Frontal Brain Tumor Research Articles

Detection of epileptiform discharges by patient state index and density spectral array during anesthetic emergence after resection of hemispheric brain tumor. Case report

Background: Processed electroencephalogram (EEGp) plays a crucial role in anesthesia as a quantitative and automated method for assessing anesthetic depth. It utilizes mathematical algorithms to furnish objective measures, offering an intuitive interface for anesthesiologists lacking specialized neurophysiology training. Among the array of visual graphical analyses, the Density Spectral Array (DSA) stands out as particularly promising. DSA furnishes a comprehensive and visual depiction of the patient's brain activity, aiding anesthesiologists in maintaining optimal anesthetic depth during surgical procedures Conclusion: This report underscores the potential of analyzing Case report: A 51-year-old male with a medical history of neurofibromatosis type 2 and a frontal hemispheric brain tumor underwent resection in the operating room under total intravenous anesthesia. Anesthetic depth was monitored utilizing SedLine® Patient Status Index (PSi). The resection proceeded uneventfully; however, upon extubation, EEG processing revealed epileptiform discharges concurrent with tonic-clonic movement of the right hand electroencephalogram waveforms alongside the latest SedLine-derived Density Spectral Array to confirm the presence of partial epileptic seizures during the immediate post-extubation and postoperative phases following brain tumor resection. Employing advanced monitoring techniques like Density Spectral Array aids in early detection of neurological complications, facilitating timely intervention and potentially enhancing patient outcomes during the critical postoperative period.

Changes in frontal aslant tract tractography in selected types of brain tumours.

To present differences in frontal aslant tract (FAT) tractography among patients diagnosed with primary brain tumours and metastatic brain tumours. The analysis included 38 patients diagnosed with a frontal brain tumour. A control group of 30 healthy patients was also considered. The FAT was delineated, taking into account ROI 1 - the superior frontal gyrus, and ROI 2 - SMA. Endpoints were determined on the pars opercularis and pars triangularis of the inferior frontal gyrus. FAT was delineated in four different ways for each patient. In the group of patients with a brain tumour, a lower volume of FAT and a reduced quantity of fibres were observed compared to the control group. Comparison of the examined parameters between patients with glioblastoma and metastasis revealed statistically significant differences for MD (p < 0.001) regardless of the selected projection. The difference in MD (mean diffusivity) among patients with metastatic tumours may be related to an increased oedema zone.

EEG spectral power during REM sleep in patients with frontal brain tumor

BackgroundThe main objective of this research was to analyze the characteristics of electrical activity in the brain during REM (Rapid Eye Movements) sleep, by using an experimental model a pathology that affects the frontal lobes, such as brain tumors. In addition to determining the impact of variables such as the frontal area (dorsolateral, medial and orbital), laterality and size of the lesion; as well as the demographic and clinical characteristics of the patients evaluated.MethodsBy using polysomnographic recordings, 10 patients were evaluated. We obtained power spectra through a homemade program. For quantitative EEG (Electroencephalogram) (qEEG) analysis, the Fast Fourier Transform (FFT) algorithm was used to obtain the spectral power of each participant, channel, and frequency band.ResultsSleep architecture and spectral power was found to be modified in patients compared to normative values. Other sociodemographic and clinical characteristics of the patients were also influenced, such as age range and antiepileptic drugs.ConclusionsBrain tumors in the frontal lobe can modify the rhythmogenesis of REM sleep, possibly due to changes of brain plasticity as an effect of the pathology. In addition to this, through this study we were able to show the association between neuroanatomical and functional changes, on the characteristics of brain electrical activity in patients with frontal brain tumor. Finally, this qEEG analysis technique allows, on the one hand, to deepen the knowledge and relationship between psychophysiological processes and, on the other hand, to be able to guide therapeutic decisions.

Sleep architecture in patients with frontal brain tumor

IntroductionThe aim of the study was to characterize sleep architecture and self-reported sleep questionnaires in patients with frontal brain tumor. MethodsEight patients with frontal brain tumor underwent polysomnographic testing and completed self-report questionnaires on sleep quality, insomnia, drowsiness and risk of obstructive sleep apnea, in addition to depression and anxiety inventories. ResultsPatients with frontal brain tumor exhibited a disruption of the sleep architecture, characterized by changes in the pattern and in the time they spend asleep. It was found that objective values (polysomnographic variables) do not necessarily correspond to the perception of alteration through subjective methods (self-reported questionnaires). ConclusionsChanges in the architecture of sleep in patients with frontal tumors allow us to understand the organization of the brain during this state in the presence of this type of pathology, which causes structural and functional changes.

