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Shao ZD, Gong YJ, Ren J, Wang J. Exploring the arcuate fasciculus from a clinical perspective. Front Neurosci 2023; 17:1307834. [PMID: 38033540 PMCID: PMC10684764 DOI: 10.3389/fnins.2023.1307834] [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: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
In recent years, language function impairment caused by intracranial diseases has gained increasing interest, mainly due to its significant impact on the language and cognitive ability, leading to a serious decline in the quality of life of patients. Consequently, researchers aimed to clarify the quantitative degree of lesions of the arcuate fasciculus and therapeutic targets to promote nerve fiber remodeling. The arcuate fasciculus is extremely prone to damage caused by diseases such as stroke and brain tumor. Hallucinating schizophrenia, autism spectrum disorder, epilepsy, chronic fatigue syndrome, chronic tinnitus, and other diseases can also lead to changes in the fractional anisotropy value of arcuate fasciculus; however, different studies have different conclusions about how this change occurs. To obtain a better understanding, more clinical studies are required. Owing to various advancements in neuroimaging, a better understanding and identification of vital targets for restoration of neurological function are possible. The arcuate fasciculus is stratified into three substructures, each having unique neurological functions. Both diffusion tensor imaging (DTI) sequences and deterministic monitoring techniques render it possible to visually and quantitatively analyze the substructure in three parts. In this review, we examined the progress of the arcuate fasciculus and quantitative DTI technology in recent years.
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Affiliation(s)
| | | | | | - Ji Wang
- Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
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2
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Abarrategui B, Mariani V, Rizzi M, Berta L, Scarpa P, Zauli FM, Squarza S, Banfi P, d’Orio P, Cardinale F, Del Vecchio M, Caruana F, Avanzini P, Sartori I. Language lateralization mapping (reversibly) masked by non-dominant focal epilepsy: a case report. Front Hum Neurosci 2023; 17:1254779. [PMID: 37900727 PMCID: PMC10600519 DOI: 10.3389/fnhum.2023.1254779] [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: 07/21/2023] [Accepted: 09/15/2023] [Indexed: 10/31/2023] Open
Abstract
Language lateralization in patients with focal epilepsy frequently diverges from the left-lateralized pattern that prevails in healthy right-handed people, but the mechanistic explanations are still a matter of debate. Here, we debate the complex interaction between focal epilepsy, language lateralization, and functional neuroimaging techniques by introducing the case of a right-handed patient with unaware focal seizures preceded by aphasia, in whom video-EEG and PET examination suggested the presence of focal cortical dysplasia in the right superior temporal gyrus, despite a normal structural MRI. The functional MRI for language was inconclusive, and the neuropsychological evaluation showed mild deficits in language functions. A bilateral stereo-EEG was proposed confirming the right superior temporal gyrus origin of seizures, revealing how ictal aphasia emerged only once seizures propagated to the left superior temporal gyrus and confirming, by cortical mapping, the left lateralization of the posterior language region. Stereo-EEG-guided radiofrequency thermocoagulations of the (right) focal cortical dysplasia not only reduced seizure frequency but led to the normalization of the neuropsychological assessment and the "restoring" of a classical left-lateralized functional MRI pattern of language. This representative case demonstrates that epileptiform activity in the superior temporal gyrus can interfere with the functioning of the contralateral homologous cortex and its associated network. In the case of presurgical evaluation in patients with epilepsy, this interference effect must be carefully taken into consideration. The multimodal language lateralization assessment reported for this patient further suggests the sensitivity of different explorations to this interference effect. Finally, the neuropsychological and functional MRI changes after thermocoagulations provide unique cues on the network pathophysiology of focal cortical dysplasia and the role of diverse techniques in indexing language lateralization in complex scenarios.
