTI FT) is used to visualize subcortical fiber tracts. Yet, there is no standard at hand to visualize language-involved subcortical fibers reliably. Thus, this study investigates the feasibility of using language-related cortical areas identified via repetitive navigated transcranial magnetic stimulation (rTMS) to seed DTI FT of subcortical language tracts. From 2011 to 2014, 37 patients with left-hemispheric perisylvian lesions were examined. Language-positive rTMS stimulation spots were integrated in the deterministic tractography software (BrainLAB, iPlanNet 3.0) as objects and used as seed regions for DTI FT. Tractography was then performed in each patient with 77 different combinations of fiber lengths (40 - 100 mm) and fractional anisotropy (FA; 0.01 - 0.5). The rTMS-based DTI FT identified all commonly known subcortical language tracts, such as the corticonuclear tract, arcuate fascicle, uncinate fascicle, superior longitudinal fascicle, inferior longitudinal fascicle, arcuate fibers, commissural fibers, corticothalamic fibers, and the fronto-occipital fascicle. In 32 patients (86.5 %), each above-named tract could be visualized, while at least 6 out of these 9 tracts were identified in each patient. A fiber length of 100 mm and an FA of 0.1 or 0.15 provided optimal visualization by revealing 125 and 61 individually tracked fibers per visualized language tract and 90 % and 73 % of all language-related tracts, respectively. This study proves the feasibility of rTMS-based DTI FT for subcortical language tracts, provides suitable settings, and shows its easy and standardizable application for the visualization of every language tract in 86.5 % of patients.
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22
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Huang H, Ding Z, Mao D, Yuan J, Zhu F, Chen S, Xu Y, Lou L, Feng X, Qi L, Qiu W, Zhang H, Zang YF. PreSurgMapp: a MATLAB Toolbox for Presurgical Mapping of Eloquent Functional Areas Based on Task-Related and Resting-State Functional MRI. Neuroinformatics 2018; 14:421-38. [PMID: 27221107 DOI: 10.1007/s12021-016-9304-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The main goal of brain tumor surgery is to maximize tumor resection while minimizing the risk of irreversible postoperative functional sequelae. Eloquent functional areas should be delineated preoperatively, particularly for patients with tumors near eloquent areas. Functional magnetic resonance imaging (fMRI) is a noninvasive technique that demonstrates great promise for presurgical planning. However, specialized data processing toolkits for presurgical planning remain lacking. Based on several functions in open-source software such as Statistical Parametric Mapping (SPM), Resting-State fMRI Data Analysis Toolkit (REST), Data Processing Assistant for Resting-State fMRI (DPARSF) and Multiple Independent Component Analysis (MICA), here, we introduce an open-source MATLAB toolbox named PreSurgMapp. This toolbox can reveal eloquent areas using comprehensive methods and various complementary fMRI modalities. For example, PreSurgMapp supports both model-based (general linear model, GLM, and seed correlation) and data-driven (independent component analysis, ICA) methods and processes both task-based and resting-state fMRI data. PreSurgMapp is designed for highly automatic and individualized functional mapping with a user-friendly graphical user interface (GUI) for time-saving pipeline processing. For example, sensorimotor and language-related components can be automatically identified without human input interference using an effective, accurate component identification algorithm using discriminability index. All the results generated can be further evaluated and compared by neuro-radiologists or neurosurgeons. This software has substantial value for clinical neuro-radiology and neuro-oncology, including application to patients with low- and high-grade brain tumors and those with epilepsy foci in the dominant language hemisphere who are planning to undergo a temporal lobectomy.
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Affiliation(s)
- Huiyuan Huang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, 58 Haishu Road, Hangzhou, 311121, People's Republic of China.,School of Education Science, Hangzhou Normal University, Hangzhou, Zhejiang, 311121, People's Republic of China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, 310015, People's Republic of China
| | - Zhongxiang Ding
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Dewang Mao
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Jianhua Yuan
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Fangmei Zhu
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Shuda Chen
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Yan Xu
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Lin Lou
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Xiaoyan Feng
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Le Qi
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, 310015, People's Republic of China
| | - Wusi Qiu
- Department of Neurosurgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, 310015, People's Republic of China
| | - Han Zhang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, 58 Haishu Road, Hangzhou, 311121, People's Republic of China. .,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, 310015, People's Republic of China.
| | - Yu-Feng Zang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, 58 Haishu Road, Hangzhou, 311121, People's Republic of China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, 310015, People's Republic of China
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Practical prognostic score for predicting the extent of resection and neurological outcome of gliomas in the sensorimotor area. Clin Neurol Neurosurg 2017; 164:25-31. [PMID: 29154228 DOI: 10.1016/j.clineuro.2017.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/04/2017] [Accepted: 11/14/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In this prospective study, we assessed the utility of a novel prognostic score (PS) in guiding the surgical strategy of patients with sensorimotor area gliomas. PATIENTS AND METHODS Form December 2012 to April 2016, we collected data from patients diagnosed with brain gliomas in the sensorimotor area. All the patients had intraoperatively confirmed contiguity or continuity with sensorimotor cortical and subcortical structures. Several clinical and radiological factors were analyzed to generate a PS for each patient (range 1-8). The end-points included the extent of resection (EOR) and neurological outcome (modified Rankin Score; mRS). We assessed the predictive power of the PS using different analyses. Crosstabs analyses and Fisher's exact test (Fet) were used to evaluate the possible predictive parameters, and for the classification of positive or negative outcomes for the chosen proxies; the significance threshold was set at p<0.05. RESULTS Using independent t-tests, we compared the mRS at different time points (pre, post, and at 6 months) for 2 subgroups from the total sample using a cut-off PS value of 4. For the EOR, a PS value of ≥5 was predictive of successful outcome, a value of 4 indicated an uncertain outcome, and a value of ≤3 predicted a worse outcome. CONCLUSIONS This PS value can be easily used in clinical settings to help predict the functional outcome and EOR in sensorimotor area tumors. Integration with information from fMRI, DTI, and TMS, along with MRI spectroscopy could further enhance the value of this PS.
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Fang S, Liang J, Qian T, Wang Y, Liu X, Fan X, Li S, Wang Y, Jiang T. Anatomic Location of Tumor Predicts the Accuracy of Motor Function Localization in Diffuse Lower-Grade Gliomas Involving the Hand Knob Area. AJNR Am J Neuroradiol 2017; 38:1990-1997. [PMID: 28838912 DOI: 10.3174/ajnr.a5342] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/04/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The accuracy of preoperative blood oxygen level-dependent fMRI remains controversial. This study assessed the association between the anatomic location of a tumor and the accuracy of fMRI-based motor function mapping in diffuse lower-grade gliomas. MATERIALS AND METHODS Thirty-five patients with lower-grade gliomas involving motor areas underwent preoperative blood oxygen level-dependent fMRI scans with grasping tasks and received intraoperative direct cortical stimulation. Patients were classified into an overlapping group and a nonoverlapping group, depending on the extent to which blood oxygen level-dependent fMRI and direct cortical stimulation results concurred. Tumor location was quantitatively measured, including the shortest distance from the tumor to the hand knob and the deviation distance of the midpoint of the hand knob in the lesion hemisphere relative to the midline compared with the normal contralateral hemisphere. RESULTS A 4-mm shortest distance from the tumor to the hand knob value was identified as optimal for differentiating the overlapping and nonoverlapping group with the receiver operating characteristic curve (sensitivity, 84.6%; specificity, 77.8%). The shortest distances from the tumor to the hand knob of ≤4 mm were associated with inaccurate fMRI-based localizations of the hand motor cortex. The shortest distances from the tumor to the hand knob were larger (P = .002), and the deviation distances for the midpoint of the hand knob in the lesion hemisphere were smaller (P = .003) in the overlapping group than in the nonoverlapping group. CONCLUSIONS This study suggests that the shortest distance from the tumor to the hand knob and the deviation distance for the midpoint of the hand knob on the lesion hemisphere are predictive of the accuracy of blood oxygen level-dependent fMRI results. Smaller shortest distances from the tumor to the hand knob and larger deviation distances for the midpoint of hand knob on the lesion hemisphere are associated with less accuracy of motor cortex localization with blood oxygen level-dependent fMRI. Preoperative fMRI data for surgical planning should be used cautiously when the shortest distance from the tumor to the hand knob is ≤4 mm, especially for lower-grade gliomas anterior to the central sulcus.
