Awake Brain Mapping by Direct Cortical Stimulation; Technical Note to Get Higher Resection Rate and Low Morbidity in Low-grade Glioma Patients

Overview

Journal Ann Med Surg (Lond)

Publisher Wolters Kluwer

Specialty Medical Education

Date 2024 Apr 5

PMID 38576956

Authors

Robert Ahmed Khan

Md Moshiur Rahman

Md Ziauddin

Muhtamim Chowdhury

Mahbub Hasan

Affiliations

Soon will be listed here.

Abstract

Introduction: Direct cortical stimulation has been used for brain mapping and localization of eloquent areas in awake patients. This simplified technique is to provide the positive areas, which can be preserved if the tumor or lesions are involved eloquent areas.

Objective: The main objective of this study is to determine whether direct cortical stimulation in awake brain mapping for low-grade glioma patients increases the rate of resection or not.

Method: The authors present a retrospective study between 2020 to 2022 that includes 35 cases in a single center, to get higher resection rate, and their consequences in awake craniotomy in low-grade glioma patients. Here, two neurosurgeons were involved and the minimum follow-up was 12 months.

Results: The authors achieved 80% removal of tumors. To get higher resection rate we emphasized negative mapping with prior anatomical analysis to understand functional realignment. Stimulation-related complications will be thoroughly discussed with a potential future direction to minimize the issues. The authors used PROMIS score to measure patients physical and mental health status and kernofsky score to measure performance status before and after successful surgery. The authors found three cases of transient deficit in repetitive stimulation. Repeated stimulation to identify the eloquent areas with low voltage frequency is a good option. Numbness in the face related to stimulation may continue for 6 weeks.

Conclusion: Functional realignment in shifted brain and edema can be seen while doing cortical and subcortical stimulation. Most of the stimulation from low to high for language mapping may vary from patient to patient. For safe removal of low-grade glioma a steep learning curve is needed to find out the negative areas, though the authors emphasize positive mapping of areas to secure the maximum eloquence.

References

Pouratian N, Asthagiri A, Jagannathan J, Shaffrey M, Schiff D . Surgery Insight: the role of surgery in the management of low-grade gliomas. Nat Clin Pract Neurol. 2007; 3(11):628-39. DOI: 10.1038/ncpneuro0634. View

Shaw E, Berkey B, Coons S, Bullard D, Brachman D, Buckner J . Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial. J Neurosurg. 2008; 109(5):835-41. PMC: 3833272. DOI: 10.3171/JNS/2008/109/11/0835. View

Chang E, Potts M, Keles G, Lamborn K, Chang S, Barbaro N . Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg. 2008; 108(2):227-35. DOI: 10.3171/JNS/2008/108/2/0227. View

Yordanova Y, Moritz-Gasser S, Duffau H . Awake surgery for WHO Grade II gliomas within "noneloquent" areas in the left dominant hemisphere: toward a "supratotal" resection. Clinical article. J Neurosurg. 2011; 115(2):232-9. DOI: 10.3171/2011.3.JNS101333. View

Alimohamadi M, Shirani M, Moharari R, Pour-Rashidi A, Ketabchi M, Khajavi M . Application of Awake Craniotomy and Intraoperative Brain Mapping for Surgical Resection of Insular Gliomas of the Dominant Hemisphere. World Neurosurg. 2016; 92:151-158. DOI: 10.1016/j.wneu.2016.04.079. View

Mofatteh M, Mashayekhi M, Arfaie S, Wei H, Kazerouni A, Skandalakis G . Awake craniotomy during pregnancy: A systematic review of the published literature. Neurosurg Rev. 2023; 46(1):290. PMC: 10620271. DOI: 10.1007/s10143-023-02187-x. View

Pouratian N, Mut M, Jagannathan J, Lopes M, Shaffrey M, Schiff D . Low-grade gliomas in older patients: a retrospective analysis of prognostic factors. J Neurooncol. 2008; 90(3):341-50. DOI: 10.1007/s11060-008-9669-3. View

Mandonnet E, Jbabdi S, Taillandier L, Galanaud D, Benali H, Capelle L . Preoperative estimation of residual volume for WHO grade II glioma resected with intraoperative functional mapping. Neuro Oncol. 2006; 9(1):63-9. PMC: 1828101. DOI: 10.1215/15228517-2006-015. View

Carrabba G, Fava E, Giussani C, Acerbi F, Portaluri F, Songa V . Cortical and subcortical motor mapping in rolandic and perirolandic glioma surgery: impact on postoperative morbidity and extent of resection. J Neurosurg Sci. 2007; 51(2):45-51. View

10.

