Continuous subcortical language mapping in awake glioma surgery
Repetitive monopolar short-train stimulation (STS) delivered from a suction probe enables continuous mapping and distance assessment of corticospinal tracts during asleep glioma resection. In this study, we explored this stimulation technique in awake glioma surgery. Fourteen patients with glioma in...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.947119/full |
| _version_ | 1828287539845267456 |
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| author | Hans W. Axelson Francesco Latini Malin Jemstedt Mats Ryttlefors Maria Zetterling |
| author_facet | Hans W. Axelson Francesco Latini Malin Jemstedt Mats Ryttlefors Maria Zetterling |
| author_sort | Hans W. Axelson |
| collection | DOAJ |
| description | Repetitive monopolar short-train stimulation (STS) delivered from a suction probe enables continuous mapping and distance assessment of corticospinal tracts during asleep glioma resection. In this study, we explored this stimulation technique in awake glioma surgery. Fourteen patients with glioma involving language-related tracts were prospectively included. Continuous (3-Hz) cathodal monopolar STS (five pulses, 250 Hz) was delivered via the tip of a suction probe throughout tumor resection while testing language performance. At 70 subcortical locations, surgery was paused to deliver STS in a steady suction probe position. Monopolar STS influence on language performance at different subcortical locations was separated into three groups. Group 1 represented locations where STS did not produce language disturbance. Groups 2 and 3 represented subcortical locations where STS produced language interference at different threshold intensities (≥7.5 and ≤5 mA, respectively). For validation, bipolar Penfield stimulation (PS; 60 Hz for 3 s) was used as a “gold standard” comparison method to detect close proximity to language-related tracts and classified as positive or negative regarding language interference. There was no language interference from STS in 28 locations (Group 1), and PS was negative for all sites. In Group 2 (STS threshold ≥ 7.5 mA; median, 10 mA), there was language interference at 18 locations, and PS (median, 4 mA) was positive in only one location. In Group 3 (STS threshold ≤ 5 mA; median, 5 mA), there was language interference at 24 locations, and positive PS (median 4 mA) was significantly (p < 0.01) more common (15 out of 24 locations) compared with Groups 1 and 2. Despite the continuous stimulation throughout tumor resection, there were no seizures in any of the patients. In five patients, temporary current spread to the facial nerve was observed. We conclude that continuous subcortical STS is feasibly also in awake glioma surgery and that no language interference from STS or interference at ≥7.5 mA seems to indicate safe distance to language tracts as judged by PS comparisons. STS language interference at STS ≤ 5 mA was not consistently confirmed by PS, which needs to be addressed. |
| first_indexed | 2024-04-13T09:48:58Z |
| format | Article |
| id | doaj.art-e86ea71b31a04dbb9f85df27ea1e69e1 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-13T09:48:58Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-e86ea71b31a04dbb9f85df27ea1e69e12022-12-22T02:51:38ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-08-011210.3389/fonc.2022.947119947119Continuous subcortical language mapping in awake glioma surgeryHans W. Axelson0Francesco Latini1Malin Jemstedt2Mats Ryttlefors3Maria Zetterling4Department of Medical Sciences, Section of Clinical Neurophysiology, Uppsala University, Uppsala, SwedenDepartment of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, SwedenDepartment of Medical Sciences, Speech-Language Pathology, Uppsala University, Uppsala, SwedenDepartment of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, SwedenDepartment of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, SwedenRepetitive monopolar short-train stimulation (STS) delivered from a suction probe enables continuous mapping and distance assessment of corticospinal tracts during asleep glioma resection. In this study, we explored this stimulation technique in awake glioma surgery. Fourteen patients with glioma involving language-related tracts were prospectively included. Continuous (3-Hz) cathodal monopolar STS (five pulses, 250 Hz) was delivered via the tip of a suction probe throughout tumor resection while testing language performance. At 70 subcortical locations, surgery was paused to deliver STS in a steady suction probe position. Monopolar STS influence on language performance at different subcortical locations was separated into three groups. Group 1 represented locations where STS did not produce language disturbance. Groups 2 and 3 represented subcortical locations where STS produced language interference at different threshold intensities (≥7.5 and ≤5 mA, respectively). For validation, bipolar Penfield stimulation (PS; 60 Hz for 3 s) was used as a “gold standard” comparison method to detect close proximity to language-related tracts and classified as positive or negative regarding language interference. There was no language interference from STS in 28 locations (Group 1), and PS was negative for all sites. In Group 2 (STS threshold ≥ 7.5 mA; median, 10 mA), there was language interference at 18 locations, and PS (median, 4 mA) was positive in only one location. In Group 3 (STS threshold ≤ 5 mA; median, 5 mA), there was language interference at 24 locations, and positive PS (median 4 mA) was significantly (p < 0.01) more common (15 out of 24 locations) compared with Groups 1 and 2. Despite the continuous stimulation throughout tumor resection, there were no seizures in any of the patients. In five patients, temporary current spread to the facial nerve was observed. We conclude that continuous subcortical STS is feasibly also in awake glioma surgery and that no language interference from STS or interference at ≥7.5 mA seems to indicate safe distance to language tracts as judged by PS comparisons. STS language interference at STS ≤ 5 mA was not consistently confirmed by PS, which needs to be addressed.https://www.frontiersin.org/articles/10.3389/fonc.2022.947119/fullawake craniotomysubcortical electrical stimulationshort-train stimulationmonopolar stimulationintraoperative language testingtractography |
| spellingShingle | Hans W. Axelson Francesco Latini Malin Jemstedt Mats Ryttlefors Maria Zetterling Continuous subcortical language mapping in awake glioma surgery Frontiers in Oncology awake craniotomy subcortical electrical stimulation short-train stimulation monopolar stimulation intraoperative language testing tractography |
| title | Continuous subcortical language mapping in awake glioma surgery |
| title_full | Continuous subcortical language mapping in awake glioma surgery |
| title_fullStr | Continuous subcortical language mapping in awake glioma surgery |
| title_full_unstemmed | Continuous subcortical language mapping in awake glioma surgery |
| title_short | Continuous subcortical language mapping in awake glioma surgery |
| title_sort | continuous subcortical language mapping in awake glioma surgery |
| topic | awake craniotomy subcortical electrical stimulation short-train stimulation monopolar stimulation intraoperative language testing tractography |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.947119/full |
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