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Affiliation(s)
- S Fang
- From the Department of Neurosurgery (S.F., Y.W., T.J.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China
| | - J Liang
- Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China
| | - T Qian
- MR Collaborations NE Asia (T.Q.), Siemens Healthcare, Beijing, China
| | - Y Wang
- From the Department of Neurosurgery (S.F., Y.W., T.J.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China
| | - X Liu
- Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China
| | - X Fan
- Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China
| | - S Li
- Functional Neuroradiology Center (S.L.), Beijing Neurosurgical Institute, Beijing, China
| | - Y Wang
- Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China
| | - T Jiang
- From the Department of Neurosurgery (S.F., Y.W., T.J.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,Beijing Neurosurgical Institute (S.F., J.L., Y.W., X.L., X.F., Y.W., T.J.), Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders Brain Tumor Center (T.J.), Beijing, China
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25
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Castellano A, Cirillo S, Bello L, Riva M, Falini A. Functional MRI for Surgery of Gliomas. Curr Treat Options Neurol 2017; 19:34. [PMID: 28831723 DOI: 10.1007/s11940-017-0469-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Advanced neuroimaging techniques such as functional MRI (fMRI) and diffusion MR tractography have been increasingly used at every stage of the surgical management of brain gliomas, as a means to improve tumor resection while preserving brain functions. This review provides an overview of the last advancements in the field of functional MRI techniques, with a particular focus on their current clinical use and reliability in the preoperative and intraoperative setting, as well as their future perspectives for personalized multimodal management of patients with gliomas. RECENT FINDINGS fMRI and diffusion MR tractography give relevant insights on the anatomo-functional organization of eloquent cortical areas and subcortical connections near or inside a tumor. Task-based fMRI and diffusion tensor imaging (DTI) tractography have proven to be valid and highly sensitive tools for localizing the distinct eloquent cortical and subcortical areas before surgery in glioma patients; they also show good accuracy when compared with intraoperative stimulation mapping data. Resting-state fMRI functional connectivity as well as new advanced HARDI (high angular resolution diffusion imaging) tractography methods are improving and reshaping the role of functional MRI for surgery of gliomas, with potential benefit for personalized treatment strategies. Noninvasive functional MRI techniques may offer the opportunity to perform a multimodal assessment in brain tumors, to be integrated with intraoperative mapping and clinical data for improving surgical management and oncological and functional outcome in patients affected by gliomas.
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Affiliation(s)
- Antonella Castellano
- Neuroradiology Unit and CERMAC, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 58-60, 20132, Milan, Italy.
| | - Sara Cirillo
- Neuroradiology Unit and CERMAC, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 58-60, 20132, Milan, Italy
| | - Lorenzo Bello
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy.,Unit of Oncological Neurosurgery, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Riva
- Unit of Oncological Neurosurgery, Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Andrea Falini
- Neuroradiology Unit and CERMAC, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 58-60, 20132, Milan, Italy
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Rosenstock T, Giampiccolo D, Schneider H, Runge SJ, Bährend I, Vajkoczy P, Picht T. Specific DTI seeding and diffusivity-analysis improve the quality and prognostic value of TMS-based deterministic DTI of the pyramidal tract. NEUROIMAGE-CLINICAL 2017; 16:276-285. [PMID: 28840099 PMCID: PMC5560117 DOI: 10.1016/j.nicl.2017.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/22/2017] [Accepted: 08/11/2017] [Indexed: 12/17/2022]
Abstract
Object Navigated transcranial magnetic stimulation (nTMS) combined with diffusion tensor imaging (DTI) is used preoperatively in patients with eloquent-located brain lesions and allows analyzing non-invasively the spatial relationship between the tumor and functional areas (e.g. the motor cortex and the corticospinal tract [CST]). In this study, we examined the diffusion parameters FA (fractional anisotropy) and ADC (apparent diffusion coefficient) within the CST in different locations and analyzed their interrater reliability and usefulness for predicting the patients' motor outcome with a precise approach of specific region of interest (ROI) seeding based on the color-coded FA-map. Methods Prospectively collected data of 30 patients undergoing bihemispheric nTMS mapping followed by nTMS-based DTI fiber tracking prior to surgery of motor eloquent high-grade gliomas were analyzed by 2 experienced and 1 unexperienced examiner. The following data were scrutinized for both hemispheres after tractography based on nTMS-motor positive cortical seeds and a 2nd region of interest in one layer of the caudal pons defined by the color-coded FA-map: the pre- and postoperative motor status (day of discharge und 3 months), the closest distance between the tracts and the tumor (TTD), the fractional anisotropy (FA) and the apparent diffusion coefficient (ADC). The latter as an average within the CST as well as specific values in different locations (peritumoral, mesencephal, pontine). Results Lower average FA-values within the affected CST as well as higher average ADC-values are significantly associated with deteriorated postoperative motor function (p = 0.006 and p = 0.026 respectively). Segmental analysis within the CST revealed that the diffusion parameters are especially disturbed on a peritumoral level and that the degree of their impairment correlates with motor deficits (FA p = 0.065, ADC p = 0.007). No significant segmental variation was seen in the healthy hemisphere. The interrater reliability showed perfect agreement for almost all analyzed parameters. Conclusions Adding diffusion weighted imaging derived information on the structural integrity of the nTMS-based tractography results improves the predictive power for postoperative motor outcome. Utilizing a second subcortical ROI which is specifically seeded based on the color-coded FA map increases the tracking quality of the CST independently of the examiner's experience. Further prospective studies are needed to validate the nTMS-based prediction of the patient's outcome. ROI seeding based on nTMS-data and FA-maps improves DTI tractography of the CST. Perfect interrater reliability for DTI tractography of the CST was observed. The pattern of diffusivity disturbance predicts the postoperative motor outcome.
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Affiliation(s)
- Tizian Rosenstock
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Davide Giampiccolo
- Institute of Neurosurgery, University Hospital, Piazzale Stefani 1, 37100 Verona, Italy
| | - Heike Schneider
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Sophia Jutta Runge
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Ina Bährend
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
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Mellerio C, Charron S, Lion S, Roca P, Kuchcinski G, Legrand L, Edjlali M, Naggara O, Meder JF, Pallud J, Oppenheim C. Perioperative functional neuroimaging of gliomas in eloquent brain areas. Neurochirurgie 2017; 63:129-134. [DOI: 10.1016/j.neuchi.2016.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/10/2016] [Accepted: 10/31/2016] [Indexed: 11/25/2022]
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28
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Devaux B, Chassoux F, Landré E, Turak B, Laurent A, Zanello M, Mellerio C, Varlet P. Surgery for dysembryoplastic neuroepithelial tumors and gangliogliomas in eloquent areas. Functional results and seizure control. Neurochirurgie 2017; 63:227-234. [PMID: 28506485 DOI: 10.1016/j.neuchi.2016.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/04/2016] [Accepted: 10/09/2016] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Dysembryoplastic neuroepithelial tumors and gangliogliomas are developmental glioneuronal tumors usually revealed by partial epilepsy. High epileptogenicity, childhood epilepsy onset, drug-resistance, temporal location, and seizure freedom after complete resection are common characteristics of both tumors. We report the specificity of surgical management, functional results and seizure outcome in cases of a tumor location in eloquent areas. METHODS Among 150 patients (88 males, 3-55 years) operated on for refractory epilepsy due to a glioneuronal tumor (1990-2015), 30 (20%, dysembryoplastic neuroepithelial tumors=21; gangliogliomas=9) had a tumor located in an eloquent cortex (sensory-motor, insular or language areas). Surgery was performed after a preoperative work-up, including stereo-electroencephalography in 48 patients (26%) and functional MRI in 100 (67%). MRI-guided lesionectomy was mainly performed in extra-temporal location, whereas an additional corticectomy was performed in a temporal location. Tumor microsurgical resections were guided using neuronavigation and cortical/subcortical electrical stimulations. Multiple stereotactic thermocoagulations were performed in two insular tumors. RESULTS New motor/language deficits related to eloquent areas occurred postoperatively in 6/30 patients (20%) without any major permanent disability. Minor sensorimotor (n=2) and moderate language disturbance (n=1) persisted in three of them. Postoperative seizure-free outcome (mean follow-up>5 years) was obtained in 81% of the entire series, but significantly decreased to 60% in eloquent areas. Incomplete tumor resection was the main cause of surgical failure. However, unfavorable seizure outcome was also observed despite complete tumor resection. Malignant transformation occurred in one ganglioglioma. CONCLUSION Epilepsy surgery for benign glioneuronal tumors in eloquent areas provides acceptable results regarding the functional risks. Complete tumor resection is crucial for long-term favorable outcome.