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Affiliation(s)
- Belén Abarrategui
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Neurology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Valeria Mariani
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Neurology and Stroke Unit, ASST Santi Paolo e Carlo, Presidio San Carlo Borromeo, Milan, Italy
| | - Michele Rizzi
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luca Berta
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Pina Scarpa
- Cognitive Neuropsychology Centre, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Flavia Maria Zauli
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Philosophy “P. Martinetti”, Università degli Studi di Milano, Milan, Italy
| | - Silvia Squarza
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paola Banfi
- Neurology and Stroke Unit, ASST Sette Laghi Ospedale di Circolo, Varese, Italy
| | - Piergiorgio d’Orio
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Unit of Neuroscience, Department of Medicine and Surgery, Università degli Studi di Parma, Parma, Italy
- Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Francesco Cardinale
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Unit of Neuroscience, Department of Medicine and Surgery, Università degli Studi di Parma, Parma, Italy
- Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Maria Del Vecchio
- Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Fausto Caruana
- Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Pietro Avanzini
- Institute of Neuroscience, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Ivana Sartori
- “Claudio Munari” Epilepsy Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Di Cristofori A, Graziano F, Rui CB, Rebora P, Di Caro D, Chiarello G, Stefanoni G, Julita C, Florio S, Ferlito D, Basso G, Citerio G, Remida P, Carrabba G, Giussani C. Exoscopic Microsurgery: A Change of Paradigm in Brain Tumor Surgery? Comparison with Standard Operative Microscope. Brain Sci 2023; 13:1035. [PMID: 37508967 PMCID: PMC10377370 DOI: 10.3390/brainsci13071035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The exoscope is a high-definition telescope recently introduced in neurosurgery. In the past few years, several reports have described the advantages and disadvantages of such technology. No studies have compared results of surgery with standard microscope and exoscope in patients with glioblastoma multiforme (GBM). METHODS Our retrospective study encompassed 177 patients operated on for GBM (WHO 2021) between February 2017 and August 2022. A total of 144 patients were operated on with a microscope only and the others with a 3D4K exoscope only. All clinical and radiological data were collected. Progression-free survival (PFS) and overall survival (OS) have been estimated in the two groups and compared by the Cox model adjusting for potential confounders (e.g., sex, age, Karnofsky performance status, gross total resection, MGMT methylated promoter, and operator's experience). RESULTS IDH was mutated in 9 (5.2%) patients and MGMT was methylated in 76 (44.4%). Overall, 122 patients received a gross total resection, 14 patients received a subtotal resection, and 41 patients received a partial resection. During follow-up, 139 (73.5%) patients experienced tumor recurrence and 18.7% of them received a second surgery. After truncation to 12 months, the median PFS for patients operated on with the microscope was 8.82 months, while for patients operated on with the exoscope it was >12 months. Instead, the OS was comparable in the two groups. The multivariable Cox model showed that the use of microscope compared to the exoscope was associated with lower progression-free survival (hazard ratio = 3.55, 95%CI = 1.66-7.56, p = 0.001). CONCLUSIONS The exoscope has proven efficacy in terms of surgical resection, which was not different to that of the microscope. Furthermore, patients operated on with the exoscope had a longer PFS. A comparable OS was observed between microscope and exoscope, but further prospective studies with longer follow-up are needed.
