Multimodal cognitive mapping in supplementary motor area glioma: purpose of a case
DOI:
https://doi.org/10.59156/smdqms10Keywords:
Awake craniotomy, Cognitive mapping, Low-grade diffuse glioma, Motor areaAbstract
Background: low-grade diffuse glioma is a brain tumor characterized by its slow growth and progressive transformation into high-grade glioma. When it affects eloquent brain areas, such as the supplementary motor area (SMA), it represents a surgical challenge. Awake, multimodal cognitive mapping, using cortical and subcortical electrostimulation, is essential to preserve critical functions and improve postoperative quality of life.
Objective: to describe our surgical technique of multimodal cognitive mapping in an awake patient for a case of diffuse glioma in the supplementary motor area (SMA).
Case description: a 24-year-old male patient, with no relevant medical history, presented with generalized tonic-clonic seizures of one month’s duration. On physical examination, the patient showed bradypsychia with no focal neurological signs. Magnetic resonance imaging revealed an infiltrative lesion in the left SMA, hyperintense on FLAIR, without contrast enhancement or diffusion restriction.
Intervention: the surgical procedure followed an asleep-awake-asleep protocol, applying multimodal functional mapping to identify safe tumor boundaries, allowing for precise resection while monitoring motor and cognitive functions in real time.
Conclusion: oncological neurosurgery has evolved toward connectome-guided resection, optimizing the balance between tumor control and functional preservation. Multimodal cognitive mapping is a safe and effective technique to achieve this goal in diffuse gliomas.
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References
1. Duffau H. Diffuse low-grade glioma, oncological outcome and quality of life: a surgical perspective: A surgical perspective. Curr Opin Oncol. 2018;30(6):383-9. Doi: http://dx.doi.org/10.1097/CCO.0000000000000483 DOI: https://doi.org/10.1097/CCO.0000000000000483
2. Duffau H. Diffuse low-grade gliomas and neuroplasticity. Diagn Interv Imaging. 2014;95(10):945-55. Doi: http://dx.doi.org/10.1016/j.diii.2014.08.001 DOI: https://doi.org/10.1016/j.diii.2014.08.001
3. Pinson H, Van Lerbeirghe J, Vanhauwaert D, Van Damme O, Hallaert G, Kalala J-P. The supplementary motor area syndrome: a neurosurgical review. Neurosurg Rev. 2022;45(1):81-90. Doi: http://dx.doi.org/10.1007/s10143-021-01566-6 DOI: https://doi.org/10.1007/s10143-021-01566-6
4. Ahmed Khan R, Rahman MM, Ziauddin M, Chowdhury M, Hasan M. Awake brain mapping by direct cortical stimulation; technical note to get higher resection rate and low morbidity in low-grade glioma patients. Ann Med Surg (Lond). 2024;86(4):1861-6. Doi: http://dx.doi.org/10.1097/MS9.0000000000001837 DOI: https://doi.org/10.1097/MS9.0000000000001837
5. De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol. 2012;30(20):2559-65. Doi: http://dx.doi.org/10.1200/JCO.2011.38.4818 DOI: https://doi.org/10.1200/JCO.2011.38.4818
6. Duffau H. Awake mapping of the brain connectome in glioma surgery: Concept is stronger than technology. Eur J Surg Oncol. 2015;41(9):1261-3. Doi: http://dx.doi.org/10.1016/j.ejso.2015.05.009 DOI: https://doi.org/10.1016/j.ejso.2015.05.009
7. Duffau H. Neural connectivity: How to reinforce the bidirectional synapse between basic neuroscience and routine neurosurgical practice? Front Neurol. 2021;12:705135. Doi: http://dx.doi.org/10.3389/fneur.2021.705135 DOI: https://doi.org/10.3389/fneur.2021.705135
8. Duffau H. Introducing the concept of brain metaplasticity in glioma: how to reorient the pattern of neural reconfiguration to optimize the therapeutic strategy. J Neurosurg. 2022;136(2):613-7. Doi: http://dx.doi.org/10.3171/2021.5.JNS211214 DOI: https://doi.org/10.3171/2021.5.JNS211214
9. Duffau H. Damaging a few millimeters of the deep white matter tracts during glioma surgery may result in a large-scale brain disconnection. J Neurosurg. 2023;140(1):311-4. Doi: http://dx.doi.org/10.3171/2023.6.JNS231048 DOI: https://doi.org/10.3171/2023.6.JNS231048
10. Duffau H, Lopes M, Denvil D, Capelle L. Delayed onset of the supplementary motor area syndrome after surgical resection of the mesial frontal lobe: a time course study using intraoperative mapping in an awake patient. Stereotact Funct Neurosurg. 2001;76(2):74-82. Doi: http://dx.doi.org/10.1159/000056496 DOI: https://doi.org/10.1159/000056496
11. Duffau H, Lopes M, Arthuis F, Bitar A, Sichez J-P, Van Effenterre R, et al. Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985-96) and with (1996-2003) functional mapping in the same institution. J Neurol Neurosurg Psychiatry. 2005;76(6):845-51. Doi: http://dx.doi.org/10.1136/jnnp.2004.048520 DOI: https://doi.org/10.1136/jnnp.2004.048520
12. Jakola AS, Myrmel KS, Kloster R, Torp SH, Lindal S, Unsgård G, et.al. Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. JAMA. 2012;308(18):1881-8. Doi: http://dx.doi.org/10.1001/jama.2012.12807 DOI: https://doi.org/10.1001/jama.2012.12807
13. Jakola AS, Skjulsvik AJ, Myrmel KS, Sjåvik K, Unsgård G, Torp SH, et al. Surgical resection versus watchful waiting in low-grade gliomas. Ann Oncol. 2017;28(8):1942-8. Doi: http://dx.doi.org/10.1093/annonc/mdx230 DOI: https://doi.org/10.1093/annonc/mdx230
14. Motomura K, Chalise L, Ohka F, Aoki K, Tanahashi K, Hirano M, et al. Supratotal resection of diffuse frontal lower grade gliomas with awake brain mapping, preserving motor, language, and neurocognitive functions. World Neurosurg. 2018;119:30-9. Doi: http://dx.doi.org/10.1016/j.wneu.2018.07.193 DOI: https://doi.org/10.1016/j.wneu.2018.07.193
15. Pouratian N, Mut M, Jagannathan J, Lopes MB, Shaffrey ME, Schiff D. Low-grade gliomas in older patients: a retrospective analysis of prognostic factors. J Neurooncol. 2008;90(3):341-50. Doi: http://dx.doi.org/10.1007/s11060-008-9669-3 DOI: https://doi.org/10.1007/s11060-008-9669-3