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Affiliation(s)
- B Devaux
- Service de neurochirurgie, hôpital Sainte-Anne, université Paris Descartes, 1, rue Cabanis, 75014 Paris, France.
| | - F Chassoux
- Service de neurochirurgie, hôpital Sainte-Anne, université Paris Descartes, 1, rue Cabanis, 75014 Paris, France
| | - E Landré
- Service de neurochirurgie, hôpital Sainte-Anne, université Paris Descartes, 1, rue Cabanis, 75014 Paris, France
| | - B Turak
- Service de neurochirurgie, hôpital Sainte-Anne, université Paris Descartes, 1, rue Cabanis, 75014 Paris, France
| | - A Laurent
- Service de neurochirurgie, hôpital Sainte-Anne, université Paris Descartes, 1, rue Cabanis, 75014 Paris, France
| | - M Zanello
- Service de neurochirurgie, hôpital Sainte-Anne, université Paris Descartes, 1, rue Cabanis, 75014 Paris, France
| | - C Mellerio
- Service d'imagerie morphologique et fonctionnelle, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
| | - P Varlet
- Service d'anatomie pathologique, hôpital Sainte-Anne, université Paris Descartes, 75014 Paris, France
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Yahyavi-Firouz-Abadi N, Pillai JJ, Lindquist MA, Calhoun VD, Agarwal S, Airan RD, Caffo B, Gujar SK, Sair HI. Presurgical Brain Mapping of the Ventral Somatomotor Network in Patients with Brain Tumors Using Resting-State fMRI. AJNR Am J Neuroradiol 2017; 38:1006-1012. [PMID: 28364005 DOI: 10.3174/ajnr.a5132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 12/25/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Resting-state fMRI readily identifies the dorsal but less consistently the ventral somatomotor network. Our aim was to assess the relative utility of resting-state fMRI in the identification of the ventral somatomotor network via comparison with task-based fMRI in patients with brain tumor. MATERIALS AND METHODS We identified 26 surgically naïve patients referred for presurgical fMRI brain mapping who had undergone both satisfactory ventral motor activation tasks and resting-state fMRI. Following standard preprocessing for task-based fMRI and resting-state fMRI, general linear model analysis of the ventral motor tasks and independent component analysis of resting-state fMRI were performed with the number of components set to 20, 30, 40, and 50. Visual overlap of task-based fMRI and resting-state fMRI at different component levels was assessed and categorized as full match, partial match, or no match. Rest-versus-task-fMRI concordance was calculated with Dice coefficients across varying fMRI thresholds before and after noise removal. Multithresholded Dice coefficient volume under the surface was calculated. RESULTS The ventral somatomotor network was identified in 81% of patients. At the subject level, better matches between resting-state fMRI and task-based fMRI were seen with an increasing order of components (53% of cases for 20 components versus 73% for 50 components). Noise-removed group-mean volume under the surface improved as component numbers increased from 20 to 50, though ANOVA demonstrated no statistically significant difference among the 4 groups. CONCLUSIONS In most patients, the ventral somatomotor network can be identified with an increase in the probability of a better match at a higher component number. There is variable concordance of the ventral somatomotor network at the single-subject level between resting-state and task-based fMRI.
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Affiliation(s)
- N Yahyavi-Firouz-Abadi
- From the Department of Radiology (N.Y.-F.-A.), Mid-Atlantic Permanente Medical Group of Kaiser Permanente, Kensington, Maryland .,Division of Neuroradiology, (N.Y.-F.-A., J.J.P., S.A., R.D.A., S.K.G., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J J Pillai
- Division of Neuroradiology, (N.Y.-F.-A., J.J.P., S.A., R.D.A., S.K.G., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M A Lindquist
- Department of Biostatistics (M.A.L., B.C.), Johns Hopkins University, Baltimore, Maryland
| | - V D Calhoun
- The Mind Research Network (S.A., V.D.C.), Departments of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico
| | - S Agarwal
- Division of Neuroradiology, (N.Y.-F.-A., J.J.P., S.A., R.D.A., S.K.G., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.,The Mind Research Network (S.A., V.D.C.), Departments of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico
| | - R D Airan
- Division of Neuroradiology, (N.Y.-F.-A., J.J.P., S.A., R.D.A., S.K.G., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - B Caffo
- Department of Biostatistics (M.A.L., B.C.), Johns Hopkins University, Baltimore, Maryland
| | - S K Gujar
- Division of Neuroradiology, (N.Y.-F.-A., J.J.P., S.A., R.D.A., S.K.G., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - H I Sair
- Division of Neuroradiology, (N.Y.-F.-A., J.J.P., S.A., R.D.A., S.K.G., H.I.S.), The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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30
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Sollmann N, Wildschuetz N, Kelm A, Conway N, Moser T, Bulubas L, Kirschke JS, Meyer B, Krieg SM. Associations between clinical outcome and navigated transcranial magnetic stimulation characteristics in patients with motor-eloquent brain lesions: a combined navigated transcranial magnetic stimulation-diffusion tensor imaging fiber tracking approach. J Neurosurg 2017; 128:800-810. [PMID: 28362239 DOI: 10.3171/2016.11.jns162322] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging fiber tracking (DTI FT) based on nTMS data are increasingly used for preoperative planning and resection guidance in patients suffering from motor-eloquent brain tumors. The present study explores whether nTMS-based DTI FT can also be used for individual preoperative risk assessment regarding surgery-related motor impairment. METHODS Data derived from preoperative nTMS motor mapping and subsequent nTMS-based tractography in 86 patients were analyzed. All patients suffered from high-grade glioma (HGG), low-grade glioma (LGG), or intracranial metastasis (MET). In this context, nTMS-based DTI FT of the corticospinal tract (CST) was performed at a range of fractional anisotropy (FA) levels based on an individualized FA threshold ([FAT]; tracking with 50%, 75%, and 100% FAT), which was defined as the highest FA value allowing for visualization of fibers (100% FAT). Minimum lesion-to-CST distances were measured, and fiber numbers of the reconstructed CST were assessed. These data were then correlated with the preoperative, postoperative, and follow-up status of motor function and the resting motor threshold (rMT). RESULTS At certain FA levels, a statistically significant difference in lesion-to-CST distances was observed between patients with HGG who had no impairment and those who developed surgery-related transient or permanent motor deficits (75% FAT: p = 0.0149; 100% FAT: p = 0.0233). In this context, no patient with a lesion-to-CST distance ≥ 12 mm suffered from any new surgery-related permanent paresis (50% FAT and 75% FAT). Furthermore, comparatively strong negative correlations were observed between the rMT and lesion-to-CST distances of patients with surgery-related transient paresis (Spearman correlation coefficient [rs]; 50% FAT: rs = -0.8660; 75% FAT: rs = -0.8660) or surgery-related permanent paresis (50% FAT: rs = -0.7656; 75% FAT: rs = -0.6763). CONCLUSIONS This is one of the first studies to show a direct correlation between imaging, clinical status, and neurophysiological markers for the integrity of the motor system in patients with brain tumors. The findings suggest that nTMS-based DTI FT might be suitable for individual risk assessment in patients with HGG, in addition to being a surgery-planning tool. Importantly, necessary data for risk assessment were obtained without significant additional efforts, making this approach potentially valuable for direct clinical use.
