Awake Surgery for Gliomas within the Right Inferior Parietal Lobule: New Insights into the Functional Connectivity Gained from Stimulation Mapping and Surgical Implications
Awake Surgery for Gliomas within the Right Inferior Parietal Lobule: New Insights into the Functional Connectivity Gained from Stimulation Mapping and Surgical Implications
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DOI：
10.1016/j.wneu.2018.01.053
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发表时间：
2018-04-01
影响因子：
2
通讯作者：
Duffau, Hugues
中科院分区：
文献类型：
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作者：
Rolland, Alice;Herbet, Guillaume;Duffau, Hugues
目的：关于右顶下小叶（IPL）内和周围的白色物质连接的功能作用知之甚少。我们使用直接电刺激清醒手术过程中，以调查这种连接，并避免切除后的永久性赤字的权利IPL glioma.METHODS：我们回顾了患者进行清醒映射的胶质瘤涉及的权利IPL。通过电刺激检测到的功能性皮质下皮质边界实现切除。术中映射的结果面临术前和术后的磁共振成像进行anatomofunctional correlations.RESULTS：14例连续患者（9名男性，平均年龄44岁）。在皮质方面，切除受限于前中央后躯体感觉区（11例）或中央前运动皮质（3例）。皮质下，丘脑皮质途径被确定在所有患者的前方。在对应于上级纵束第III部分的前方和外侧（6例患者）引起了发音障碍。在更深处和上方，刺激上级纵束II部或弓状束引起空间障碍（6例患者）。更外侧和后方，破坏额枕下束诱发非语言语义障碍（7例）。6例患者在刺激视辐射时出现视力障碍。除1例外，所有患者均行全切除或次全切除。有没有永久性的损害，除了预期的左上级quadrantanopia 4 patients.CONCLUSIONS：这是第一个手术系列集中在右侧IPL胶质瘤。在该区域内和周围检测到的复杂功能连接完全支持使用术中多模式功能标测来优化结局。
OBJECTIVE: Little is known about the functional role of the white matter connections running within and around the right inferior parietal lobule (IPL). We used direct electrostimulation during awake surgery to investigate this connectivity and to avoid permanent deficit after resection for right IPL gliomas.METHODS: We reviewed patients who underwent awake mapping for a glioma involving the right IPL. Resection was achieved up to functional corticosubcortical boundaries detected by electrostimulation. Results of the intraoperative mapping were confronted to preoperative and postoperative magnetic resonance imaging to perform anatomofunctional correlations.RESULTS: Fourteen consecutive patients were enrolled (9 men; mean age, 44 years). Cortically, the resection was limited anteriorly by the retrocentral somatosensory area (11 patients) or by the precentral motor cortex (3 patients). Subcortically, the thalamocortical pathways were identified anteriorly in all patients. Articulatory disturbances were elicited anteriorly and laterally (6 patients) corresponding to the superior longitudinal fasciculus part III. Deeper and superiorly, stimulating the superior longitudinal fasciculus part II or the arcuate fasciculus induced spatial disorders (6 patients). More laterally and posteriorly, disrupting the inferior fronto-occipital fasciculus induced nonverbal semantic disorders (7 patients). Six patients had visual deficits while the optic radiations were stimulated. A total or subtotal resection was achieved in all patients but one. There were no permanent impairments, except an expected left superior quadrantanopia in 4 patients.CONCLUSIONS: This is the first surgical series focusing on right IPL gliomas. The complex functional connectivity detected within and around this region fully supports the use of intraoperative multimodal functional mapping for optimizing outcomes.