Left Frontal Glioma Research Articles

Shared and malignancy-specific functional plasticity of dynamic brain properties for patients with left frontal glioma.

The time-varying brain activity may parallel the disease progression of cerebral glioma. Assessment of brain dynamics would better characterize the pathological profile of glioma and the relevant functional remodeling. This study aims to investigate the dynamic properties of functional networks based on sliding-window approach for patients with left frontal glioma. The generalized functional plasticity due to glioma was characterized by reduced dynamic amplitude of low-frequency fluctuation of somatosensory networks, reduced dynamic functional connectivity between homotopic regions mainly involving dorsal attention network and subcortical nuclei, and enhanced subcortical dynamic functional connectivity. Malignancy-specific functional remodeling featured a chaotic modification of dynamic amplitude of low-frequency fluctuation and dynamic functional connectivity for low-grade gliomas, and attenuated dynamic functional connectivity of the intrahemispheric cortico-subcortical connections and reduced dynamic amplitude of low-frequency fluctuation of the bilateral caudate for high-grade gliomas. Network dynamic activity was clustered into four distinct configuration states. The occurrence and dwell time of the weakly connected state were reduced in patients' brains. Support vector machine model combined with predictive dynamic features achieved an averaged accuracy of 87.9% in distinguishing low- and high-grade gliomas. In conclusion, dynamic network properties are highly predictive of the malignant grade of gliomas, thus could serve as new biomarkers for disease characterization.

Correlation between brain functional connectivity and neurocognitive function in patients with left frontal glioma

The association between neurocognitive function (NCF) impairment and brain cortical functional connectivity in glioma patients remains unclear. The correlations between brain oscillatory activity or functional connectivity and NCF measured by the Wechsler Adult Intelligence Scale full-scale intelligence quotient scores (WAIS FSIQ), the Wechsler Memory Scale-revised general memory scores (WMS-R GM), and the Western aphasia battery aphasia quotient scores (WAB AQ) were evaluated in 18 patients with left frontal glioma using resting-state electroencephalography (EEG). Current source density (CSD) and lagged phase synchronization (LPS) were analyzed using exact low-resolution electromagnetic tomography (eLORETA). Although 2 and 2 patients scored in the borderline range of WAIS FSIQ and WMS-R GM, respectively, the mean WAIS FSIQ, WMS-R GM, and WAB AQ values of all patients were within normal limits, and none had aphasia. In the correlation analysis, lower WMS-R GM was associated with a higher LPS value between the right anterior prefrontal cortex and the left superior parietal lobule in the beta1 band (13–20 Hz, R = − 0.802, P = 0.012). These findings suggest that LPS evaluated by scalp EEG is associated with memory function in patients with left frontal glioma and mild NCF disorders.

Cover Image

COVER ILLUSTRATION The image shows a left frontal glioma (brown) with cortical language areas identified via navigated transcranial magnetic stimulation (nTMS) (purple) non-invasively. Language-involved subcortical fiber tracts, such as the superior longitudinal fascicle I-III, uncinate fascle, inferior frontooccipital fascicle and corticobulbar fibers were visualized via function-based diffusion tensor imaging. This is perfomed by using the purple cortical nTMS areas as seed regions to assign function to white matter tracts.

Rapid Intra-operative Diagnosis of CNS Lymphoma on Squash & Imprint Smears – A Boon for the Surgeon: Case Report

Primary CNS Lymphoma [PCNL] accounts for 3% of all brain tumors. Diagnosing PCNL on squash and imprint cytology is a challenge for the pathologist but a boon for the operating surgeon as the knowledge of the nature of the lesion determines the nature of surgery. We report a case of 59 years old immunocompetent male who presented with right hemiparesis and headache. MRI Brain was suggestive of Left frontal Glioma. Intra-operatively, squash cytology and imprint smears of tissue from the lesion showed scattered lymphoid cells which also exhibited perivascular cuffing. Cytology was suggestive of lymphoma with differential of an inflammatory pathology. Histopathological examination and positivity for LCA, CD 20, Bcl 2 and Mum 1 on IHC confirmed the diagnosis of Diffuse Large B Cell Lymphoma-Brain. It is important to distinguish lymphoma from glioma or metastasis in CNS because of totally different lines of management. Knowledge of empirical diagnosis during surgery can guide the surgeon to ensure that adequate tissue is excised so that sample for immunophenotyping or further tests is available.