The connection between frontal lobe brain tumors and lower urinary tract symptoms - Series of 347 patients.

The present study aimed to provide an early insight into the effect of intra-axial frontal lobe tumors on the micturition center and its potential role in producing compression in and around the prefrontal cortex. A total of 149 symptomatic patients were selected for urodynamic testing. The study sample included all patients with intra-axial frontal lobe tumors treated at two locations: the University Medical Center Tuebingen (Germany), and Azad University of Medical Sciences (Iran) between 2017 and 2020. Lower urinary tract symptoms (LUTS) were recorded in patients with frontal lobe compression due to local tumor growth. The symptomatic patients had brain magnetic resonance (MRI) images taken to examine for possible lesions. The treated patients (149 patients with a median age of 55 years) were evaluated using computer urodynamic investigation and voiding diaries. The results of urodynamic testing of 149 symptomatic patients showed detrusor over-activity in 82 (55%) patients, dyssynergia of detrusor-sphincter in 67 (45%) patients, uninhibited sphincter relaxation in 40 (27%) patients, and low-compliance bladder in 21 (14%) patients. There was no significant correlation found between tumor size and urinary symptoms (p = 0.103, Spearman q = 0.826). Frontal intra-axial tumors compressing and infiltrating the prefrontal cortex influence the micturition center and produce lower urinary tract symptoms. The tumors of the right frontal lobe were directly associated with incontinence, which was completely disappeared in 70% of the patients within 2 years.

Simultaneous Bilateral Femoral Neck Fracture Due to a Tonic-Clonic Seizure and High-Dose Steroid Therapy

Simultaneous bilateral femoral neck fractures (FNFs) are extremely rare and usually associated with an underlying condition affecting the bone quality and mineralization. Convulsions have also been described as a possible cause, mostly as a consequence of epilepsy, hyponatremia, and hypocalcemia. We present a 52-year-old female patient, with bilateral displaced FNFs due to a tonic-clonic seizure and high-dose steroid therapy related to a frontal lobe anaplastic oligodendroglioma brain tumor resection. Two days after admission, bilateral one-stage uncemented total hip arthroplasty (THA) under general anesthesia and through a posterolateral approach was performed using a metal-on-polyethylene bearing surface. Several risk factors can be identified in this unique case, such as the high-dose steroid therapy, the low-demand activity of the patient due to her functional sequelae, and finally, the convulsive episode. Surgeons should be aware of this uncommon injury to ensure early diagnosis and treatment in all patients with a previous history of seizures, chronic steroid use, severe hip pain, and inability to walk. For bone metabolic diseases, preventive measures should be indicated to avoid these complications. Bilateral one-stage uncemented THA represents an effective procedure with a low complication rate allowing early rehabilitation.

Direct electrical stimulation of the left frontal aslant tract disrupts sentence planning without affecting articulation

ABSTRACTSentence production involves mapping from deep structures that specify meaning and thematic roles to surface structures that specify the order and sequencing of production ready elements. We propose that the frontal aslant tract is a key pathway for sequencing complex actions with deep hierarchical structure. In the domain of language, and primarily with respect to the left FAT, we refer to this as the ‘Syntagmatic Constraints On Positional Elements’ (SCOPE) hypothesis. One prediction made by the SCOPE hypothesis is that disruption of the frontal aslant tract should disrupt sentence production at grammatical phrase boundaries, with no disruption of articulatory processes. We test this prediction in a patient undergoing direct electrical stimulation mapping of the frontal aslant tract during an awake craniotomy to remove a left frontal brain tumor. We found that stimulation of the left FAT prolonged inter-word durations at the start of grammatical phrases, while inter-word durations internal to noun phrases were unaffected, and there was no effect on intra-word articulatory duration. These results provide initial support for the SCOPE hypothesis, and motivate novel directions for future research to explore the functions of this recently discovered component of the language system.