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Affiliation(s)
- Andrea Di Cristofori
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Francesca Graziano
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, Piazza Ateneo Nuovo, 120126 Milan, Italy
| | - Chiara Benedetta Rui
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, Piazza Ateneo Nuovo, 120126 Milan, Italy
| | - Diego Di Caro
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Gaia Chiarello
- Pathology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Giovanni Stefanoni
- Neurology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Chiara Julita
- Radiotherapy, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Santa Florio
- Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Davide Ferlito
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Gianpaolo Basso
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Giuseppe Citerio
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurointensive Care Unit, Department of Neuroscience, Fondazione IRCCS San Gerardo deiTintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Paolo Remida
- Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Giorgio Carrabba
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Carlo Giussani
- Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy
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4
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Giussani C, Carrabba G, Rui CB, Chiarello G, Stefanoni G, Julita C, De Vito A, Cinalli MA, Basso G, Remida P, Citerio G, Di Cristofori A. Perilesional resection technique of glioblastoma: intraoperative ultrasound and histological findings of the resection borders in a single center experience. J Neurooncol 2023; 161:625-632. [PMID: 36690859 PMCID: PMC9992251 DOI: 10.1007/s11060-022-04232-z] [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: 07/07/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The surgical goal in glioblastoma treatment is the maximal safe resection of the tumor. Currently the lack of consensus on surgical technique opens different approaches. This study describes the "perilesional technique" and its outcomes in terms of the extent of resection, progression free survival and overall survival. METHODS Patients included (n = 40) received a diagnosis of glioblastoma and underwent surgery using the perilesional dissection technique at "San Gerardo Hospital"between 2018 and 2021. The tumor core was progressively isolated using a circumferential movement, healthy brain margins were protected with Cottonoid patties in a "shingles on the roof" fashion, then the tumorwas removed en bloc. Intraoperative ultrasound (iOUS) was used and at least 1 bioptic sample of "healthy" margin of the resection was collected and analyzed. The extent of resection was quantified. Extent of surgical resection (EOR) and progression free survival (PFS)were safety endpoints of the procedure. RESULTS Thirty-four patients (85%) received a gross total resection(GTR) while 3 (7.5%) patients received a sub-total resection (STR), and 3 (7.5%) a partial resection (PR). The mean post-operative residual volume was 1.44 cm3 (range 0-15.9 cm3).During surgery, a total of 76 margins were collected: 51 (67.1%) were tumor free, 25 (32.9%) were infiltrated. The median PFS was 13.4 months, 15.3 in the GTR group and 9.6 months in the STR-PR group. CONCLUSIONS Perilesional resection is an efficient technique which aims to bring the surgeon to a safe environment, carefully reaching the "healthy" brain before removing the tumoren bloc. This technique can achieve excellent tumor margins, extent of resection, and preservation of apatient's functions.
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Affiliation(s)
- Carlo Giussani
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. .,Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy.
| | - Giorgio Carrabba
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Chiara Benedetta Rui
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Gaia Chiarello
- Neuropathology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, MB, 20900, Monza, Italy
| | - Giovanni Stefanoni
- Neurology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Chiara Julita
- Radiotherapy, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Andrea De Vito
- Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Maria Allegra Cinalli
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Gianpaolo Basso
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Paolo Remida
- Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Giuseppe Citerio
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Neurointensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Andrea Di Cristofori
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
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5
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Giambra M, Di Cristofori A, Valtorta S, Manfrellotti R, Bigiogera V, Basso G, Moresco RM, Giussani C, Bentivegna A. The peritumoral brain zone in glioblastoma: where we are and where we are going. J Neurosci Res 2023; 101:199-216. [PMID: 36300592 PMCID: PMC10091804 DOI: 10.1002/jnr.25134] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/01/2022] [Accepted: 10/01/2022] [Indexed: 12/13/2022]
Abstract
Glioblastoma (GBM) is the most aggressive and invasive primary brain tumor. Current therapies are not curative, and patients' outcomes remain poor with an overall survival of 20.9 months after surgery. The typical growing pattern of GBM develops by infiltrating the surrounding apparent normal brain tissue within which the recurrence is expected to appear in the majority of cases. Thus, in the last decades, an increased interest has developed to investigate the cellular and molecular interactions between GBM and the peritumoral brain zone (PBZ) bordering the tumor tissue. The aim of this review is to provide up-to-date knowledge about the oncogenic properties of the PBZ to highlight possible druggable targets for more effective treatment of GBM by limiting the formation of recurrence, which is almost inevitable in the majority of patients. Starting from the description of the cellular components, passing through the illustration of the molecular profiles, we finally focused on more clinical aspects, represented by imaging and radiological details. The complete picture that emerges from this review could provide new input for future investigations aimed at identifying new effective strategies to eradicate this still incurable tumor.