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Affiliation(s)
- Nico Sollmann
- 1Department of Neurosurgery.,2TUM-Neuroimaging Center, and
| | | | - Anna Kelm
- 1Department of Neurosurgery.,2TUM-Neuroimaging Center, and
| | - Neal Conway
- 1Department of Neurosurgery.,2TUM-Neuroimaging Center, and
| | - Tobias Moser
- 1Department of Neurosurgery.,2TUM-Neuroimaging Center, and
| | - Lucia Bulubas
- 1Department of Neurosurgery.,2TUM-Neuroimaging Center, and
| | - Jan S Kirschke
- 3Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München,Germany
| | | | - Sandro M Krieg
- 1Department of Neurosurgery.,2TUM-Neuroimaging Center, and
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Lima Cardoso P, Dymerska B, Bachratá B, Fischmeister FPS, Mahr N, Matt E, Trattnig S, Beisteiner R, Robinson SD. The clinical relevance of distortion correction in presurgical fMRI at 7T. Neuroimage 2016; 168:490-498. [PMID: 28027961 DOI: 10.1016/j.neuroimage.2016.12.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 11/19/2022] Open
Abstract
Presurgical planning with fMRI benefits from increased reliability and the possibility to reduce measurement time introduced by using ultra-high field. Echo-planar imaging suffers, however, from geometric distortions which scale with field strength and potentially give rise to clinically significant displacement of functional activation. We evaluate the effectiveness of a dynamic distortion correction (DDC) method based on unmodified single-echo EPI in the context of simulated presurgical planning fMRI at 7T and compare it with static distortion correction (SDC). The extent of distortion in EPI and activation shifts are investigated in a group of eleven patients with a range of neuropathologies who performed a motor task. The consequences of neglecting to correct images for susceptibility-induced distortions are assessed in a clinical context. It was possible to generate time series of EPI-based field maps which were free of artifacts in the eloquent brain areas relevant to presurgical fMRI, despite the presence of signal dropouts caused by pathologies and post-operative sites. Distortions of up to 5.1mm were observed in the primary motor cortex in raw EPI. These were accurately corrected with DDC and slightly less accurately with SDC. The dynamic nature of distortions in UHF clinical fMRI was demonstrated via investigation of temporal variation in voxel shift maps, confirming the potential inadequacy of SDC based on a single reference field map, particularly in the vicinity of pathologies or in the presence of motion. In two patients, the distortion correction was potentially clinically significant in that it might have affected the localization or interpretation of activation and could thereby have influenced the treatment plan. Distortion correction is shown to be effective and clinically relevant in presurgical planning at 7T.
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Affiliation(s)
- Pedro Lima Cardoso
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria.
| | - Barbara Dymerska
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria.
| | - Beáta Bachratá
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria.
| | - Florian Ph S Fischmeister
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria; Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Nina Mahr
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria; Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Eva Matt
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria; Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Siegfried Trattnig
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria.
| | - Roland Beisteiner
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria; Study Group Clinical fMRI, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Simon Daniel Robinson
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria.
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Functional Magnetic Resonance Imaging for Preoperative Planning in Brain Tumour Surgery. Can J Neurol Sci 2016; 44:59-68. [PMID: 28004630 DOI: 10.1017/cjn.2016.306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Functional magnetic resonance imaging (fMRI) is being increasingly used for the preoperative evaluation of patients with brain tumours. METHODS The study is a retrospective chart review investigating the use of clinical fMRI from 2002 through 2013 in the preoperative evaluation of brain tumour patients. Baseline demographic and clinical data were collected. The specific fMRI protocols used for each patient were recorded. RESULTS Sixty patients were identified over the 12-year period. The tumour types most commonly investigated were high-grade glioma (World Health Organization grade III or IV), low-grade glioma (World Health Organization grade II), and meningioma. Most common presenting symptoms were seizures (69.6%), language deficits (23.2%), and headache (19.6%). There was a predominance of left hemispheric lesions investigated with fMRI (76.8% vs 23.2% for right). The most commonly involved lobes were frontal (64.3%), temporal (33.9%), parietal (21.4%), and insular (7.1%). The most common fMRI paradigms were language (83.9%), motor (75.0%), sensory (16.1%), and memory (10.7%). The majority of patients ultimately underwent a craniotomy (75.0%), whereas smaller groups underwent stereotactic biopsy (8.9%) and nonsurgical management (16.1%). Time from request for fMRI to actual fMRI acquisition was 3.1±2.3 weeks. Time from fMRI acquisition to intervention was 4.9±5.5 weeks. CONCLUSIONS We have characterized patient demographics in a retrospective single-surgeon cohort undergoing preoperative clinical fMRI at a Canadian centre. Our experience suggests an acceptable wait time from scan request to scan completion/analysis and from scan to intervention.
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Krieg SM, Picht T, Sollmann N, Bährend I, Ringel F, Nagarajan SS, Meyer B, Tarapore PE. Resection of Motor Eloquent Metastases Aided by Preoperative nTMS-Based Motor Maps-Comparison of Two Observational Cohorts. Front Oncol 2016; 6:261. [PMID: 28066717 PMCID: PMC5174728 DOI: 10.3389/fonc.2016.00261] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/08/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction Preoperative mapping of motor areas with navigated transcranial magnetic stimulation (nTMS) has been shown to improve surgical outcomes for peri-Rolandic lesions and, in particular, for gliomas. However, the impact of this technique on surgical outcomes for peri-Rolandic metastatic lesions is yet unknown. Objective To investigate the impact of nTMS on surgical outcomes for peri-Rolandic metastatic lesions, various clinical parameters were analyzed in our international study group. Methods Two prospectively enrolled cohorts were compared by investigating patients receiving preoperative nTMS (2010–2015; 120 patients) and patients who did not receive preoperative nTMS (2006–2015; 130 patients). Tumor location, pathology, size, and preoperative deficits were comparable. Results The nTMS group showed a lower rate of residual tumor on postoperative magnetic resonance imaging (odds ratio 0.3025; 95% confidence interval 0.1356–0.6749). On long-term follow-up, surgery-related paresis was decreased in the nTMS group (nTMS vs. non-nTMS; improved: 30.8 vs. 13.1%, unchanged: 65.8 vs. 73.8%, worse: 3.4 vs. 13.1% of patients; p = 0.0002). Moreover, the nTMS group received smaller craniotomies (nTMS: 16.7 ± 8.6 cm2 vs. non-nTMS: 25.0 ± 17.1 cm2; p < 0.0001). Surgical time differed significantly between the two groups (nTMS: 128.8 ± 49.4 min vs. non-nTMS: 158.0 ± 65.8 min; p = 0.0002). Conclusion This non-randomized study suggests that preoperative motor mapping by nTMS may improve the treatment of patients undergoing surgical resection of metastases in peri-Rolandic regions. These findings suggest that further evaluation with a prospective, randomized trial may be warranted.
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Affiliation(s)
- Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Ina Bährend
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Srikantan S Nagarajan
- Biomagnetic Imaging Laboratory, Department of Radiology, University of California San Francisco , San Francisco, CA , USA
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Phiroz E Tarapore
- Department of Neurological Surgery, University of California San Francisco , San Francisco, CA , USA
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Abstract
For a long time, although the functional anatomy of human cortex has extensively been studied, subcortical white matter tracts have received little consideration. Recent advances in tractography have opened the door to a non-invasive investigation of the subcortical fibers in vivo. However, this method cannot study directly the function of the bundles. Interestingly, for the first time in the history of cognitive neurosciences, direct axonal electrostimulation (DES) mapping of the neural pathways offers the unique opportunity to investigate the function of the connectomal anatomy. Indeed, this technique is able to perform real-time anatomo-functional correlations in awake patients who undergo brain surgery, especially at the level of the subcortical fibers. Here, the aim is to review original data issued from DES of myelinated tracts in adults, with regard to the functional connectivity mediating the sensorimotor, visuo-spatial, language, cognitive and emotional functions, as well as the interactions between these different sub-networks, leading ultimately to explore consciousness. Therefore, axonal stimulation is a valuable tool in the field of connectomics, that is, the map of neural connections, in order to switch from the traditional localizationist view of brain processing to a networking model in which cerebral functions are underpinned by the dynamic interactions of large-scale distributed and parallel sub-circuits. Such connectomal account should integrate the anatomic constraint represented by the subcortical fascicles. Indeed, post-lesional neuroplasticity is possible only on the condition that the white matter fibers are preserved, to allow communication and temporal synchronization among delocalized inter-connected networks.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Av Augustin Fliche, 34295 Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1051 Laboratory, Team "Brain Plasticity, Stem Cells and Glial Tumors", Institute for Neurosciences of Montpellier, Montpellier University Medical Center, 34091 Montpellier, France
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Kaneko OF, Fischbein NJ, Rosenberg J, Wintermark M, Zeineh MM. The "White Gray Sign" Identifies the Central Sulcus on 3T High-Resolution T1-Weighted Images. AJNR Am J Neuroradiol 2016; 38:276-280. [PMID: 27932507 DOI: 10.3174/ajnr.a5014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/20/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The central sulcus is an important anatomic landmark, but most methods of identifying it rely on variable gyral and sulcal patterns. We describe and assess the accuracy of reduced gray-white contrast along the central sulcus, an observation we term the "white gray sign." MATERIALS AND METHODS We conducted a retrospective review of 51 fMRIs with a T1-weighted 3D inversion recovery fast-spoiled gradient-echo and concomitant hand-motor fMRI, which served as confirmation for the location of the central sulcus. To measure gray-white contrast across the central and adjacent sulci, we performed a quantitative analysis of 25 normal hemispheres along the anterior and posterior cortices and intervening white matter of the pre- and postcentral gyri. 3D inversion recovery fast-spoiled gradient-echo axial images from 51 fMRIs were then evaluated by 2 raters for the presence of the white gray sign as well as additional established signs of the central sulcus: the bracket, cortical thickness, omega, and T signs. RESULTS The mean gray-white contrast along the central sulcus was 0.218 anteriorly and 0.237 posteriorly, compared with 0.320 and 0.295 along the posterior precentral and anterior postcentral sulci, respectively (P < .001). Both raters correctly identified the central sulcus in all 35 normal and 16 abnormal hemispheres. The white gray sign had the highest agreement of all signs between raters and was rated as present the most often among all the signs. CONCLUSIONS Reduced gray-white contrast around the central sulcus is a reliable sign for identification of the central sulcus on 3D inversion recovery fast-spoiled gradient-echo images.