Pseudodepression as an Anticipatory Symptom of Frontal Lobe Brain Tumors

Frontal brain tumors often cause psychiatric disorders related to the functions of the prefrontal cortex. The prefrontal cortex expresses cognitive functions, which are superior functions concerning personality, conception, planning, ability to manage social relations. The dorsolateral part of the prefrontal cortex, if damaged, causes a depressive symptomatology, consisting of apathy, mood reduction and other symptoms. Kleist defined depression secondary to brain tumors, pseudodepression syndrome. It is a rare condition associated to brain frontal tumors, the depression that occurs first and not vice versa. The reasons are not clear. However, it is important to control depressed patients over the years, they must perform neuroimaging tests, avoiding the late discovery of a brain frontal tumor.

PTEN-LOF AND PI3K GOF– BETWEEN A ROCK AND A HARD PLACE

Introduction Cowden syndrome is a genetically-mediated tumor syndrome caused by PTEN loss-of-function (PTEN-LOF) which results in, a recently recognized, paradoxical gain of function of PI-3-kinase (PI3K GOF) leading to an auto-inflammatory/immunodeficiency syndrome. We report a case manifesting with this syndrome. Case Description A 23-year old female presents to the immunodeficiency clinic for evaluation. She was healthy until age 6, when she developed recurrent uveitis, multiple polyps on EGD/colonoscopy and a deep left frontal para-sagittal brain tumor. At age 14, patient had genetic testing with whole exome sequencing revealing PTEN-LOF. Later, patient developed chronic rhinosinusitis requiring frequent antibiotics and sinus surgeries. Subsequently, patient was diagnosed with medullary carcinoma of thyroid and multiple lipomas. Immune workup revealed poor pneumococcal vaccine response, low CD3+ count, undetectable IgA, low IgG (489), and elevated CRP. IgG supplementation was initiated. Discussion Cowden syndrome is a rare, autosomal dominant disease affecting 1:200,000 individuals characterized by PTEN-LOF that begins with mucocutaneous then thyroid, colon and brain involvement in the form of hamartomas/malignancies. The PI3K pathway of cell growth, proliferation, survival, and metabolism is controlled by PI3K and PTEN, which are positive and negative regulators respectively. PTEN-LOF releases the negative regulation on PI3K/AKT/mTOR activation resulting in immune dysregulation, tumorigenesis, and immunodeficiency via an activated phosphatidylinositol-3-kinase δ syndrome (APDS)- like deficiency with impaired B cell differentiation and function. The patient we present had chronic sinusitis, hypogammaglobinemia, and the characteristic CD4 lymphopenia, and exemplifies the importance of recognizing Cowden syndrome manifesting as an immunodeficiency. Cowden syndrome is a genetically-mediated tumor syndrome caused by PTEN loss-of-function (PTEN-LOF) which results in, a recently recognized, paradoxical gain of function of PI-3-kinase (PI3K GOF) leading to an auto-inflammatory/immunodeficiency syndrome. We report a case manifesting with this syndrome. A 23-year old female presents to the immunodeficiency clinic for evaluation. She was healthy until age 6, when she developed recurrent uveitis, multiple polyps on EGD/colonoscopy and a deep left frontal para-sagittal brain tumor. At age 14, patient had genetic testing with whole exome sequencing revealing PTEN-LOF. Later, patient developed chronic rhinosinusitis requiring frequent antibiotics and sinus surgeries. Subsequently, patient was diagnosed with medullary carcinoma of thyroid and multiple lipomas. Immune workup revealed poor pneumococcal vaccine response, low CD3+ count, undetectable IgA, low IgG (489), and elevated CRP. IgG supplementation was initiated. Cowden syndrome is a rare, autosomal dominant disease affecting 1:200,000 individuals characterized by PTEN-LOF that begins with mucocutaneous then thyroid, colon and brain involvement in the form of hamartomas/malignancies. The PI3K pathway of cell growth, proliferation, survival, and metabolism is controlled by PI3K and PTEN, which are positive and negative regulators respectively. PTEN-LOF releases the negative regulation on PI3K/AKT/mTOR activation resulting in immune dysregulation, tumorigenesis, and immunodeficiency via an activated phosphatidylinositol-3-kinase δ syndrome (APDS)- like deficiency with impaired B cell differentiation and function. The patient we present had chronic sinusitis, hypogammaglobinemia, and the characteristic CD4 lymphopenia, and exemplifies the importance of recognizing Cowden syndrome manifesting as an immunodeficiency.