Differential Effects of a Left Frontal Glioma on the Cortical Thickness and Complexity of Both Hemispheres.

Glioma is a type of brain tumor that infiltrates and compresses the brain as it grows. Focal gliomas affect functional connectivity both in the local region of the lesion and the global network of the brain. Any anatomical changes associated with a glioma should thus be clarified. We examined the cortical structures of 15 patients with a glioma in the left lateral frontal cortex and compared them with those of 15 healthy controls by surface-based morphometry. Two regional parameters were measured with 3D-MRI: the cortical thickness (CT) and cortical fractal dimension (FD). The FD serves as an index of the topological complexity of a local cortical surface. Our comparative analyses of these parameters revealed that the left frontal gliomas had global effects on the cortical structures of both hemispheres. The structural changes in the right hemisphere were mainly characterized by a decrease in CT and mild concomitant decrease in FD, whereas those in the peripheral regions of the glioma (left hemisphere) were mainly characterized by a decrease in FD with relative preservation of CT. These differences were found irrespective of tumor volume, location, or grade. These results elucidate the structural effects of gliomas, which extend to the distant contralateral regions.

A case of left frontal high-grade glioma diagnosed during pregnancy

BackgroundAs pregnancy accelerates glioma growth, therapeutic abortion has been recommended prior to tumor resection. Additionally, it has also been suggested that the extent of glioma resection is closely correlated with patient survival.Case presentationA 162-cm, 61.4-kg, 30-year-old, right-handed primigravida was referred to our institution at 21 weeks gestation to obtain a second opinion. At 18 weeks gestation, the patient developed new-onset generalized convulsive seizures (GCSs), which were poorly controlled by anticonvulsant polytherapy, early in the second trimester. A 6-cm lesion located in her left frontal supplementary motor area (SMA) was suspected as a grade III glioma, classified according to the World Health Organization (WHO) guidelines. Due to the limited evidence on the use of adjuvant therapy during pregnancy, tumors causing neurological symptoms and seizures must be treated, in order to stabilize the maternal condition and enable a safe birth. In the case of pregnant patients, awake craniotomy using intraoperative magnetic resonance imaging (iMRI) is considered advantageous, achieving gross total resection with a reduction of direct cortical stimulation, which may induce seizure, and so reducing fetal exposure to anesthetics. The “Asleep-Awake-Asleep” technique was performed at 27 weeks and 2 days gestation. As use of propofol in pregnant patients is prohibited, general anesthesia was maintained through administration of sevoflurane and remifentanil until the first scan of iMRI, and was subsequently re-induced with dexmedetomidine when tumor removal had been accomplished. A supraglottic airway (SGA) was used until the patient’s cranium was opened. There were no complications during either the procedure or the post-operative period. At 35 weeks gestation, the patient delivered a healthy baby of 2317 g. Pathological examination of the patient, revealed an anaplastic astrocytoma, thus radiotherapy and chemotherapy began 2 months post-delivery. There is no evidence of tumor recurrence in the patient and the child did not show any medical or developmental concerns at the point of the 17-month follow-up.ConclusionsSince evidence on the use of adjuvant therapy during pregnancy is limited, extensive resection with functional monitoring is recommended if a brain tumor is presumed to be malignant. Awake craniotomy is considered advantageous to pregnant patients because subjective movement preserves the patient’s motor function and reduces fetal exposure to anesthetics. Therefore, providing multidisciplinary discussion takes place within the decision-making process, as well as careful perioperative preparation, awake craniotomy should be considered, even in the case of pregnant patients.

Rare case of Coexisting Meningioma and Glioma in Same Patient: A Case Report

Coexsiting different pathology brain neoplasm are quite rare in neurosurgery. However occasionally we come across such cases. This case is a female presenting with seizures and headache. Imaging revealed falcine meningioma and left frontal glioma. Single surgery for both lesions was unique and later histopathology confirmed the lesions. Postoperative period was uneventful. Patient was referred to radiotherapy for glioma. Patient is being followed up in OPD and is doing well.

Awake Craniotomy and Intraoperative MRI for Maximal Safe Resection in a Case of an Extensive Left Frontal and Insular Low-grade Glioma: 3-Dimensional Operative Video.

