How I do it? Anatomical multifocal high-grade glioma resection
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HOW I DO IT - TUMOR - GLIOMA
How I do it? Anatomical multifocal high-grade glioma resection Zixiao Yang 1 & Jianping Song 1
&
Wei Zhu 1
Received: 31 May 2020 / Accepted: 27 October 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background If an awake surgery is somehow not available for gliomas at the language area, understanding the anatomy and welldesigned surgical strategy are important. Method We present a case with left hemispheric multifocal high-grade gliomas located deeply at the left temporal pole, the Wernicke’s area, and mesial temporal region. Because the patient could not endure the awake surgery and obtain practicable functional magnetic resonance imaging (MRI) for eloquent cortex evaluation, we removed the lesions following the anatomical resection strategy guided by diffusion tensor imaging (DTI). Conclusion This case demonstrates the value of DTI and the importance of anatomical resection strategies in glioma surgeries. Keywords Anatomy . Glioma . High-grade glioma . Resection
Introduction and relevant surgical anatomy Awake surgery with brain mapping is first choice in gliomas at the language area [1]. Theoretically, neurological function preservation can be achieved by the brain mapping with subcortical stimulation in a fully cooperated awake surgery. However, if the patient could not cooperate or tolerate the prolonged awake surgery, general anesthesia may be a rational option. However, under general anesthesia, the surgical outcome largely depended on the surgeon’s experience and understanding of the anatomy. Here, we present a case of multifocal high-grade glioma affecting the language area, which was successfully treated by anatomical resection in a non-awake surgery. A 62-year-old male suffered from slurred speech for 4 months; he also developed right lower extremity weakness 2 days before admission. The physical examination revealed both motor and sensory aphasia. The muscle strength of right lower limb was grade II. The preThis article is part of the Topical Collection on Tumor – Glioma * Jianping Song [email protected] 1
Department of Neurosurgery, Huashan Hospital, Shanghai Medical Collage, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai 200040, China
operative magnetic resonance imaging (MRI) revealed multiple lesions located in the left hemisphere, including the temporal pole, mesial temporal region, and deep inside the inferior parietal lobe (Fig. 1). The multifocal highgrade glioma was highly suspected, and a treatment strategy of maximal safe resection with language function preservation was made. Therefore, the eloquent cortex and speech-related white matter tracks are the key anatomical structures to be preserved during the operation [2, 3]. Besides, we need to secure the en passage arteries to the language area which may also supply the tumor. In this case, the Wernicke’s area, superior longitudinal fasciculus, arcuate fasciculus, and the inferior fronto-occipital fasciculus are the most important anatomic structures worthy of
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