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Intra-operative mapping of reading and writing circuits in brain tumour patients

Presentatie RUG - 14 mei 2014

Fleur van Ierschot

on 26 September 2014

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Transcript of Intra-operative mapping of reading and writing circuits in brain tumour patients

PhD Project Proposal IDEALAB
14 may 2014
University of Groningen

Intra-operative mapping of reading and writing in brain tumour patients
DES provides an excellent tool to inspect neuropsychology and neuroanatomy of language

DuLIP protocol to assess language pre- and post surgery

No reading and writing tests
Unknown relation linguistic outcome and intraoperative mapping
Awake craniotomy
Fleur van Ierschot
Food for thought
Clinical goal

Assessment of other cognitive functions

Practical issues

Other improvements?
(Duffau et al., 2005)

Often infiltrated in crucial language areas

Awake craniotomy
Maximizing tumour resection
Diminishing postoperative impairments

Poor life expectancy, focus on postoperative quality of life

(Tonn, 2007)

Asleep - awake - asleep protocol during surgery

Intra-operative localization of essential structures for cognitive functions, especially language

Monitored via neuroimaging (DTI, MRI) and behavioural mapping methods
Patient performs tasks consciously while cerebral tissue is temporarily inactivated

Disruption of task performance indicates crucial language areas

Time and clinical restrictions:
Mainly object naming and repetition tasks
(De Witte & Marien, 2013)
(Duffau et al., 2005)
Subcortical areas remain unknown
Wide variations in assessments and outcomes
Might overlap in lexical (ventral) and nonlexical (dorsal) processing
time restriction 4sec
intra-operative data gathering
(Duffau., 2007)
Only 66% overlap of structures identified by DES vs. pre-operative fMRI

Insight in brain re-organisation
Crucial in more recent dynamic view of brain function localization

Suggested collective neural underpinnings:
Crucial cortical areas identified
(Purcell et al., 2011)
(Roux et al., 2014)
(Duffau et al., 2005)
Direct Electrical Stimulation (DES)
highly accurate, at 5mm
Preservation of linguistic functions

Pre-, intra- and post surgery monitoring

DuLIP : Dutch Linguistic Intraoperative Protocol

Elaborate testing pre- and post-, restricted intra operative testing
Tests chosen based on pre-operative mapping (MRI, DTI) and behavioural dysfunctions.

Relation pre- and post assessment examined, yet:

reading and writing

Language assessment in glioma patients often restricted to naming and word repetition tasks
Different activation patterns
Non-transparent: occipital & inferior parietal lobe
visual processing & word recoding
Transparent: superior temporal gyrus
phonological processing
Post-operative differences across languages?

Aim: add more complex reading and writing tasks
English - Dutch - Italian: difference in transparency
Linking pre-, intra-
and post assessment data

Can post-operative (dys)functioning be predicted during surgery?
Vital intra-operative data gathered by neuroimaging mapping methods (fMRI, DTI) and behavioural data (naming, repetition)

Relation pre- and post behavioural data with intraoperative data unknown

Clinical relevance:

Theoretical relevance:
Intra-operative behavioural assessment
No reading and writing tests
Unknown link with intraoperative mapping

reading and writing

Intra-operative focus on phonology
Linking pre-, intra- and post assessment
Intra-operative decision making to increase postoperative quality of life

Increased sensitivity in mapping (naming) has significant positive effects on clinical outcome

Used for both clinical and theoretical purposes
relatively small patient population
data different hospitals
Full transcript