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Affiliation(s)
- Martina Giambra
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,PhD Program in Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Andrea Di Cristofori
- PhD Program in Neuroscience, University of Milano-Bicocca, Monza, Italy.,Division of Neurosurgery, Azienda Socio Sanitaria Territoriale - Monza, Ospedale San Gerardo, Monza, Italy
| | - Silvia Valtorta
- Department of Nuclear Medicine, San Raffaele Scientific Institute, IRCCS, Milan, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Segrate, Italy.,NBFC, National Biodiversity Future Center, 90133, Palermo, Italy
| | - Roberto Manfrellotti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Division of Neurosurgery, Azienda Socio Sanitaria Territoriale - Monza, Ospedale San Gerardo, Monza, Italy
| | - Vittorio Bigiogera
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Gianpaolo Basso
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Rosa Maria Moresco
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Nuclear Medicine, San Raffaele Scientific Institute, IRCCS, Milan, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Segrate, Italy
| | - Carlo Giussani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Division of Neurosurgery, Azienda Socio Sanitaria Territoriale - Monza, Ospedale San Gerardo, Monza, Italy
| | - Angela Bentivegna
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Natalizi F, Piras F, Vecchio D, Spalletta G, Piras F. Preoperative Navigated Transcranial Magnetic Stimulation: New Insight for Brain Tumor-Related Language Mapping. J Pers Med 2022; 12:1589. [PMID: 36294728 PMCID: PMC9604795 DOI: 10.3390/jpm12101589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 08/30/2023] Open
Abstract
Preoperative brain mapping methods are particularly important in modern neuro-oncology when a tumor affects eloquent language areas since damage to parts of the language circuits can cause significant impairments in daily life. This narrative review examines the literature regarding preoperative and intraoperative language mapping using repetitive navigated transcranial magnetic stimulation (rnTMS) with or without direct electrical stimulation (DES) in adult patients with tumors in eloquent language areas. The literature shows that rnTMS is accurate in detecting preexisting language disorders and positive intraoperative mapping regions. In terms of the region extent and clinical outcomes, rnTMS has been shown to be accurate in identifying positive sites to guide resection, reducing surgery duration and craniotomy size and thus improving clinical outcomes. Before incorporating rnTMS into the neurosurgical workflow, the refinement of protocols and a consensus within the neuro-oncology community are required.
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Affiliation(s)
- Federica Natalizi
- Laboratory of Neurophychiatry, IRCSS Santa Lucia Fundation, Via Ardeatina 306, 00134 Rome, Italy
- Department of Psychology, “Sapienza” University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- PhD Program in Behavioral Neuroscience, Sapienza University of Rome, 00161 Rome, Italy
| | - Federica Piras
- Laboratory of Neurophychiatry, IRCSS Santa Lucia Fundation, Via Ardeatina 306, 00134 Rome, Italy
| | - Daniela Vecchio
- Laboratory of Neurophychiatry, IRCSS Santa Lucia Fundation, Via Ardeatina 306, 00134 Rome, Italy
| | - Gianfranco Spalletta
- Laboratory of Neurophychiatry, IRCSS Santa Lucia Fundation, Via Ardeatina 306, 00134 Rome, Italy
| | - Fabrizio Piras
- Laboratory of Neurophychiatry, IRCSS Santa Lucia Fundation, Via Ardeatina 306, 00134 Rome, Italy
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7
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Carrabba G, Fiore G, Di Cristofori A, Bana C, Borellini L, Zarino B, Conte G, Triulzi F, Rocca A, Giussani C, Caroli M, Locatelli M, Bertani G. Diffusion tensor imaging, intra-operative neurophysiological monitoring and small craniotomy: Results in a consecutive series of 103 gliomas. Front Oncol 2022; 12:897147. [PMID: 36176387 PMCID: PMC9513471 DOI: 10.3389/fonc.2022.897147] [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] [Received: 03/15/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Diffusion tensor imaging (DTI) allows visualization of the main white matter tracts while intraoperative neurophysiological monitoring (IONM) represents the gold standard for surgical resection of gliomas. In recent years, the use of small craniotomies has gained popularity thanks to neuronavigation and to the low morbidity rates associated with shorter surgical procedures. The aim of this study was to review a series of patients operated for glioma using DTI, IONM, and tumor-targeted craniotomies. The retrospective analysis included patients with supratentorial glioma who met the following inclusion criteria: preoperative DTI, intraoperative IONM, tumor-targeted craniotomy, pre- and postoperative MRI, and complete clinical charts. The DTI was performed on a 3T scanner. The IONM included electroencephalography (EEG), transcranial (TC) and/or cortical motor-evoked potentials (MEP), electrocorticography (ECoG), and direct electrical stimulation (DES). Outcomes included postoperative neurological deficits, volumetric extent of resection (EOR), and overall survival (OS). One hundred and three patients (61 men, 42 women; mean age 54 ± 14 years) were included and presented the following WHO histologies: 65 grade IV, 19 grade III, and 19 grade II gliomas. After 3 months, only three patients had new neurological deficits. The median postoperative volume was 0cc (IQR 3). The median OS for grade IV gliomas was 15 months, while for low-grade gliomas it was not reached. In our experience, a small craniotomy and a tumor resection supported by IONM and DTI permitted to achieve satisfactory results in terms of neurological outcomes, EOR, and OS for glioma patients.