Early Pseudodepression Anticipating the Appearance of A Frontal Lobe Brain Tumor: Could it Be Considered A Risk Factor? Literature Review and Case Description

Background: Frontal lobe brain tumors often cause psychiatric disorders such as depression, if damage is related to dorsolateral part of the prefrontal cortex.It is more appropriate the term pseudodepression in cases where it is secondary to organic causes, such as in brain tumors. Vice versa, it is a very rare condition in which depressive symptoms anticipate the onset of a brain tumor, as showed by few cases reported in literature. Procedure: We describe a case of pseudodepression syndrome followed 20 years after, by the appearance of a frontal lobe meningioma. Conclusions: There are many hypotheses whereby a depression can anticipate the onset of a brain tumor. According to some authors, depression could be a risk factor for the onset of brain tumors. Hence the need, in a subject suffering from depression, to perform periodic control neuroimaging exams, to detect the possible presence of a brain tumor.

Pseudodepression Anticipating Frontal Brain Tumors: Fault of the Diagnostic Process?

Pseudodepression Anticipating Frontal Brain Tumors: Fault of the Diagnostic Process?

Pharmacokinetics and pharmacodynamics of propofol: changes in patients with frontal brain tumours

BackgroundModels of propofol pharmacokinetics and pharmacodynamics developed in patients without brain pathology are widely used for target-controlled infusion (TCI) during brain tumour excision operations. The goal of this study was to determine if the presence of a frontal brain tumour influences propofol pharmacokinetics and pharmacodynamics and existing PK-PD model performance. MethodsTwenty patients with a frontal brain tumour and 20 control patients received a propofol infusion to achieve an induction–emergence–induction anaesthetic sequence. Propofol plasma concentration was measured every 4 min and at each transition of the conscious state. Bispectral index (BIS) values were continuously recorded. We used non-linear mixed-effects modelling to analyse the effects of the presence of a brain tumour on the pharmacokinetics and pharmacodynamics of propofol. Subsequently we calculated the predictive performance of Marsh, Schnider, and Eleveld models in terms of median prediction error (MdPE) and median absolute prediction error (MdAPE). ResultsPatients with brain tumours showed 40% higher propofol clearance than control patients. Performance of the Schnider model (MdPEpk −20.0%, MdAPEpk 23.4%) and Eleveld volunteer model (MdPEpk −8.58%, MdAPEpk 21.6%) were good. The Marsh model performed less well (MdPEpk −14.3%, MdAPEpk 41.4%), as did the Eleveld patient model (MdPEpk −30.8%, MdAPEpk 32.1%).The first-order rate constant (ke0; 0.108 min−1), the concentration in the effects compartment associated with 50% of the maximum effect (Ce50; 2.77 ml litre−1) and γ (1.49) did not significantly differ between groups. Lower baseline BIS values were found in patients with brain tumours (90 vs 95). ConclusionsBrain tumours might alter the pharmacokinetics of propofol. Caution should be exerted when using propofol TCI in patients with frontal brain tumours due to higher clearance. Trial registry numberNCT01060631.

9. Navigated transcranial magnetic stimulation (nTMS) for preoperative mapping in motor areas tumor surgery: Comparison with functional magnetic resonance imaging (fMRI) and intraoperative direct cortical stimulation

Navigated transcranial magnetic stimulation (nTMS) is a novel technology in the field of neurosurgery for noninvasive delineation of cortical functional topography. Recent studies show that it can detect eloquent cortical areas directly, comparable to intraoperative direct cortical stimulation (DCS). The aim of this study was to evaluate the nTMS in comparison with functional magnetic resonance imaging (fMRI) in the setting of brain tumors involving motor areas. Thirteen consecutive patients affected by frontal lobe brain tumors were enrolled in the study. All patients received an fMRI and nTMS examination preoperatively. Consistency of preoperative mapping with intraoperative DCS was assessed off-line by means of the neuronavigation system: as result, nTMS produced statistically significant higher accuracy scores of the motor area localization than fMRI. Moreover, nTMS has fewer restrictions for preoperative functional mapping than fMRI and requires only a limited level of compliance: so it represents an useful and reliable technique during preoperative planning for surgical decision making in the clinical setting.