Mandonnet E, Pallud J, Clatz O, Taillandier L, Konukoglu E, Duffau H . Computational modeling of the WHO grade II glioma dynamics: principles and applications to management paradigm. Neurosurg Rev. 2008; 31(3):263-9. DOI: 10.1007/s10143-008-0128-6. View

11.

Mathew G, Agha R, Albrecht J, Goel P, Mukherjee I, Pai P . STROCSS 2021: Strengthening the reporting of cohort, cross-sectional and case-control studies in surgery. Int J Surg. 2021; 96:106165. DOI: 10.1016/j.ijsu.2021.106165. View

12.

Motomura K, Ohka F, Aoki K, Saito R . Supratotal Resection of Gliomas With Awake Brain Mapping: Maximal Tumor Resection Preserving Motor, Language, and Neurocognitive Functions. Front Neurol. 2022; 13:874826. PMC: 9133877. DOI: 10.3389/fneur.2022.874826. View

13.

Della Puppa A, De Pellegrin S, DAvella E, Gioffre G, Rossetto M, Gerardi A . 5-aminolevulinic acid (5-ALA) fluorescence guided surgery of high-grade gliomas in eloquent areas assisted by functional mapping. Our experience and review of the literature. Acta Neurochir (Wien). 2013; 155(6):965-72. DOI: 10.1007/s00701-013-1660-x. View

14.

Duffau H . Awake Mapping With Transopercular Approach in Right Insular-Centered Low-Grade Gliomas Improves Neurological Outcomes and Return to Work. Neurosurgery. 2022; 91(1):182-190. DOI: 10.1227/neu.0000000000001966. View

15.

Duffau H, Lopes M, Arthuis F, Bitar A, Sichez J, Van Effenterre R . Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985-96) and with (1996-2003) functional mapping in the same institution. J Neurol Neurosurg Psychiatry. 2005; 76(6):845-51. PMC: 1739650. DOI: 10.1136/jnnp.2004.048520. View

16.

Farina P, Lombardi G, Bergo E, Roma A, Zagonel V . Treatment of malignant gliomas in elderly patients: a concise overview of the literature. Biomed Res Int. 2014; 2014:734281. PMC: 4016934. DOI: 10.1155/2014/734281. View

17.

Sato T, Okumura T, Nishiwaki K . Preanesthesia scalp blocks reduce intraoperative pain and hypertension in the asleep-awake-asleep method of awake craniotomy: A retrospective study. J Clin Anesth. 2020; 66:109946. DOI: 10.1016/j.jclinane.2020.109946. View

18.

Duffau H . Intraoperative cortico-subcortical stimulations in surgery of low-grade gliomas. Expert Rev Neurother. 2005; 5(4):473-85. DOI: 10.1586/14737175.5.4.473. View

19.

Bello L, Gallucci M, Fava M, Carrabba G, Giussani C, Acerbi F . Intraoperative subcortical language tract mapping guides surgical removal of gliomas involving speech areas. Neurosurgery. 2007; 60(1):67-80. DOI: 10.1227/01.NEU.0000249206.58601.DE. View

20.

Beylerli O, Encarnacion Ramirez M, Shumadalova A, Ilyasova T, Zemlyanskiy M, Beilerli A . Cell-Free miRNAs as Non-Invasive Biomarkers in Brain Tumors. Diagnostics (Basel). 2023; 13(18). PMC: 10529040. DOI: 10.3390/diagnostics13182888. View