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Affiliation(s)
- Giorgio Carrabba
- Neurosugery, Azienda Socio Sanitaria Territoriale Monza - Ospedale San Gerardo di Monza, Monza, Italy
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milan, Italy
- *Correspondence: Giorgio Carrabba,
| | - Giorgio Fiore
- Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Andrea Di Cristofori
- Neurosugery, Azienda Socio Sanitaria Territoriale Monza - Ospedale San Gerardo di Monza, Monza, Italy
| | - Cristina Bana
- Neurophysiopathology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Linda Borellini
- Neurophysiopathology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Barbara Zarino
- Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Giorgio Conte
- Neuroradiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milano, Milano, Italy
| | - Fabio Triulzi
- Neuroradiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milano, Milano, Italy
| | - Alessandra Rocca
- Neurosugery, Azienda Socio Sanitaria Territoriale Monza - Ospedale San Gerardo di Monza, Monza, Italy
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Carlo Giussani
- Neurosugery, Azienda Socio Sanitaria Territoriale Monza - Ospedale San Gerardo di Monza, Monza, Italy
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Manuela Caroli
- Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Marco Locatelli
- Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Milan, Italy
| | - Giulio Bertani
- Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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8
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Wu D, Zhang M, Geng J, Chen X. Noninvasive Prediction of Language Lateralization Through Arcuate Fasciculus Tractography in Patients With Low-Grade Gliomas: Correlation With The Wada Test. Front Oncol 2022; 12:936228. [PMID: 35936675 PMCID: PMC9354698 DOI: 10.3389/fonc.2022.936228] [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] [Received: 05/05/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Language lateralization is unique to humans, so clarifying dominant side is helpful for removing gliomas involving language areas. This study investigated the arcuate fasciculus (AF) reconstructed by diffusion tensor imaging–based tractography (DTT) in predicting language lateralization in patients with low-grade gliomas. Wada test was performed to determine the language Dominant Hemisphere (DH) and the Contralateral Hemisphere. DTI data [1.5-T magnetic resonance imaging (MRI)] was used to reconstruct AF by two independent operators using a DTT method. Fiber number, volume, and fractional anisotropy (FA) of bilateral reconstructed AF were measured. Lateralization indexes (LIs), including Number Index (NI), Volume Index (VI), and FA Index (FI), were accordingly calculated by mean values. A total of 21 patients with WHO Grade II gliomas in the left hemisphere were included. Every patient received a successful Wada test and reconstruction of bilateral AF. DTT metrics of reconstructed AF, such as fiber number, volume, and FA, showed significantly asymmetric between hemispheres. All the LI (NI, VI, and FI) values were statistically higher in the DH determined by the Wada test. No discrepancy was found between the prediction using the cutoff values of DTT metrics and the results of WADA test. The Kappa values were 0.829, 0.696, and 0.611, indicating NI and VI as more reliable predictor than FI although FI itself may also be feasible. Compared with the Wada test, we consider that DTT of AF is a non-invasive, simple, relatively accurate, and feasible method in predicting language lateralization in patients with low-grade gliomas.
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Affiliation(s)
- Dongdong Wu
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Meng Zhang
- Department of Neurosurgery, The Second Hospital of Southern Theater of Chinese Navy, Sanya, China
| | - Jiefeng Geng
- Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaolei Chen
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Xiaolei Chen,
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