Abstract:
OBJECT:Early and aggressive resection of low-grade gliomas (LGGs) leads to increased overall patient survival, decreased malignant progression, and better seizure control. This case series describes the authors' approach to achieving optimal neurological and surgical outcomes in patients referred by outside neurosurgeons for stereotactic biopsy of tumors believed to be complex or a high surgical risk, due to their diffuse nature on neuroimaging and their obvious infiltration of functional cortex. METHODS:Seven patients underwent individualized neuroimaging evaluation preoperatively, which included routine brain MRI with and without contrast administration for intraoperative neuronavigation, functional MRI with speech and motor mapping, diffusion tensor imaging to delineate white matter tracts, and MR perfusion to identify potential foci of higher grade malignancy within the tumor. Awake craniotomy with intraoperative motor and speech mapping was performed in all patients. Tumor removal was initiated through a transsylvian approach for insular lesions, and through multiple corticotomies in stimulation-confirmed noneloquent areas for all other lesions. Resection was continued until neuronavigation indicated normal brain, cortical or subcortical stimulation revealed functional cortex, or the patient began to experience a minor neurological deficit on intraoperative testing. RESULTS:Gross-total resection was achieved in 1 patient and subtotal resection (> 80%) in 6 patients, as assessed by postoperative MRI. Over the average follow-up duration of 31 months, no patient experienced a progression or recurrence. Long-term seizure control was excellent in 6 patients who achieved Engel Class I outcomes. Neurologically, all 7 patients experienced mild temporary deficits or seizures that completely resolved, and 1 patient continues to have mild expressive aphasia. CONCLUSIONS:Significant resection of diffuse, infiltrating LGGs is possible, even in presumed eloquent cortex. Aggressive resection maximizes seizure control and does not necessarily cause permanent neurological deficits. Individualized preoperative neuroimaging evaluation, including tractography and awake craniotomy with intraoperative speech and motor mapping, is an essential tool in achieving these outcomes.
journal_name
Neurosurg Focusjournal_title
Neurosurgical focusauthors
Wilden JA,Voorhies J,Mosier KM,O'Neill DP,Cohen-Gadol AAdoi
10.3171/2012.12.FOCUS12338subject
Has Abstractpub_date
2013-02-01 00:00:00pages
E5issue
2issn
1092-0684journal_volume
34pub_type
杂志文章abstract::Cerebral venous sinus thrombosis (CVST) is characterized by formation of widespread thrombus within the cerebral venous sinus system. CVST can cause venous hypertension, venous infarcts, hemorrhage and seizures. It is managed in most cases with systemic anticoagulation through the use of heparin to resolve the thrombu...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2014.V2.FOCUS14186
更新日期:2014-07-01 00:00:00
abstract::Genetic alterations in the cells of intradural spinal tumors can have a significant impact on the treatment options, counseling, and prognosis for patients. Although surgery is the primary therapy for most intradural tumors, radiochemothera-peutic modalities and targeted interventions play an ever-evolving role in tre...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2015.5.FOCUS15143
更新日期:2015-08-01 00:00:00
abstract::A historical review is presented of the original descriptions of lumbar discectomy, focusing on the evolution toward a less invasive surgical approach following the introduction of the operating microscope. From the initial work in Europe by Yasargil and Caspar to the popularization of microdiscectomy by Williams and ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2002.13.2.4
更新日期:2002-08-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2005.19.5.7
更新日期:2005-11-15 00:00:00
abstract:OBJECTIVE:Cavernoma-related epilepsy (CRE) is a frequent symptom in patients with cerebral cavernous malformations (CCMs). Reports on surgical management and seizure outcome of epileptogenic CCM often focus on intracranial cavernoma in general. Therefore, data on CCMs within the temporal lobe are scarce. The authors th...
journal_title:Neurosurgical focus
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doi:10.3171/2020.1.FOCUS19920
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journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章,评审
doi:10.3171/foc.2005.19.6.4
更新日期:2005-12-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2005.19.5.11
更新日期:2005-11-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/FOC.2009.26.2.E8
更新日期:2009-02-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.6.FOCUS20315
更新日期:2020-09-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2003.15.5.13
更新日期:2003-11-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2017.3.FOCUS16534
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journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章
doi:
更新日期:2004-01-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2011.8.FOCUS11132
更新日期:2011-10-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2007.22.5.13
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.1999.7.4.2
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2010.12.FOCUS10277
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/FOC.2008.25.11.E10
更新日期:2008-01-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2004.17.4.4
更新日期:2004-10-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/FOC-07/08/E1
更新日期:2007-01-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2019.4.FOCUS19145
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2012.8.FOCUS12255
更新日期:2012-11-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2018.7.FOCUS18270
更新日期:2018-10-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2009.9.FOCUS09191
更新日期:2009-12-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2015.2.FOCUS14784
更新日期:2015-04-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章
doi:10.3171/2012.6.FOCUS12131
更新日期:2012-08-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2006.20.1.11
更新日期:2006-01-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.11.FOCUS20783
更新日期:2021-01-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2014.9.FOCUS14521
更新日期:2014-12-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2002.12.4.2
更新日期:2002-04-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章
doi:10.3171/foc.2007.22.6.2
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