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Intraoperative stimulation mapping of language centers during glioma surgery can improve functional and clinical outcomes, study suggests
Tuesday, September 30 2008 | Comments
What's This?
Intraoperative stimulation mapping is a safe, accurate, reproducible, and reliable method of detecting language pathways, enabling neurosurgeons to better understand the individual subcortical connectivity of language by performing online anatomofunctional correlation in patients who are awake and making it possible to increase the quality of glioma resection while preserving the patient's quality of life, according to the results of a large study conducted in France. Between October 1996 and March 2007, neurosurgeons used intraoperative electrical mapping during surgery on 115 patients (69 males; mean age, 35 years) with a corticosubcortical World Health Organization Grade II glioma located in eloquent brain areas. Only right-handed patients with a tumor involving the left-dominant hemisphere were included in this study. The presenting symptoms consisted of seizures (n=103) and mild language disorders (n=12). Nine patients presented with pharmacologically resistant epilepsy.
The researchers used preoperative magnetic resonance imaging (MRI) to analyze the topography of the tumors. The patients received local anesthesia but were awake during surgery so that functional (particularly language), cortical, and subcortical mapping could be performed using direct electrical stimulation. The investigators explained that this method enabled them to detect not only cortical language sites but also subcortical language tracts by inducing transient functional disturbances.
The study authors commented that the various language disorders appeared to be specific to a given pathway, as shown using anatomofunctional correlations performed by combining functional information provided by intraoperative subcortical stimulation and anatomical data provided by postoperative MRI.
All of the patients experienced transient deficits in language functioning, which the authors said is expected when the extent of resection is maximized because the tumor is systematically removed until subcortical language structures are encountered, leaving no margin around the eloquent pathways. However, the researchers reported that 98% of the patients recovered after 1 to 3 months of functional rehabilitation.
Intraoperative subcortical stimulation represents an accurate and reliable tool to understand better the anatomofunctional connectivity of the language network and to use this knowledge to improve the results of Grade II glioma surgery within the left-dominant hemisphere, the investigators concluded, adding that it is possible to optimize the risk-to-benefit ratio of surgery of Grade II gliomas located within the dominant hemisphere by identifying the functional integrity of the white matter tracts and deep gray nuclei.
"Combining these complementary techniques will give the neurosurgeon the opportunity to improve his or her knowledge of cerebral processing, and thus to optimize the results of brain surgery while extending surgical indications within eloquent areas," the study authors wrote. (Duffau H, et al. J Neurosurg 2008;109:461-471.)
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