Brain ; physiopathology ; Brain Neoplasms ; surgery ; Cognition Disorders ; physiopathology ; Humans ; Magnetic Resonance Imaging ; methods ; Oxygen ; blood

Epilepsy surgery has been demonstrated to be an effective alternative treatment for intractable partial or localization related epilepsy. Primary intracranial neoplasms and other structural lesions of the brain are important etiological factors in patients with partial seizure disorders. A neuroimaging identified lesion in patients with seizures, not necessarily medically refractory, may also be an indication for surgery in selected patients. Twelve patients operated on under local or general anesthesia for resection surgery underwent intraoperative recording(electrocorticogram) and/or functional mapping by electrical stimulation or somatosensory evoked potentials-(SSEPs) for identification of the secondary epileptogenic area and/or functional area; 2 meningiomas, 5 astrocytomas, 1 gangliocytoma, 1 abscess, 1 small AVM, 1 cysticercosis and one gliosis by previous intracerebral hemorrhage with middle cerebral artery(MCA) aneurysm. Among these, additional corticectomy or anterior temporal lobectomy was performed in eleven patients. All the patients did well after surgery with good outcomes as seizure free in nine(75%) out of 12 patients with 11.9 months of follow-up period, without any neurological deficits. Intraoperative recording and functional mapping of adjacent areas of the structural lesions of the brain are useful in surgery and can guide the extent of further resection.
Adolescent ; Adult ; *Brain Mapping ; Brain Neoplasms/physiopathology/*surgery ; Electroencephalography ; Evoked Potentials, Somatosensory ; Female ; Human ; Intraoperative Period ; Male ; Middle Age ; Seizures/physiopathology/*surgery ; Support, Non-U.S. Gov't

BACKGROUNDRecent advances on functional mapping have enabled us to conduct surgery on gliomas within the eloquent area. The objective of the article is to discuss the feasibility of a planned fractionated strategy of resection on low-grade gliomas (LGGs) involving Broca's area. We report the first surgical series of planned fractionated resections on LGGs within Broca's area, focusing on language functional reshaping.

METHODSFour patients were treated with fractionated operations for LGGs involving Broca's area. All cases underwent conventional magnetic resonance (MR) scanning, language functional MR and diffusion tensor imaging (DTI) before operation. The resections were then performed on patients under awake anesthesia using intraoperative electrical stimulation (IES) for functional mapping. Pre- and post-operative neuro-psychological examinations were evaluated.

RESULTSTotal resections were achieved in all cases as confirmed by the postoperative control MR. After transient language worsening, all patients recovered to normal 3-6 months later. Language functional MR scannings have shown language functional cortical and subcortical pathway reorganization (in the perilesion or contra-lateral hemisphere) after the operation. All patients returned to a normal socioprofessional life.

CONCLUSIONSBy utilizing the dynamic interaction between brain plasticity and fractionated resections, we can totally remove the tumor involving Broca's structure without inducing permanent postoperative deficits and even improve the quality of life.

Adult ; Brain Neoplasms ; physiopathology ; psychology ; surgery ; Female ; Frontal Lobe ; Glioma ; physiopathology ; psychology ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Neuronal Plasticity ; Neuropsychological Tests

Acupuncture Analgesia ; methods ; Adult ; Anesthesia, Intravenous ; methods ; Brain Neoplasms ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Glioma ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVETo explore surgical treatment of gliomas involving the supplementary motor area (SMA) in the superior frontal gyrus.

METHODSClinical data and follow-up outcome of 16 patients with low graded astrocytomas involving the supplementary motor area were analyzed.

RESULTSSMA syndrome was developed in 6 patients in whom the posterior tumor resection line was at a distance of more than 1 cm from the precentral sulcus and resolved after 12 months. Hemiplegia occurred however in 8 patients in whom the resection line was less than 1 cm to precentral sulcus and only resolved in 3 patients during follow period 12 months.

CONCLUSIONSWhen the resection is performed at a distance of less than 1 cm from the precentral sulcus, surgery for gliomas of involving the supplementary motor area in the superior frontal gyrus may be result in permanent morbidity.

Adult ; Astrocytoma ; surgery ; Brain Neoplasms ; surgery ; Female ; Follow-Up Studies ; Frontal Lobe ; surgery ; Humans ; Male ; Middle Aged ; Movement Disorders ; etiology ; physiopathology ; Neurosurgical Procedures ; adverse effects ; methods ; Recovery of Function ; Speech Disorders ; etiology ; physiopathology