Awake Craniotomy and Intraoperative MRI for Maximal Safe Resection in a Case of an Extensive Left Frontal and Insular Low-grade Glioma: 3-Dimensional Operative Video.

Left frontal glioma induces functional connectivity changes in syntax-related networks.

BackgroundA glioma leads to a global loss of functional connectivity among multiple regions. However, the relationships between performance/activation changes and functional connectivity remain unclear. Our previous studies (Brain 137:1193–1212; Brain Lang 110:71–80) have shown that a glioma in the left lateral premotor cortex or the opercular/triangular parts of the left inferior frontal gyrus causes agrammatic comprehension accompanied by abnormal activations in 14 syntax-related regions. We have also confirmed that a glioma in the other left frontal regions does not affect task performances and activation patterns.ResultsBy a partial correlation method for the time-series functional magnetic resonance imaging data, we analyzed the functional connectivity in 21 patients with a left frontal glioma. We observed that almost all of the functional connectivity exhibited chaotic changes in the agrammatic patients. In contrast, some functional connectivity was preserved in an orderly manner in the patients who showed normal performances and activation patterns. More specifically, these latter patients showed normal connectivity between the left fronto-parietal regions, as well as normal connectivity between the left triangular and orbital parts of the left inferior frontal gyrus.ConclusionsOur results indicate that these pathways are most crucial among the syntax-related networks. Both data from the activation patterns and functional connectivity, which are different in temporal domains, should thus be combined to assess any behavioral deficits associated with brain abnormalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-1104-6) contains supplementary material, which is available to authorized users.

Three neural networks that support syntactic processing in language

Elucidation of language disorders is one of the fundamental issues in clinical neuroscience. We used magnetic resonance imaging and a syntactic task in Japanese to examine the behavior and brain structures of patients with a left frontal glioma. We successfully showed that they had different types of language disorders (particularly agrammatic comprehension) dependent on the location of the glioma. Moreover, we describe three neural networks that support syntactic processing, including an extensive network within the cerebellum and both hemispheres of the brain.

Differential reorganization of three syntax-related networks induced by a left frontal glioma

The opercular/triangular parts of the left inferior frontal gyrus and the left lateral premotor cortex are critical in syntactic processing. We have recently indicated that a glioma in one of these regions is sufficient to cause agrammatic comprehension. In the present study, we aimed to show how normally existing syntax-related networks are functionally reorganized by a lesion. Twenty-one patients with a left frontal glioma preoperatively performed a picture-sentence matching task, and underwent functional magnetic resonance imaging scans in an event-related design. We established two qualitatively different types of agrammatic comprehension, depending on glioma location. Patients with a glioma in the left lateral premotor cortex had a more profound deficit in the comprehension of scrambled sentences than that of active and passive sentences. In contrast, patients with a glioma in the opercular/triangular parts of the left inferior frontal gyrus had a more profound deficit in the comprehension of passive and scrambled sentences than that of active sentences. Moreover, we found dramatic changes in the activation patterns in these two patient groups, which accompanied abnormal overactivity and/or underactivity in the syntax-related regions. Furthermore, by examining functional connectivity in the normal brain, we identified three syntax-related networks among those regions, and anatomically visualized connections within individual networks by using diffusion tensor imaging. The first network consists of the opercular/triangular parts of the left inferior frontal gyrus, left intraparietal sulcus, right frontal regions, presupplementary motor area, and right temporal regions. These regions were overactivated in the patients with a glioma in the left lateral premotor cortex only for correct responses, indicating a cognitive change. The second network consists of the left lateral premotor cortex, left angular gyrus, lingual gyrus, and cerebellar nuclei. These regions were overactivated in the patients with a glioma in the opercular/triangular parts of the left inferior frontal gyrus for both correct and incorrect responses, indicating a neuronal change. The third network consists of the left ventral frontal and posterior temporal regions. These regions were underactivated in the patients with a glioma in the opercular/triangular parts of the left inferior frontal gyrus, indicating another neuronal change. These results demonstrate that agrammatic comprehension is associated with the global reorganization of functionally distinct networks, which indeed reflects a differential change in the relative contribution of these three networks to normal syntax-related functions.

Dissociated Language Functions: A Matter of Atypical Language Lateralization or Cerebral Plasticity?

