gms | German Medical Science

59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

Higher-order functions: Brain mapping during tumor surgery in awake patients

Meeting Abstract

  • corresponding author C. Brogna - Department of Neuroscience, Neurosurgery, SAPIENZA, University of Rome, Italy
  • A. Battaglia-Mayer - Department of Physiology and Pharmacology, SAPIENZA, University of Rome, Italy
  • M. Salvati - Department of Neuroscience, Neurosurgery, SAPIENZA, University of Rome, Italy
  • M. Rojas - Radiology DEA Department, SAPIENZA, University of Rome, Italy
  • A. D’Elia - Department of Neuroscience, Neurosurgery, SAPIENZA, University of Rome, Italy
  • G. Melone - Department of Neuroscience, Neurosurgery, SAPIENZA, University of Rome, Italy
  • S. Iaconelli - Department of Physiology and Pharmacology, SAPIENZA, University of Rome, Italy
  • F. Doricchi - Department of Psychology, SAPIENZA, University of Rome, Italy
  • G. Gualdi - Radiology DEA Department, SAPIENZA, University of Rome, Italy
  • R. Caminiti - Department of Physiology and Pharmacology, SAPIENZA, University of Rome, Italy
  • R. Delfini - Department of Neuroscience, Neurosurgery, SAPIENZA, University of Rome, Italy

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP 093

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc361.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Brogna et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Functional brain mapping during surgery in awake patients minimizes the consequences of tumour removal on behaviour. Beyond the identification of the so-called “motor strip”, mapping should also identify association areas, that represent the largest part of the cerebral cortex. Lesions in these regions and in their subcortical systems do not determine obvious neurological defects, but complex disorders that severely affect daily life.

Methods: We have implemented a number of neuropsychological tests to asses the patients’ cognitive functions, preoperatively, during surgery, and postoperatively. Testing is tailored to brain region which is target of surgery, based on knowledge of its role on behaviour, as it emerges from neuroanatomical and neurophysiolocal studies in non-human primates, as well as from neuropsychological studies. Testing cognitive function during surgery in awake patients requires the presentation of a battery of tests and the assessment of patients’ behaviour after inactivation of the brain tissue that is around or even inside a tumour lesion.

Results: We have used this approach on two subjects suffering from high-grade gliomas, the first localized in the right Superior Parietal Lobule (BA 5/7), the second in the posterior part of the left Superior Frontal Gyrus (BA 6). Both patients were tested for Optic Ataxia (OA) and Hemispatial Neglect, and in several visuomotor tasks requiring coordinated eye-hand movement. Preoperatively, in the parietal patient we only found a severe OA when he reached to peripheral visual target with the left hand. During surgery, the inactivation of a region located posterior to the tumoral mass resulted in misreaching also with the right hand, and this was a clear indication for sparing this region. After surgery, a mild OA persisted with the left arm. In the frontal patient no obvious impairment was found under all testing condition. The main defect observed consisted in arrest of language production in a reading task, after inactivation of a medial fibres bundle underlying the Supplementary Motor Area.

Conclusions: The consequences of surgery on patients’ behaviour will strongly depend on the depth of neuropsychological assessment at all stages of treatment. The relatively “slow” growth of tumours, as compared to stroke, might favour reorganization of cortical function, due to brain plasticity, and makes preoperative cognitive disorders often elusive and difficult to detect on qualitative grounds.