Main clinical findings and their frequency in cortical-subcortical areas tested in awake brain mapping for diffuse low-grade glioma

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-05-02 DOI:10.1016/j.jocn.2025.111290

Lucas Alverne F. Albuquerque , Leonardo José Monteiro de Macêdo Filho , Cicera Jairlly Veras Rocha , Gabryella S. Diógenes , Fátima C. Pessoa , Felipe Silva Borges , João Paulo Almeida , Andrei F. Joaquim

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引用次数: 0

Abstract

Background

The main objective of awake surgery for brain gliomas is to achieve maximum tumor removal while safeguarding cognitive functions. This approach offers a unique chance to gain deeper insights into brain function. This study aims to detail the clinical findings and their relationship, frequency and probability of occurring in cortical and subcortical anatomical structures at both hemispheres.

Methods

This series represents our initial series of 51 consecutive diffuse low-grade gliomas (DLGG) treated with awake surgery.

Results

The surgeries were evenly distributed between the left hemisphere (LH, n = 26 − all right-handed) and the right hemisphere (RH, n = 25 − one left-handed and one ambidextrous). In the LH, the main clinical findings during cortical mapping were positive motor responses (51 times; 33.3 % of clinical findings), followed by speech arrest (26; 16.9 %) and semantic paraphasia (19; 12.4 %). For LH subcortical responses: semantic paraphasia (36; 36.7 %), anomia (16; 16.3 %) and speech perseveration (13; 13.2 %). In the RH the main clinical findings during cortical mapping were positive motor responses (46; 38 % of clinical findings), negative motor responses (21; 17.3 %) and speech arrest (18; 14.8 %). For RH subcortical responses: negative motor responses (9; 21.9 %), positive motor responses (7; 17 %), and semantic paraphasia (5; 11.1 %).

The cortical anatomical structures with the highest average functional findings per exposure were the precentral gyrus (average of 2.1 findings per evaluation), vPMC (ventral premotor cortex) (1.5) and postcentral gyrus (1.2); and in the subcortical area: IFOF (Inferior Fronto-Occipital Fasciculus) (1.2), corticospinal tract (1.0) and somatic sensory fibers (1.0).

Conclusion

The clinical findings in each hemisphere are extremely important information for all neuro-oncological approaches. We highlight the brain regions most likely to have intraoperative findings. We emphasize the importance of functional findings in the RH, which, in addition to motor function, sensitivity, eye movement, visual alteration, social cognition, spatial awareness, and attention, also includes significant language findings.

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弥漫性低级别胶质瘤的主要临床表现及其在清醒脑测图中皮层-皮层下区域的频率

脑胶质瘤清醒手术的主要目的是在保证认知功能的同时最大限度地切除肿瘤。这种方法为深入了解大脑功能提供了一个独特的机会。本研究的目的是详细的临床表现和他们的关系，频率和概率发生在皮层和皮层下解剖结构的两个半球。方法本研究为51例连续经清醒手术治疗的弥漫性低级别胶质瘤（DLGG）的初步研究。结果手术均匀分布于左半球（LH, n = 26）和右半球（RH, n = 25），分别为1例左手和1例双右手。在LH中，主要临床表现为运动反应阳性(51次；33.3%的临床表现)，其次是言语停止(26；16.9%)和语义错乱(19；12.4%)。LH皮质下反应：语意性失配(36；36.7%)，精神失常(16；16.3%)和言语坚持(13；13.2%)。RH的主要临床表现为阳性运动反应(46；38%的临床表现)，负运动反应(21；17.3%)和言语阻滞(18%；14.8%)。RH皮质下反应：负运动反应(9；21.9%)，积极的运动反应(7%；17%)，以及语意错乱(5；11.1%)。每次暴露平均功能发现最高的皮质解剖结构是中央前回（每次评估平均2.1个发现）、vPMC（腹侧运动前皮层）（1.5个）和中央后回（1.2个）；皮层下区：IFOF（额枕下束）（1.2），皮质脊髓束（1.0）和躯体感觉纤维（1.0）。结论各半球的临床表现对所有神经肿瘤学途径都是极其重要的信息。我们强调最有可能出现术中发现的大脑区域。我们强调左脑功能发现的重要性，除了运动功能、敏感性、眼球运动、视觉改变、社会认知、空间意识和注意力外，还包括重要的语言发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.