The left hemisphere is generally considered to harbor language functions. Atypical cortical language lateralization is mainly demonstrated in left-handed and ambidextrous individuals, whereas dissociated language functions have been reported in association with brain injuries as a part of the reorganization process. We present a thoughtful discussion on the underlying mechanisms of dissociated language functions through an illustrative case of dissociated expressive language. A 31-year-old left-handed woman presented with a recurrent left frontal glioma. Preoperative language functional magnetic resonance imaging (fMRI) panel revealed right-sided dominance for two different language tasks (verbal fluency and visual naming), and the word chain task demonstrated maximal activation in the left hemisphere at the posterior margin of the tumor. The patient was operated on awake to assess language functions intraoperatively. Preoperative fMRI findings were confirmed revealing a task-specific dissociation of expressive language functions. Surgical resection was taken to the functional boundaries. Postoperatively, no language dysfunction occurred. Dissociated language functions are prone to occur in long-standing lesions. Different patterns of dissociation may be encountered due to interindividual particularities and cerebral plasticity. The presented patient is unique by demonstrating new insight into expressive language dissociation, emphasizing the role of a preoperative language fMRI panel and the capability of intraoperative language mapping for identifying special language networks.

Working memory and the identification of facial expression in patients with left frontal glioma.

Patients with brain tumors may have cognitive dysfunctions including memory deterioration, such as working memory, that affect quality of life. This study was to explore the presence of defects in working memory and the identification of facial expressions in patients with left frontal glioma. This case-control study recruited 11 matched pairs of patients and healthy control subjects (mean age ± standard deviation, 37.00 ± 10.96 years vs 36.73 ± 11.20 years; 7 male and 4 female) from March through December 2011. The psychological tests contained tests that estimate verbal/visual-spatial working memory, executive function, and the identification of facial expressions. According to the paired samples analysis, there were no differences in the anxiety and depression scores or in the intelligence quotients between the 2 groups (P > .05). All indices of the Digit Span Test were significantly worse in patients than in control subjects (P < .05), but the Tapping Test scores did not differ between patient and control groups. Of all 7 Wisconsin Card Sorting Test (WCST) indexes, only the Preservative Response was significantly different between patients and control subjects (P < .05). Patients were significantly less accurate in detecting angry facial expressions than were control subjects (30.3% vs 57.6%; P < .05) but showed no deficits in the identification of other expressions. The backward indexes of the Digit Span Test were associated with emotion scores and tumor size and grade (P < .05). Patients with left frontal glioma had deficits in verbal working memory and the ability to identify anger. These may have resulted from damage to functional frontal cortex regions, in which roles in these 2 capabilities have not been confirmed. However, verbal working memory performance might be affected by emotional and tumor-related factors.

Refractory semantic access dysphasia resulting from resection of a left frontal glioma

The existence of semantic access disorders is now well established, however the precise cognitive and anatomical underpinnings are still debated. Here we describe the case of a patient that became aphasic after the resection of a left frontal glioma. Detailed lesion reconstruction indicates that the lesion was mostly restricted to the left dorsal and ventral prefrontal cortices and the underlying white matter, but sparing temporal lobes. Critically, the patient showed all the signs of refractory semantic access dysphasia, supporting the association between this syndrome and damage to left prefrontal areas likely to subserve retrieval and selection mechanisms for verbal material.

Clip assisted use of gelatin–thrombin matrix sealant as a rescue procedure to treat a hidden arterial tear

Major intracranial arteries can be injured during tumor removal. Surgeons routinely manage this event by using either microvascular direct repair, by-pass of the wounded segment or the placement of a sutureless device. These procedures, however, are not always possible due to artery brittleness, deep operating field, vascular configuration, or restricted viewing field. In this particular case, we illustrate an example of innovative use of gelatin–thrombin matrix sealant used to repair a hidden tear of pericallosal–callosomarginal bifurcation. A 49-year-old man underwent resection of a recurrent left frontal glioma. During an attempt to remove a firmly attached portion of the tumor, a tear occured in the pericallosal–callosomarginal bifurcation. The wall defect was repaired with a temporary vascular clip placed on the pericallosal artery and gelatin–thrombin matrix sealant sprayed over the tear. An intraoperative indocyanine videoangiography showed patency of both the pericallosal and callosomarginal arteries. Gelatin–thrombin matrix sealant is useful to control bleeding from an artery when the viewing field is restricted. In some cases, however, blood outflow must first be reduced in order to allow clot formation.