We report a case of acute comitant esotropia in a child with a cerebellar tumor. A 3-year-old boy was referred for management of a 9 month history of acute acquired comitant esotropia. On first presentation, the patient's angle of esodeviation was 50 prism-diopters (PD) at distance and near fixation without any lateral incomitance. The cycloplegic refraction revealed +0.75 diopters in both eyes. Very mild bilateral papilledema was found on the fundus examination, but the neurological examination did not reveal any other pathological findings. Brain MRI showed a 5 cm mass located in the midline of the cerebellum as well as hydrocephalus. The mass was completely excised and histological examination confirmed the diagnosis of pilocytic astrocytoma. Despite neurosurgery, the patient's strabismus remained unresolved. One year after neurosurgery, both medial rectus muscles were surgically recessed by 6 mm, resulting in esotropia of 8PD at distant and near fixation without restoration of bifoveal fusion at follow-up 2 years after the eye muscle surgery. Therefore, acute onset comitant esotropia in a child can be the first sign of a cerebellar tumor, even without any other neurological signs and symptoms.
Acute Disease ; Astrocytoma/*complications/surgery ; Brain/pathology ; Cerebellar Neoplasms/*complications/diagnosis/surgery ; Child, Preschool ; Esotropia/*etiology/pathology/physiopathology/surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Neurosurgical Procedures ; Oculomotor Muscles/surgery ; Refraction, Ocular ; Time Factors

OBJECTIVETo explore the role of preoperative blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) and diffusion tensor tractography (DTT) to identify the relationship between motor cortical area, pyramidal tracts with brain gliomas in neurosurgical treatment of intraoperative electrical stimulation for gliomas involving motor areas at 3T.

METHODSTwenty-eight patients with brain gliomas involving motor areas were included. They underwent MRI examination, which included conventional T1WI, T2WI, BOLD-fMRI of bilateral hands movement paradigm and diffusion tensor imaging (DTI). The data of BOLD-fMRI and DTI were transferred to the workstation (Leonardo syngo 2003A, Siemens) and analyzed. Activation mapping of hands movement, fractional Anisotropy (FA) Color and three dimensional pyramidal tracts were produced. The relationship between motor cortical area, pyramidal tracts and brain gliomas was demonstrated, which was used to optimize the pre-surgical planning. With guidance of the result of BOLD-fMRI and DTT, all patients received microsurgery under anaesthesia retaining consciousness using intraoperative motor functional brain mapping with the method of direct electrical stimulations. The brain lesions were removed as far as possible in the case of eloquent areas and sub-cortical important white matters preservation. The preoperative and postoperative KPS of all patients were operated to evaluate the state of patients.

RESULTSBOLD-fMRI, DTI were performed successfully in 28 patients. The relationship between the primary motor cortex, premotor area, supplementary motor area, pyramidal tracts and brain gliomas localized by preoperative fMRI and DTI. Under anaesthesia retaining consciousness, the primary motor area was monitored by the method of direct electrical stimulations with the guidance of preoperative BOLD-fMRI. There was good correlation between preoperative fMRI and intraoperative cortical stimulation. Furthermore, the preoperative mappings and DTT could make up for the un-monitored motor areas and pyramidal tracts during operative cortical stimulation. Comparing the preoperative KPS, the postoperative KPS was advanced.

CONCLUSIONSBOLD-fMRI and DTT could non-invasively localize the relationship between brain motor cortex, pyramidal tracts and brain gliomas in vivo to optimize the surgical planning, guide the microsurgery under anaesthesia retaining consciousness using intraoperative motor functional brain mapping with the method of direct electrical stimulations and remove brain tumors as far as possible in the case of eloquent areas and sub-cortical important white matters preservation.

Adult ; Brain Neoplasms ; pathology ; physiopathology ; surgery ; Diffusion Magnetic Resonance Imaging ; methods ; Echo-Planar Imaging ; methods ; Female ; Glioma ; pathology ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Monitoring, Intraoperative ; Neuronavigation ; methods ; Transcutaneous Electric Nerve Stimulation ; methods

INTRODUCTIONResection or even biopsy of an intra-axial mass lesion in close relationship to eloquent cortex carries a major risk of neurological deficit. We review the safety and effectiveness of craniotomy under local anaesthesia and monitored conscious sedation for resection of mass lesions involving eloquent cortex.

MATERIALS AND METHODSWe performed a 3-year retrospective review of patients who underwent awake craniotomy under local anaesthesia at the National Neuroscience Institute, Singapore. All patients had tumours in close proximity to eloquent cortex, including speech areas in the dominant hemisphere as well as primary sensory and motor cortex in either hemisphere. Brain mapping was performed by direct cortical stimulation using the Ojemann stimulator to identify a safe corridor for surgical approach to the tumour. Intraoperative physiological monitoring was carried out by assessment of speech, motor and sensory functions during the process of surgical resection. All resections were evaluated and verified by postoperative imaging and reviewed by an independent assessor. Postoperative complications and neurological deficits, as well as extent of tumour resection, were evaluated.

RESULTSA total of 20 patients underwent stereotactic resection over a period of 3 years from July 2003 to August 2006. There were 7 male patients and 13 female patients, with a mean age of 39.8 years. The average length of stay was 5.5 days. There were no major anaesthetic complications and no perioperative deaths. Postoperative neurological deficits were seen in 6 patients (30%) and this was permanent in only 1 patient (5%). The degree of cytoreduction achieved was greater than 90% in 58% of patients and a further 21% had greater than 80% cytoreduction.