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Affiliation(s)
- O F Kaneko
- From the Department of Radiology, Neuroradiology Section, Stanford University, Stanford, California
| | - N J Fischbein
- From the Department of Radiology, Neuroradiology Section, Stanford University, Stanford, California
| | - J Rosenberg
- From the Department of Radiology, Neuroradiology Section, Stanford University, Stanford, California
| | - M Wintermark
- From the Department of Radiology, Neuroradiology Section, Stanford University, Stanford, California
| | - M M Zeineh
- From the Department of Radiology, Neuroradiology Section, Stanford University, Stanford, California.
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36
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Weiss Lucas C, Tursunova I, Neuschmelting V, Nettekoven C, Oros-Peusquens AM, Stoffels G, Faymonville AM, Jon SN, Langen KJ, Lockau H, Goldbrunner R, Grefkes C. Functional MRI vs. navigated TMS to optimize M1 seed volume delineation for DTI tractography. A prospective study in patients with brain tumours adjacent to the corticospinal tract. NEUROIMAGE-CLINICAL 2016; 13:297-309. [PMID: 28050345 PMCID: PMC5192048 DOI: 10.1016/j.nicl.2016.11.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/18/2016] [Accepted: 11/19/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND DTI-based tractography is an increasingly important tool for planning brain surgery in patients suffering from brain tumours. However, there is an ongoing debate which tracking approaches yield the most valid results. Especially the use of functional localizer data such as navigated transcranial magnetic stimulation (nTMS) or functional magnetic resonance imaging (fMRI) seem to improve fibre tracking data in conditions where anatomical landmarks are less informative due to tumour-induced distortions of the gyral anatomy. We here compared which of the two localizer techniques yields more plausible results with respect to mapping different functional portions of the corticospinal tract (CST) in brain tumour patients. METHODS The CSTs of 18 patients with intracranial tumours in the vicinity of the primary motor area (M1) were investigated by means of deterministic DTI. The core zone of the tumour-adjacent hand, foot and/or tongue M1 representation served as cortical regions of interest (ROIs). M1 core zones were defined by both the nTMS hot-spots and the fMRI local activation maxima. In addition, for all patients, a subcortical ROI at the level of the inferior anterior pons was implemented into the tracking algorithm in order to improve the anatomical specificity of CST reconstructions. As intra-individual control, we additionally tracked the CST of the hand motor region of the unaffected, i.e., non-lesional hemisphere, again comparing fMRI and nTMS M1 seeds. The plausibility of the fMRI-ROI- vs. nTMS-ROI-based fibre trajectories was assessed by a-priori defined anatomical criteria. Moreover, the anatomical relationship of different fibre courses was compared regarding their distribution in the anterior-posterior direction as well as their location within the posterior limb of the internal capsule (PLIC). RESULTS Overall, higher plausibility rates were observed for the use of nTMS- as compared to fMRI-defined cortical ROIs (p < 0.05) in tumour vicinity. On the non-lesional hemisphere, however, equally good plausibility rates (100%) were observed for both localizer techniques. fMRI-originated fibres generally followed a more posterior course relative to the nTMS-based tracts (p < 0.01) in both the lesional and non-lesional hemisphere. CONCLUSION NTMS achieved better tracking results than fMRI in conditions when the cortical tract origin (M1) was located in close vicinity to a brain tumour, probably influencing neurovascular coupling. Hence, especially in situations with altered BOLD signal physiology, nTMS seems to be the method of choice in order to identify seed regions for CST mapping in patients.
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Key Words
- APB, Abductor pollicis brevis muscle
- BOLD, Blood-oxygenation-level dependent
- CST
- CST, Corticospinal tract
- DCS, Direct cortical stimulation
- DTI, Diffusion tensor imaging
- Deterministic
- EF, Electric field
- EMG, Electromyography
- FA(T), Fractional anisotropy (threshold)
- FACT, Fibre assignment by continuous tracking
- FOV, Field-of-view
- FWE, Family-wise error
- KPS, Karnofsky performance scale
- LT, Lateral tongue muscle, anterior third
- M1, Primary motor cortex
- MEP, Motor-evoked potential
- MFL, Minimal fibre length
- MPRAGE, Magnetization prepared rapid acquisition gradient echo (T1 MR seq.)
- OR, Odd's ratio
- PLIC, Posterior limb of the internal capsule
- PM, Plantar muscle
- Pyramidal tract
- RMT, Resting motor threshold
- ROI
- ROI, Region-of-interest
- SD, Standard deviation
- SE, Standard error
- Somatotopic
- X-sq, X-squared (Pearson's chi-square test)
- dMRI, Diffusion magnetic resonance imaging (i.e., diffusion-weighted imaging, DWI)
- fMRI
- fMRI, Functional magnetic resonance imaging
- nTMS
- nTMS, Neuronavigated transcranial magnetic stimulation
- pxsq, p-value according to Pearson's chi-square test
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Affiliation(s)
| | - Irada Tursunova
- University of Cologne, Center of Neurosurgery, 50924 Cologne, Germany
| | | | | | | | - Gabriele Stoffels
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany
| | | | - Shah N Jon
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany; RWTH Aachen University, University Clinic Aachen, Departments of Nuclear Medicine and Neurology, 52074 Aachen, Germany; Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, Victoria, Australia; Monash Institute of Medical Engineering, Monash University, Melbourne, Victoria, Australia; Monash Biomedical Imaging, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Karl Josef Langen
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany; RWTH Aachen University, University Clinic Aachen, Departments of Nuclear Medicine and Neurology, 52074 Aachen, Germany
| | - Hannah Lockau
- University of Cologne, Department of Radiology, 50937 Cologne, Germany
| | | | - Christian Grefkes
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany; University of Cologne, Department of Neurology, 50924 Cologne, Germany
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Morrison MA, Tam F, Garavaglia MM, Hare GMT, Cusimano MD, Schweizer TA, Das S, Graham SJ. Sources of Variation Influencing Concordance between Functional MRI and Direct Cortical Stimulation in Brain Tumor Surgery. Front Neurosci 2016; 10:461. [PMID: 27803645 PMCID: PMC5067437 DOI: 10.3389/fnins.2016.00461] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/26/2016] [Indexed: 11/13/2022] Open
Abstract
Object: Preoperative functional magnetic resonance imaging (fMRI) remains a promising method to aid in the surgical management of patients diagnosed with brain tumors. For patients that are candidates for awake craniotomies, surgical decisions can potentially be improved by fMRI but this depends on the level of concordance between preoperative brain maps and the maps provided by the gold standard intraoperative method, direct cortical stimulation (DCS). There have been numerous studies of the concordance between fMRI and DCS using sensitivity and specificity measures, however the results are variable across studies and the key factors influencing variability are not well understood. Thus, the present work addresses the influence of technical factors on fMRI and DCS concordance. Methods: Motor and language mapping data were collected for a group of glioma patients (n = 14) who underwent both preoperative fMRI and intraoperative DCS in an awake craniotomy procedure for tumor removal. Normative fMRI data were also acquired in a healthy control group (n = 12). The fMRI and DCS mapping data were co-registered; true positive (TP), true negative (TN), false positive (FP), and false negative (FN) occurrences were tabulated over the exposed brain surface. Sensitivity and specificity were measured for the total group, and for the motor and language sub-groups. The influence of grid placement, fMRI statistical thresholding, and task standardization were assessed. Correlations between proportions of agreement and error were also carefully scrutinized to evaluate concordance in more detail. Results: Concordance was significantly better for motor vs. language mapping. There was an inverse relationship between TP and TN with increasing statistical threshold, and FP dominated the total error. Sensitivity and specificity were reduced when tasks were not standardized across fMRI and DCS. Conclusions: Although the agreement between fMRI and DCS is good, variability is introduced by technical factors that can diminish the quality of patient data. Neurosurgeons should evaluate the usefulness of fMRI data while considering that (a) discordance arises primarily from FP fMRI results; (b) there is an inherent trade-off between sensitivity and specificity with fMRI statistical threshold; and
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Affiliation(s)
- Melanie A. Morrison
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
- Department of Medical Biophysics, University of TorontoToronto, ON, Canada
| | - Fred Tam
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
| | - Marco M. Garavaglia
- Department of Anaesthesia, University of TorontoToronto, ON, Canada
- Department of Anaesthesia, Toronto Western HospitalToronto, ON, Canada
| | - Gregory M. T. Hare
- Department of Anaesthesia, University of TorontoToronto, ON, Canada