Intraoperative monitoring of cerebral oximetry and depth of anaesthesia during neuroanesthesia procedures.

This review reports recent evidence on intraoperative monitoring of cerebral oximetry and depth of anaesthesia during neuroanaesthesia procedures. The clinical benefits of intraoperative monitoring with cerebral oximetry [near infrared spectroscopy (NIRS) and brain tissue oxygenation monitoring (brptiO2)] and depth of anaesthesia with bispectral index (BIS) have recently been studied in surgical (carotid endarterectomy, cerebral arteriovenous malformations resection and brain tumour resections) and neuroradiological vascular procedures. BrptiO2/PaO2 ratio is much more reliable than absolute brptiO2 readings in detecting hypoxia in arteriovenous malformation resections. NIRS can help clinicians monitor those patients receiving endovascular treatment for acute ischaemic stroke and during carotid endarterectomy, but the value of applying cerebral oximetry in patients with cerebral vasospasm needs to be further evaluated. Awake craniotomy demonstrated that because of considerable pharmacokinetic/pharmacodynamic interindividual variation, BIS titration is recommended. Thus, the presence of a frontal brain tumour did not affect ipsilateral BIS values. Recent studies provide interesting evidence of intraoperative monitoring of NIRS, brptiO2 and BIS. The brptiO2/PaO2 ratio is much more reliable than an absolute brptiO2 reading; NIRS helps clinicians to monitor patients who are undergoing endovascular treatment, and BIS guides the titration of anaesthesia during awake craniotomy; its values are not affected by the presence of a frontal brain tumour.

Language system organization in a quadrilingual with a brain tumor: Implications for understanding of the language network

In pre-neurosurgery language mapping it is critical to identify language-specific regions in multilingual speakers. We conducted pre-operative functional magnetic resonance imaging, and intraoperative language mapping in the unique case of a highly proficient quadrilingual with a left frontal brain tumor who acquired her second language at age 5, and her third and fourth languages at 15. We found a predominantly different organization in each language with only a few areas shared by all 4 languages. Contrary to existing evidence, impairment across languages was not related to age of acquisition, amount of exposure, or language similarity. This case suggests that the functional structure of the language system may be highly idiosyncratic in multilingual individuals and supports detailed study in this group to inform neurocognitive models of language.

When does a strategy intervention overcome a failure of inhibition? Evidence from two left frontal brain tumour cases

IntroductionInitiation and inhibition of responses are crucial for appropriate behaviour across different settings. Initiation and inhibition difficulties are well documented following frontal damage, although task differences have limited our understanding. The Hayling Sentence Completion Test was designed to assess verbal initiation and inhibition within the same task. This study investigates the ability of two patients with left frontal tumours (KI: high grade glioma; PM: meningioma) to use a strategy to overcome profound suppression failures on the Hayling Test. MethodKI and PM completed the Hayling Test and two experimental tasks. The Selection Investigation assessed verbal initiation on a sentence completion task that varied selection demands (high/low). The Suppression and Strategy Investigation assessed ability to implement four strategies aimed to override a suppression failure and facilitate production of an unconnected word. ResultsOn the Hayling Test, KI and PM initiated responses to complete high constraint sentences, in contrast to impaired suppression. KI benefitted minimally from strategies to overcome suppression failure although one strategy (object naming) was partially successful. KI's errors revealed fast suppression errors, in contrast to slow no responses, and selection ability was also impaired for verbal initiation. PM, however, implemented each strategy 100% to overcome a suppression failure and had no difficulty completing sentences meaningfully, regardless of selection demands. ConclusionThis first investigation of strategy implementation to overcome profound suppression impairments provides insights into verbal initiation, inhibition, selection and strategy mechanisms, which has implications for neurorehabilitation. Specifically, both patients had profound inhibition deficits but KI also presented with a selection deficit and was unable to implement a strategy. By contrast, PM's selection ability was intact but she was unable to generate, rather than implement, a strategy. We suggest that KI has both fast, uncontrolled semantic output and response inhibition difficulty, whereas PM's difficulty is underpinned by motivational factors.