INTRAOPERATIVE LANGUAGE LOCALIZATIONIN MULTILINGUAL PATIENTS WITH GLIOMAS

OBJECTIVE Intraoperative localization of speech is problematic in patients that are fluent with different languages. Previous studies have generated various results depending on the series of patients studied, the type of language and the sensitivity of the tasks applied. It is not clear if languages are mediated by multiple and separate cortical areas, or shared by common areas. Globally considered, previous studies recommended performing a multiple intra-operative mapping for all the languages the patient is fluent for. Aim of this work was to study the feasibility of performing an intra-operative multiple language mapping in a group of multilingual patients with a glioma undergoing awake craniotomy for tumor removal, to describe the intraoperative cortical and subcortical findings in the area of craniotomy, with the final goal to maximally preserve their functional language. METHODS Seven late highly proficient multilingual patients with a left frontal glioma were submitted pre-operatively to a battery of tests to evaluate oral language production, comprehension, and repetition. Each language was tested serially starting from the first acquired language. Items which were correctly named during these tests were used to build personalized blocks to be used intraoperatively. Language mapping was undertaken during awake craniotomies, by the use of a Ojemann cortical stimulator during counting and oral naming tasks. Subcortical stimulation by using the same current threshold was applied during tumor resection, in a back and forth fashion, and the same tests. RESULTS Cortical sites essential for oral naming were found in 87.5% of patients, those for the first acquired language in 1 to 4 sites, those for the other languages in 1 to 3 sites. Sites for each language were distinct and separate. Number and location of sites were not predictable, being randomly and widely distributed in the cortex around or less frequently over the tumor area. Subcortical stimulations found tracts for the first acquired language in 4 patients, and for the other languages in 3 patients. Three of these patients decreased their fluency immediately after surgery, affecting the first acquired language, which fully recovered in two patients and partially in one. The procedure was agile and well tolerated by the patients. CONCLUSION These findings show that multiple cortical and subcortical language mapping during awake craniotomy for tumor removal is a feasible procedure. They support the concept that intraoperative mapping should be performed for all the languages the patient is fluent for to preserve functional integrity.

Intraoperative Language Localizationin Multilingual Patients With Gliomas

Intraoperative localization of speech is problematic in patients who are fluent in different languages. Previous studies have generated various results depending on the series of patients studied, the type of language, and the sensitivity of the tasks applied. It is not clear whether languages are mediated by multiple and separate cortical areas or shared by common areas. Globally considered, previous studies recommended performing a multiple intraoperative mapping for all the languages in which the patient is fluent. The aim of this work was to study the feasibility of performing an intraoperative multiple language mapping in a group of multilingual patients with a glioma undergoing awake craniotomy for tumor removal and to describe the intraoperative cortical and subcortical findings in the area of craniotomy, with the final goal to maximally preserve patients' functional language. Seven late, highly proficient multilingual patients with a left frontal glioma were submitted preoperatively to a battery of tests to evaluate oral language production, comprehension, and repetition. Each language was tested serially starting from the first acquired language. Items that were correctly named during these tests were used to build personalized blocks to be used intraoperatively. Language mapping was undertaken during awake craniotomies by the use of an Ojemann cortical stimulator during counting and oral naming tasks. Subcortical stimulation by using the same current threshold was applied during tumor resection, in a back and forth fashion, and the same tests. Cortical sites essential for oral naming were found in 87.5% of patients, those for the first acquired language in one to four sites, those for the other languages in one to three sites. Sites for each language were distinct and separate. Number and location of sites were not predictable, being randomly and widely distributed in the cortex around or less frequently over the tumor area. Subcortical stimulations found tracts for the first acquired language in four patients and for the other languages in three patients. Three of these patients decreased their fluency immediately after surgery, affecting the first acquired language, which fully recovered in two patients and partially in one. The procedure was agile and well tolerated by the patients. These findings show that multiple cortical and subcortical language mapping during awake craniotomy for tumor removal is a feasible procedure. They support the concept that intraoperative mapping should be performed for all the languages in which the patient is fluent in to preserve functional integrity.