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Department of Anaesthesia, St. Michael's HospitalToronto, ON, Canada
| | - Michael D. Cusimano
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Division of Neurosurgery, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Tom A. Schweizer
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Sunit Das
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Division of Neurosurgery, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Simon J. Graham
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
- Department of Medical Biophysics, University of TorontoToronto, ON, Canada
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Clinical considerations and surgical approaches for low-grade gliomas in deep hemispheric locations: insular lesions. Childs Nerv Syst 2016; 32:1875-93. [PMID: 27659830 DOI: 10.1007/s00381-016-3183-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 07/06/2016] [Indexed: 12/31/2022]
Abstract
Insula and paralimbic region represent a common location for gliomas in adulthood. However, limbic and paralimbic tumors are rare in children. Reports of pediatric insular tumors are scarce in literature, and most of them are included in adult's series, so their management and outcome can be outlined only after extracting data from these reports. Due to their predominantly low grade, they usually have a benign course for some time, what make them ideal candidates for total resection. However, their intricate location and spread to key areas, including the temporal lobe, make them a surgical challenge. The transsylvian route, with or without resection of the frontal and/or temporal operculae, which requires exposure of part or all of the insula is commonly selected for insular tumor approaches. Intraoperative functional mapping is a standard procedure for resection of central region tumors in adults. In children and young individuals, awake craniotomy is not always possible and surgical planning usually relay on functional and anatomical preoperative studies. The main goal when approaching an insular tumor is to achieve the largest extent of resection to increase overall patient survival while preserving the functional status, minimizing postoperative morbidity and increasing the quality of life. The extent of resection seems to be correlated also with the control of associated (and usually intractable) epilepsy.
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Kobyakov GL, Lubnin AY, Kulikov AS, Gavrilov AG, Goryaynov SA, Poddubskiy AA, Lodygina KS. [Awake craniotomy]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2016; 80:107-116. [PMID: 27186613 DOI: 10.17116/neiro2016801107-116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Awake craniotomy is a neurosurgical intervention aimed at identifying and preserving the eloquent functional brain areas during resection of tumors located near the cortical and subcortical language centers. This article provides a review of the modern literature devoted to the issue. The anatomical rationale and data of preoperative functional neuroimaging, intraoperative electrophysiological monitoring, and neuropsychological tests as well as the strategy of active surgical intervention are presented. Awake craniotomy is a rapidly developing technique aimed at both preserving speech and motor functions and improving our knowledge in the field of speech psychophysiology.
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Affiliation(s)
- G L Kobyakov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A Yu Lubnin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A S Kulikov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A G Gavrilov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - K S Lodygina
- Burdenko Neurosurgical Institute, Moscow, Russia
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Negwer C, Sollmann N, Ille S, Hauck T, Maurer S, Kirschke JS, Ringel F, Meyer B, Krieg SM. Language pathway tracking: comparing nTMS-based DTI fiber tracking with a cubic ROIs-based protocol. J Neurosurg 2016; 126:1006-1014. [PMID: 27231977 DOI: 10.3171/2016.2.jns152382] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Diffusion tensor imaging (DTI) fiber tracking (FT) has been widely used in glioma surgery in recent years. It can provide helpful information about subcortical structures, especially in patients with eloquent space-occupying lesions. This study compared the newly developed navigated transcranial magnetic stimulation (nTMS)-based DTI FT of language pathways with the most reproducible protocol for language pathway tractography, using cubic regions of interest (ROIs) for the arcuate fascicle. METHODS Thirty-seven patients with left-sided perisylvian lesions underwent language mapping by repetitive nTMS. DTI FT was performed using the cubic ROIs-based protocol and the authors' nTMS-based DTI FT approach. The same minimal fiber length and fractional anisotropy were chosen (50 mm and 0.2, respectively). Both protocols were performed with standard clinical tractography software. RESULTS Both methods visualized language-related fiber tracts (i.e., corticonuclear tract, arcuate fascicle, uncinate fascicle, superior longitudinal fascicle, inferior longitudinal fascicle, arcuate fibers, commissural fibers, corticothalamic fibers, and frontooccipital fascicle) in all 37 patients. Using the cubic ROIs-based protocol, 39.9% of these language-related fiber tracts were detected in the examined patients, as opposed to 76.0% when performing nTMS-based DTI FT. For specifically tracking the arcuate fascicle, however, the cubic ROIs-based approach showed better results (97.3% vs 75.7% with nTMS-based DTI FT). CONCLUSIONS The cubic ROIs-based protocol was designed for arcuate fascicle tractography, and this study shows that it is still useful for this intention. However, superior results were obtained using the nTMS-based DTI FT for visualization of other language-related fiber tracts.
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Affiliation(s)
- Chiara Negwer
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Nico Sollmann
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Sebastian Ille
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Theresa Hauck
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | | | - Jan S Kirschke
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | | | | | - Sandro M Krieg
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
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41
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The value of preoperative functional cortical mapping using navigated TMS. Neurophysiol Clin 2016; 46:125-33. [PMID: 27229765 DOI: 10.1016/j.neucli.2016.05.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 05/02/2016] [Indexed: 01/29/2023] Open
Abstract
The surgical removal of brain tumours in so-called eloquent regions is frequently associated with a high risk of causing disabling postoperative deficits. Among the preoperative techniques proposed to help neurosurgical planning and procedure, navigated transcranial magnetic stimulation (nTMS) is increasingly performed. A high level of evidence is now available in the literature regarding the anatomical and functional accuracy of this mapping technique. This article presents the principles and facts demonstrating the value of using nTMS in clinical practice to preserve motor or language functions from deleterious lesions secondary to brain tumour resection or epilepsy surgery.
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Sollmann N, Kubitscheck A, Maurer S, Ille S, Hauck T, Kirschke JS, Ringel F, Meyer B, Krieg SM. Preoperative language mapping by repetitive navigated transcranial magnetic stimulation and diffusion tensor imaging fiber tracking and their comparison to intraoperative stimulation. Neuroradiology 2016; 58:807-18. [PMID: 27079196 DOI: 10.1007/s00234-016-1685-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 04/04/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Repetitive navigated transcranial magnetic stimulation (rTMS) can be used for preoperative language mapping, but it still suffers from comparatively high sensitivity and low specificity when compared to direct cortical stimulation (DCS). Therefore, this study evaluates whether the additional consideration of rTMS-based diffusion tensor imaging fiber tracking (DTI FT) for identifying language-positive brain regions improves specificity when compared to DCS. METHODS We performed rTMS, rTMS-based DTI FT, and DCS during awake surgery combined with object naming in 20 patients suffering from left-sided perisylvian brain lesions. For rTMS, different error rate thresholds (ERTs) and error types were considered, and DTI FT was conducted with individualized fractional anisotropy thresholds (FATs). Then, receiver operating characteristics (ROC) for rTMS vs. DCS, rTMS-based DTI FT vs. DCS, and rTMS spots confirmed by rTMS-based DTI FT vs. DCS were calculated. RESULTS In general, rTMS vs. DCS was in good accordance with previous literature (sensitivity/specificity: 92.7/13.3 % for all naming errors without ERT). In addition, rTMS-based DTI FT vs. DCS led to balanced results when tracking was based on all errors as well (sensitivity/specificity: 62.8/64.3 % for 100 % FAT). However, rTMS combined with rTMS-based DTI FT vs. DCS did not lead to any improvement in specificity when compared to rTMS vs. DCS alone. CONCLUSION The additional use of rTMS-based DTI FT to rTMS did not improve the identification of DCS-positive language areas during awake surgery. Yet, concerning rTMS-based DTI FT, this new technique must be validated itself by intraoperative subcortical stimulation.
