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01-11-2021 | Glioma | Case Report - Brain Tumors

Language recovery through a two-stage awake surgery in an aphasic patient with a voluminous left fronto-temporo-insular glioma: case report

Authors: Elisa Louppe, Sylvie Moritz-Gasser, Hugues Duffau

Published in: Acta Neurochirurgica | Issue 11/2021

Abstract

Awake surgery is difficult in glioma patients with preoperative aphasia. A 29-year-old right-handed bilingual (Spanish/English) patient experienced intractable seizures with severe language disorders due to a voluminous left fronto-temporo-insular tumor. We performed awake procedure with initial laborious language mapping, but with real-time improvement throughout the debulking, allowing preservation of the connectivity. A substantial residue was left. Postoperative cognitive rehabilitation resulted in a dramatic functional improvement, in both languages, permitting a complementary awake surgery, this time with a perfect collaboration of the patient. This multistep strategy enabled 92% of resection while enhancing quality of life with language recovery and epilepsy control.

Almairac F, Herbet G, Moritz-Gasser S, de Champfleur NM, Duffau H (2015) The left inferior fronto-occipital fasciculus subserves language semantics: a multilevel lesion study. Brain Struct Funct 220(4):1983–1995CrossRef

Azad TD, Duffau H (2020) Limitations of functional neuroimaging for patient selection and surgical planning in glioma surgery. Neurosurg Focus 48(2):E12CrossRef

Bu LH, Zhang J, Lu JF, Wu JS (2020) Glioma surgery with awake language mapping versus generalized anesthesia: a systematic review. Neurosurg Rev. https://doi.org/10.1007/s10143-020-01418-9

Darlix A, Rigau V, Fraisse J, Gozé C, Fabbro M, Duffau H (2020) Postoperative follow-up for selected diffuse low-grade gliomas with WHO grade III/IV foci. Neurology 94(8):e830–e841CrossRef

Duffau H (2013) The reliability of asleep-awake-asleep protocol for intraoperative functional mapping and cognitive monitoring in glioma surgery. Acta Neurochir (Wien) 155(10):1803–1804CrossRef

Duffau H (2015) Stimulation mapping of white matter tracts to study brain functional connectivity. Nat Rev Neurol 11(5):255–265CrossRef

Duffau Hu (2020) Why brain radiation therapy should take account of the individual structural and functional connectivity: toward an irradiation “à la carte.” Crit Rev Oncol Hematol 154:103073CrossRef

Duffau H (2021) New philosophy, clinical pearls and methods for intraoperative cognition mapping and monitoring “à la carte” in brain tumor patients. Neurosurgery 88(5):919–930CrossRef

Duffau H, Gatignol P, Mandonnet E, Capelle L, Taillandier L (2008) Intraoperative subcortical stimulation mapping of language pathways in a consecutive series of 115 patients with Grade II glioma in the left dominant hemisphere. J Neurosurg 109(3):461–471CrossRef

10.

Duffau H, Gatignol P, Mandonnet E, Peruzzi P, Tzourio-Mazoyer N, Capelle L (2005) New insights into the anatomo-functional connectivity of the semantic system: a study using cortico-subcortical electrostimulations. Brain 128:797–810CrossRef

11.

Ferracci FX, Duffau H (2018) Improving surgical outcome for gliomas with intraoperative mapping. Expert Rev Neurother 18(4):333–341CrossRef

12.

Gogos AJ, Young JS, Morshed RA, Hervey-Jumper SL, Berger MS (2020) Awake glioma surgery: technical evolution and nuances. J Neurooncol 147(3):515–524CrossRef

13.

Herbet G, Duffau H (2019) Awake craniotomy and bedside cognitive mapping in neurosurgery. In: Pearson CM, Ecklund-Johnson E, Gale SD (eds) Neurosurgical Neuropsychology. Academic Press, Chennai, pp 113–138CrossRef

14.

Herbet G, Duffau H (2020) Revisiting the functional anatomy of the human brain: toward a meta-networking theory of cerebral functions. Physiol Rev 100(3):1181–1228CrossRef

15.

Herbet G, Maheu M, Costi E, Lafargue G, Duffau H (2016) Mapping neuroplastic potential in brain-damaged patients. Brain 139:829–844CrossRef

16.

Ius T, Angelini E, Thiebaut de Schotten M, Mandonnet E, Duffau H (2011) Evidence for potentials and limitations of brain plasticity using an atlas of functional resectability of WHO grade II gliomas: towards a “minimal common brain.” Neuroimage 56:992–1000CrossRef

17.

Khan OH, Herbet G, Moritz-Gasser S, Duffau H (2014) The role of left inferior fronto-occipital fascicle in verbal perseveration: a brain electrostimulation mapping study. Brain Topogr 27(3):403–411CrossRef

18.

Metz-Lutz MN, Kremin H, Deloche G (1991) Standardisation d’un test de dénomination orale: contrôle des effets de l’âge, du sexe et du niveau de scolarité chez les sujets adultes normaux. Rev Neuropsychol 1:73–95

19.

Moritz-Gasser S, Duffau H (2009) Cognitive processes and neural basis of language switching: proposal of a new model. NeuroReport 20(18):1577–1580CrossRef

20.

Pujol S, Wells W, Pierpaoli C et al (2015) The DTI challenge: toward standardized evaluation of diffusion tensor imaging tractography for neurosurgery: the DTI challenge on tractography for neurosurgery. J Neuroimaging 25(6):875–882CrossRef

21.

Sellier A, Moritz-Gasser S, Lemaitre A-L, Herbet G, Duffau H (2020) Presence of a translator in the operating theater for awake mapping in foreign patients with low-grade glioma: a surgical experience based on 18 different native languages. J Neurosurg 1–9. https://doi.org/10.3171/2020.6.JNS201071

Title: Language recovery through a two-stage awake surgery in an aphasic patient with a voluminous left fronto-temporo-insular glioma: case report
Authors: Elisa Louppe
Sylvie Moritz-Gasser
Hugues Duffau
Publication date: 01-11-2021
Publisher: Springer Vienna
Keywords: Glioma
Glioma
Epilepsy
Glioma
Aphasia
Published in: Acta Neurochirurgica / Issue 11/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-021-04932-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Language recovery through a two-stage awake surgery in an aphasic patient with a voluminous left fronto-temporo-insular glioma: case report

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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