CONCLUSIONTumour surgery with conscious sedation in combination with frameless computer stereotactic guidance is a safe technique that allows maximal resection of lesions in close relationship to eloquent cortex and has a low risk of neurological deficit.

Adolescent ; Adult ; Aged ; Anesthetics, Local ; administration & dosage ; Brain Neoplasms ; surgery ; Cerebral Cortex ; physiopathology ; surgery ; Child ; Conscious Sedation ; Craniotomy ; Female ; Humans ; Male ; Medical Audit ; Middle Aged ; Outcome Assessment (Health Care) ; Perioperative Care ; Retrospective Studies ; Singapore

PURPOSE: Patients with non-small cell lung cancer (NSCLC) and simultaneously having brain metastases at the initial diagnosis, presenting symptoms related brain metastasis, survived shorter duration and showed poor quality of life. We analyzed our experiences on surgical treatment of brain metastasis in patients with NSCLC. MATERIALS AND METHODS: We performed a single-center, retrospective review of 36 patients with NSCLC and synchronous brain metastases between April 2006 and December 2011. Patients were categorized according to the presence of neurological symptoms and having a brain surgery. As a result, 14 patients did not show neurological symptoms and 22 patients presented neurological symptoms. Symptomatic 22 patients were divided into two groups according to undergoing brain surgery (neurosurgery group; n=11, non-neurosurgery group; n=11). We analyzed overall surgery (OS), intracranial progression-free survival (PFS), and quality of life. RESULTS: Survival analysis showed there was no difference between patients with neurosurgery (OS, 12.1 months) and non-neurosurgery (OS, 10.2 months; p=0.550). Likewise for intracranial PFS, there was no significant difference between patients with neurosurgery (PFS, 6.3 months) and non-neurosurgery (PFS, 5.3 months; p=0.666). Reliable neurological one month follow up by the Medical Research Council neurological function evaluation scale were performed in symptomatic 22 patients. The scale improved in eight (73%) patients in the neurosurgery group, but only in three (27%) patients in the non-neurosurgery group (p=0.0495). CONCLUSION: Patients with NSCLC and synchronous brain metastases, presenting neurological symptoms showed no survival benefit from neurosurgical resection, although quality of life was improved due to early control of neurological symptoms.
Adult ; Aged ; Aged, 80 and over ; Brain Neoplasms/physiopathology/*secondary/*surgery ; Carcinoma, Non-Small-Cell Lung/mortality/*pathology ; Demography ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Lung Neoplasms/*pathology ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo compare the relation between the preoperative functional magnetic resonance imaging (fMRI) with blood oxygen level dependent (BOLD) technique and intraoperative motor evoked potential (MEP) monitoring for cortical mapping of primary motor cortex in patients with tumors near the central area. And to determine whether non-invasive preoperative fMRI can provide results equivalent to those achieved with the invasive neurosurgical "gold standard".

METHODSA prospective study of 16 patients with various pathological tumors of the central area was conducted. Preoperative fMRI scans using the BOLD contrast technique in each patient were performed. An activation scan was achieved by using a motor task paradigm, which consisted of simple flexion-extension finger movements and finger-to-thumb touching in a repeating pattern. The anatomical structure was delineated by the T(1)-weighted three-dimensional fast spoiled gradient recalled sequence (3D/FSPGR) immediately afterward. The BOLD images were overlaid on the T(1)-weighted 3D/FSPGR images, and then co-registered to the neuronavigation system. The fMRI activations were documented by using a neuronavigation system in sequence, and compared to standardized intraoperative MEP monitoring, which included direct cortical electrical stimulation (DCES) or transcranial cortical electrical stimulation (TCES) or their combination. The compound muscle action potentials of forearm flexor and hand muscle responses were recorded during either TCES or DCES. Two techniques were compared to determine the accuracy for cortical mapping of primary motor areas with fMRI.

RESULTSOverall, the intraoperative MEP monitoring showed good correlation with fMRI activation in 92.3% of cases. The coincidence rate, however, was 100.0% between TCES and fMRI, and 66.7% between DCES and fMRI respectively. There was no statistically difference between two cortical mapping techniques, chi-square test of paired comparison of enumeration data, P < 0.01.

CONCLUSIONBOLD fMRI was a high sensitive and reliable technique to locate the position of the primary motor areas and their spatial relation with adjacent tumor, especially for the presurgical planning in patients with central area brain tumor.

Adolescent ; Adult ; Brain Neoplasms ; pathology ; physiopathology ; surgery ; Child ; Evoked Potentials, Motor ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Monitoring, Intraoperative ; Motor Cortex ; pathology ; physiology ; Neuronavigation ; Oximetry ; Prospective Studies ; Transcranial Magnetic Stimulation ; methods