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Affiliation(s)
- Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Antonia Kubitscheck
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany
| | - Stefanie Maurer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Theresa Hauck
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Jan S Kirschke
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, München, 81675, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, München, Germany.
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Sollmann N, Negwer C, Ille S, Maurer S, Hauck T, Kirschke JS, Ringel F, Meyer B, Krieg SM. Feasibility of nTMS-based DTI fiber tracking of language pathways in neurosurgical patients using a fractional anisotropy threshold. J Neurosci Methods 2016; 267:45-54. [PMID: 27059128 DOI: 10.1016/j.jneumeth.2016.04.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Navigated transcranial magnetic stimulation (nTMS) provides language maps in brain tumor patients. Yet, corresponding data on the visualization of language-related subcortical pathways is lacking. Therefore, this study evaluates the feasibility of nTMS-based diffusion tensor imaging fiber tracking (DTI FT) for subcortical language pathways by a fractional anisotropy (FA) protocol. NEW METHOD DTI FT was performed in 37 patients suffering from left-sided perisylvian brain lesions based on nTMS data exclusively, using the FA-based protocol originally established for the corticospinal tract (CST) by Frey et al. (2012): minimum fiber length was 110mm and the highest individual FA value leading to visualization of white matter tracts was determined as the FA threshold (FAT). Then, deterministic DTI FT using an FA value of 100%, 75%, 50%, and 25% of the individual FAT (with 25% as an additional setting to the original protocol) was performed. RESULTS Our approach visualized 9 language-related subcortical white matter pathways. By using 100% FAT, the mean percentage of visualized tracts was 13.5%, whereas DTI FT performed with 75%, 50%, and 25% FAT detected 30.6%, 61.3%, and 93.7% of language-related fiber tracts, respectively. COMPARISON WITH EXISTING METHODS nTMS language mapping alone is not able to visualize subcortical language-related pathways. CONCLUSIONS This study shows that nTMS language maps are feasible for DTI FT of language-related pathways within the scope of a FAT-based protocol. Although this approach is novel and might be helpful during scientific neuroimaging and tumor resection, intraoperative validation is needed to go beyond the level of feasibility.
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Affiliation(s)
- Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Chiara Negwer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Stefanie Maurer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Theresa Hauck
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Jan S Kirschke
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
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44
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Sollmann N, Negwer C, Tussis L, Hauck T, Ille S, Maurer S, Giglhuber K, Bauer JS, Ringel F, Meyer B, Krieg SM. Interhemispheric connectivity revealed by diffusion tensor imaging fiber tracking derived from navigated transcranial magnetic stimulation maps as a sign of language function at risk in patients with brain tumors. J Neurosurg 2016; 126:222-233. [PMID: 27035166 DOI: 10.3171/2016.1.jns152053] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Resection of brain tumors in language-eloquent areas entails the risk of postoperative aphasia. It has been demonstrated via navigated transcranial magnetic stimulation (nTMS) that language function can partially shift to the unaffected hemisphere due to tumor-induced plasticity. Therefore, this study was designed to evaluate whether interhemispheric connectivity (IC) detected by nTMS-based diffusion tensor imaging-fiber tracking (DTI-FT) can be used to predict surgery-related aphasia in patients with brain tumors. METHODS Thirty-eight patients with left-sided perisylvian brain lesions underwent cortical language mapping of both hemispheres by nTMS prior to awake surgery. Then, nTMS-based DTI-FT was conducted with a fractional anisotropy (FA) of 0.01 and 0.2 to visualize nTMS-based IC. Receiver operating characteristics were calculated for the prediction of a postoperative (irrespective of the preoperative state) and a new surgery-related aphasia by the presence of detectable IC. RESULTS Language mapping by nTMS was possible in all patients. Seventeen patients (44.7%) suffered from surgery-related worsening of language performance (transient aphasia according to 3-month follow-up in 16 subjects [42.1%]; new permanent aphasia according to 3-month follow-up in 1 patient [2.6%]). Regarding the correlation of aphasia to nTMS-based IC, statistically significant differences were revealed for both evaluated FA values. However, better results were observed for tractography with an FA of 0.2, which led to a specificity of 93% (postoperative aphasia) and 90% (surgery-related aphasia). For postoperative aphasia, the corresponding OR was 0.1282 (95% CI 0.0143-1.1520), and for surgery-related aphasia the OR was 0.1184 (95% CI 0.0208-0.6754). CONCLUSIONS According to these results, IC detected by preoperative nTMS-based DTI-FT might be regarded as a risk factor for surgery-related aphasia, with a specificity of up to 93%. However, because the majority of enrolled patients suffered from transient aphasia postoperatively, it has to be evaluated whether this approach distinctly leads to similar results among patients with permanent language deficits. Despite this restriction, this approach might contribute to individualized patient consultation prior to tumor resection in clinical practice.
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Affiliation(s)
- Nico Sollmann
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Chiara Negwer
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Lorena Tussis
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Theresa Hauck
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Sebastian Ille
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | | | | | - Jan S Bauer
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Germany
| | | | | | - Sandro M Krieg
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
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Hou BL, Bhatia S, Carpenter JS. Quantitative comparisons on hand motor functional areas determined by resting state and task BOLD fMRI and anatomical MRI for pre-surgical planning of patients with brain tumors. NEUROIMAGE-CLINICAL 2016; 11:378-387. [PMID: 27069871 PMCID: PMC4810013 DOI: 10.1016/j.nicl.2016.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/17/2016] [Accepted: 03/01/2016] [Indexed: 11/24/2022]
Abstract
For pre-surgical planning we present quantitative comparison of the location of the hand motor functional area determined by right hand finger tapping BOLD fMRI, resting state BOLD fMRI, and anatomically using high resolution T1 weighted images. Data were obtained on 10 healthy subjects and 25 patients with left sided brain tumors. Our results show that there are important differences in the locations (i.e., > 20 mm) of the determined hand motor voxels by these three MR imaging methods. This can have significant effect on the pre-surgical planning of these patients depending on the modality used. In 13 of the 25 cases (i.e., 52%) the distances between the task-determined and the rs-fMRI determined hand areas were more than 20 mm; in 13 of 25 cases (i.e., 52%) the distances between the task-determined and anatomically determined hand areas were > 20 mm; and in 16 of 25 cases (i.e., 64%) the distances between the rs-fMRI determined and anatomically determined hand areas were more than 20 mm. In just three cases, the distances determined by all three modalities were within 20 mm of each other. The differences in the location or fingerprint of the hand motor areas, as determined by these three MR methods result from the different underlying mechanisms of these three modalities and possibly the effects of tumors on these modalities.
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Affiliation(s)
- Bob L Hou
- Department of Radiology, WVU, Morgantown, WV 26506, USA.
| | - Sanjay Bhatia
- Department of Neurosurgery, WVU, Morgantown, WV 26506, USA
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Niu C, Liu X, Yang Y, Zhang K, Min Z, Wang M, Li W, Guo L, Lin P, Zhang M. Assessing Region of Interest Schemes for the Corticospinal Tract in Patients With Brain Tumors. Medicine (Baltimore) 2016; 95:e3189. [PMID: 27015212 PMCID: PMC4998407 DOI: 10.1097/md.0000000000003189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) techniques are widely used for identifying the corticospinal tract (CST) white matter pathways as part of presurgical planning. However, mass effects in patients with brain tumors tend to cause anatomical distortions and compensatory functional reorganization of the cortex, which may lead to inaccurate mapping of white matter tracts. To overcome these problems, we compared different region-of-interest (ROI) selection schemes to track CST fibers in patients with brain tumors. Our study investigated the CSTs of 16 patients with intracranial tumors. The patients were classified into 3 subgroups according to the spatial relationships of the lesion and the primary motor cortex (PMC)/internal capsule. Specifically, we investigated the key factors that cause distorted tractography in patients with tumors. We compared 3 CST tractography methods that used different ROI selection schemes. The results indicate that CST fiber tracking methods based only on anatomical ROIs could possibly lead to distortions near the PMC region and may be unable to effectively localize the PMC. In contrast, the dual ROI method, which uses ROIs that have been selected from both blood oxygen level-dependent functional MRI (BOLD-fMRI) activation and anatomical landmarks, enabled the tracking of fibers to the motor cortex. The results demonstrate that the dual ROI method can localize the entire CST fiber pathway and can accurately describe the spatial relationships of CST fibers relative to the tumor. These results illustrate the reliability of using fMRI-guided DTT in patients with tumors. The combination of fMRI and anatomical information enhances the identification of tracts of interest in brains with anatomical deformations, which provides neurosurgeons with a more accurate approach for visualizing and localizing white matter fiber tracts in patients with brain tumors. This approach enhances surgical performance and perserves brain function.