Cognitive Function in Patients Before and After Micro-neurosurgical Resection of Frontal Brain Tumors

Patients with lesions of the prefrontal cortex as a result of frontal brain tumors (intra- and extra-axial) can show impairments of executive functions 1 2 3 4. Although there are a large number of psychological tests, the detection of impairments of relevant everyday executive functions in these patients is still extremely difficult. In 30 patients with lesions of the prefrontal cortex, the executive functions were tested with the Behavioral Assessment of Dysexecutive Syndrome (BADS) and 21 patients were also followed up postoperatively. Additionally, if possible, the Wisconsin Card Sorting Test (WCST), a widely used executive function test, and the Wechsler Adult Intelligence Scale (WAIS) for general cognitive performance were conducted. Pre- and postoperatively, a total of 16 patients were followed up with all three tests. The aim was to investigate the neuropsychological assessment pre- and postoperatively, to evaluate it in terms of deficits and changes in performance and to ensure that no new relevant everyday cognitive deficits arose. Preoperatively, only one patient, who could not be tested post-surgery, showed a reduced overall profile value in the BADS. In all tested patients, there was no evidence of deterioration of cognitive status 8 - 12 weeks postoperatively. Further investigations using fMRI should be used to clarify whether the results obtained should be interpreted as neuroplastic adaptations of prefrontal cognitive functions or as a failure to detect deficits due to a lack of sensitivity of the tests used.

Repeated intracerebral hemorrhage as a presentation of pulmonary giant cell carcinoma with brain metastases

Pulmonary giant cell cancer is a malignant, aggressive, and rare neoplasm. It has the tendency to bleed in the brain. We present a patient with progressive impairment of short-term memory and apathy. Multiple hemorrhagic metastatic tumors in both cerebral hemispheres were found on image examination. Chest computed tomography (CT) showed suspected bronchogenic carcinoma. The left frontal brain tumor was removed, and pulmonary giant cell cancer was proved by pathology. Unfortunately, intracerebral hemorrhages in different locations were found to increase in the following brain computed tomography. A second and a third brain tumor excision were performed. Pathology showed the same metastatic giant cell carcinoma. The clinical course rapidly deteriorated, and the patient's survival duration was about 11 months. This rare case provides us a unique clinical behavior of bleeding tendency, rapid growth, and aggressive characters of this metastatic pulmonary giant cell cancer.

Bispectral index values and propofol concentrations at loss and return of consciousness in patients with frontal brain tumours and control patients

BackgroundThe influence of frontal brain tumours on bispectral index (BIS) measurements and propofol requirements is unknown. The primary aim of our study was to determine whether BIS values recorded at loss and return of consciousness (LOC and ROC, respectively) differ between patients with unilateral frontal brain tumours and control patients. Secondary goals were to compare propofol requirements for LOC and to determine whether there were significant inter-hemispheric differences between BIS values in tumour and control patients. MethodsWe enrolled 20 patients with a frontal brain tumour and 20 control patients. Bilateral BIS measurements were done during induction of propofol anaesthesia, during recovery of consciousness, and during a second induction of anaesthesia. The isolated-forearm test was used to determine the moments of LOC1, ROC, and LOC2. Arterial blood samples were obtained every 4 min for determination of measured propofol concentrations. ResultsThe median BIS values recorded at LOC1, ROC, and LOC2 did not differ between the groups. There were no significant inter-hemispheric differences in BIS in tumour and control patients. The median [inter-quartile range (IQR)] total propofol doses at LOC1 were 82 (75–92) and 78 (68–91) mg in tumour and control patients, respectively. The median (IQR) measured plasma propofol concentrations at LOC1 were 12 (9–14) and 13 (11–15) µg ml−1 in the tumour and control groups, respectively. ConclusionsThe presence of a frontal brain tumour did not affect ipsilateral BIS values, and so need not influence the placement of unilateral BIS electrodes if BIS monitoring is used to titrate propofol anaesthesia.

Is the representation about social groups distinct from that of other concepts? A neuropsychological study

Is the representation about social groups distinct from that of other concepts? A neuropsychological study