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Affiliation(s)
- Chen Niu
- From the Department of Medical Imaging, The First Affiliated Hospital of Xi'An Jiaotong University, Xi'an, Shaanxi (CN, MG, WL, LG, MZ); Key Laboratory of Biomedical Information Engineering of Education Ministry, Institute of Biomedical Engineering, Xi'an Jiaotong University, Xi'an (XL); School of Information Technology, Jiangxi University of Finance and Economics, Nanchang, People's Republic of China (YY); Department of Electronics Engineering, Northwestern Polytechnical University, Xi'an (KZ); Department of Neurosurgey, First Affiliated Hospital of Xi'An Jiaotong University, Xi'an, Shaanxi (MW); Key Laboratory of Biomedical Information Engineering of Education Ministry, Institute of Biomedical Engineering, Xi'an Jiaotong University, Xi'an (PL); and Department of Medical Imaging, The First Affiliated Hospital of Xi'An Jiaotong University, Xi'an (MZ), Shaanxi, China
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Batra P, Bandt SK, Leuthardt EC. Resting state functional connectivity magnetic resonance imaging integrated with intraoperative neuronavigation for functional mapping after aborted awake craniotomy. Surg Neurol Int 2016; 7:13. [PMID: 26958419 PMCID: PMC4766807 DOI: 10.4103/2152-7806.175885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 12/29/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Awake craniotomy is currently the gold standard for aggressive tumor resections in eloquent cortex. However, a significant subset of patients is unable to tolerate this procedure, particularly the very young or old or those with psychiatric comorbidities, cardiopulmonary comorbidities, or obesity, among other conditions. In these cases, typical alternative procedures include biopsy alone or subtotal resection, both of which are associated with diminished surgical outcomes. CASE DESCRIPTION Here, we report the successful use of a preoperatively obtained resting state functional connectivity magnetic resonance imaging (MRI) integrated with intraoperative neuronavigation software in order to perform functional cortical mapping in the setting of an aborted awake craniotomy due to loss of airway. CONCLUSION Resting state functional connectivity MRI integrated with intraoperative neuronavigation software can provide an alternative option for functional cortical mapping in the setting of an aborted awake craniotomy.
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Affiliation(s)
- Prag Batra
- Department of Computer Science, Washington University, St. Louis, Missouri, USA
| | - S Kathleen Bandt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Biomedical Engineering, Washington University, St. Louis, Missouri, USA; Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, Missouri, USA
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Sollmann N, Ille S, Tussis L, Maurer S, Hauck T, Negwer C, Bauer JS, Ringel F, Meyer B, Krieg SM. Correlating subcortical interhemispheric connectivity and cortical hemispheric dominance in brain tumor patients: A repetitive navigated transcranial magnetic stimulation study. Clin Neurol Neurosurg 2016; 141:56-64. [DOI: 10.1016/j.clineuro.2015.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/14/2015] [Indexed: 12/31/2022]
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Abstract
Functional magnetic resonance imaging (fMRI) maps the spatiotemporal distribution of neural activity in the brain under varying cognitive conditions. Since its inception in 1991, blood oxygen level-dependent (BOLD) fMRI has rapidly become a vital methodology in basic and applied neuroscience research. In the clinical realm, it has become an established tool for presurgical functional brain mapping. This chapter has three principal aims. First, we review key physiologic, biophysical, and methodologic principles that underlie BOLD fMRI, regardless of its particular area of application. These principles inform a nuanced interpretation of the BOLD fMRI signal, along with its neurophysiologic significance and pitfalls. Second, we illustrate the clinical application of task-based fMRI to presurgical motor, language, and memory mapping in patients with lesions near eloquent brain areas. Integration of BOLD fMRI and diffusion tensor white-matter tractography provides a road map for presurgical planning and intraoperative navigation that helps to maximize the extent of lesion resection while minimizing the risk of postoperative neurologic deficits. Finally, we highlight several basic principles of resting-state fMRI and its emerging translational clinical applications. Resting-state fMRI represents an important paradigm shift, focusing attention on functional connectivity within intrinsic cognitive networks.
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Affiliation(s)
- Bradley R Buchbinder
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Fisicaro RA, Jiao RX, Stathopoulos C, Petrovich Brennan NM, Peck KK, Holodny AI. Challenges in Identifying the Foot Motor Region in Patients with Brain Tumor on Routine MRI: Advantages of fMRI. AJNR Am J Neuroradiol 2015; 36:1488-93. [PMID: 25882288 DOI: 10.3174/ajnr.a4292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/13/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Accurate localization of the foot/leg motor homunculus is essential because iatrogenic damage can render a patient wheelchair- or bed-bound. We hypothesized the following: 1) Readers would identify the foot motor homunculus <100% of the time on routine MR imaging, 2) neuroradiologists would perform better than nonradiologists, and 3) those with fMRI experience would perform better than those without it. MATERIALS AND METHODS Thirty-five attending-level raters (24 neuroradiologists, 11 nonradiologists) evaluated 14 brain tumors involving the frontoparietal convexity. Raters were asked to identify the location of the foot motor homunculus and determine whether the tumor involved the foot motor area and/or motor cortex by using anatomic MR imaging. Results were compared on the basis of prior fMRI experience and medical specialty by using Mann-Whitney U test statistics. RESULTS No rater was 100% correct. Raters correctly identified whether the tumor was in the foot motor cortex 77% of the time. Raters with fMRI experience were significantly better than raters without experience at foot motor fMRI centroid predictions (13 ± 6 mm versus 20 ± 13 mm from the foot motor cortex center, P = 2 × 10(-6)) and arrow placement in the motor gyrus (67% versus 47%, P = 7 × 10(-5)). Neuroradiologists were significantly better than nonradiologists at foot motor fMRI centroid predictions (15 ± 8 mm versus 20 ± 14 mm, P = .005) and arrow placement in the motor gyrus (61% versus 46%, P = .008). CONCLUSIONS The inability of experienced readers to consistently identify the location of the foot motor homunculus on routine MR imaging argues for using fMRI in the preoperative setting. Experience with fMRI leads to improved accuracy in identifying anatomic structures, even on routine MR imaging.
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Affiliation(s)
- R A Fisicaro
- From the Functional MRI Laboratory, Department of Radiology (R.A.F., R.X.J., C.S., N.M.P.B., K.K.P, A.I.H.)
| | - R X Jiao
- From the Functional MRI Laboratory, Department of Radiology (R.A.F., R.X.J., C.S., N.M.P.B., K.K.P, A.I.H.)
| | - C Stathopoulos
- From the Functional MRI Laboratory, Department of Radiology (R.A.F., R.X.J., C.S., N.M.P.B., K.K.P, A.I.H.)
| | - N M Petrovich Brennan
- From the Functional MRI Laboratory, Department of Radiology (R.A.F., R.X.J., C.S., N.M.P.B., K.K.P, A.I.H.)
| | - K K Peck
- From the Functional MRI Laboratory, Department of Radiology (R.A.F., R.X.J., C.S., N.M.P.B., K.K.P, A.I.H.) Department of Medical Physics (K.K.P.)
| | - A I Holodny
- From the Functional MRI Laboratory, Department of Radiology (R.A.F., R.X.J., C.S., N.M.P.B., K.K.P, A.I.H.) the Brain Tumor Center (A.I.H.), Memorial Sloan-Kettering Cancer Center, New York, New York.
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