[Clinical and neuropsychological survey of patients with glioma of the corpus callosum]. / Kliniko-neiropsikhologicheskie issledovaniya bol'nykh s gliomami mozolistogo tela.

BACKGROUND: We found no reports devoted to a comprehensive analysis of cognitive impairment that can determine the quality of life in patients with glioma of the corpus callosum and topical affiliation of these disorders. OBJECTIVE: Clinical and neuropsychological study of mental disorders in patients with gliomas of the corpus callosum, qualification of topical affiliation of the identified syndromes. MATERIAL AND METHODS: We examined 30 patients with gliomas of the corpus callosum using the Luria's approach to clinical and neuropsychological survey. RESULTS: We identified the features of cognitive impairment depending on localization of glioma in the corpus callosum. Non-spontaneity, reduced criticism to own condition up to denial of disease and memory impairment were more common in patients with anterior gliomas of the corpus callosum. These disorders can be associated with tumor spread into medial parts of frontal lobes. Subcortical symptoms including hypomimia, quiet dull voice, involuntary urination, severe disorders of dynamic praxis and memory impairment were more common in patients with glioma of the middle part of the corpus callosum. These disorders can be associated with dorsal tumor spread towards posterior part of the frontal lobe or ventrally towards the basal ganglia. Memory disorders more often manifested by Korsakoff syndrome prevailed in patients with posterior gliomas of the corpus callosum. This finding can be associated with ventral growth of tumor towards the fornix. CONCLUSION: We identified the features of cognitive impairment depending on localization of glioma in the corpus callosum. Split-brain symptoms were rare in these patients and observed in lesions of middle and posterior parts of the corpus callosum only in 3 patients.

[Broca's area intraoperative mapping with cortico-cortical evoked potentials]. / Intraoperatsionnoe kartirovanie rechevoi zony Broka metodom registratsii kortiko-kortikal'nykh vyzvannykh potentsialov.

OBJECTIVE: Mapping of effective speech connections between the frontal and temporal lobes with cortico-cortical evoked potentials. MATERIAL AND METHODS: There were 3 patients with brain tumors in the left frontoparietal region. The neoplasms were localized in the dominant hemisphere near cortical speech centers and pathways. Cortico-cortical evoked potentials were intraoperatively recorded in response to bipolar stimulation with a direct current delivered through the subdural electrodes (single rectangular biphasic impulses with duration of 300 µs and frequency of 1 Hz). Stimulation intensity was gradually increased from 2 mA within 3-4 mA. Registration was carried out by averaging ECoG (30-50 stimuli in each session) in the 300-ms epoch after stimulus. Direct cortical stimulation was used to validate the results of cortico-cortical speech mapping with cortico-cortical evoked potentials. RESULTS: In our cases, we obtained cortico-cortical evoked potentials from inferior frontal gyrus after stimulation of superior temporal gyrus. In one case, this effective relationship was unidirectional, in the other two patients reciprocal. Mean latency of N1 peak was 65 ms (range 49.6-90 ms), mean amplitude 71 µV (range 50-100 µV). Cortico-cortical mapping data were confirmed by detection of Broca's area in 2 out of 3 cases out during direct cortical stimulation with maximum amplitude of N1 wave. «Awake craniotomy¼ protocol was applied. In one case, Broca's area was not detected during direct stimulation. No postoperative speech impairment was noted. CONCLUSION: Initial results of cortical mapping with cortico-cortical evoked potentials in a small sample confirmed its practical significance for analysis of cortical projections of effective speech communications between the frontal and temporal lobes. Further study of this method in large samples is required.

[Intraoperative fluorescence diagnostics in surgery of intracranial meningiomas: analysis of 101 cases]. / Intraoperatsionnaia fluorestsentnaia diagnostika v khirurgii intrakranial'nykh meningiom: analiz 101 nabliudeniia.

Fluorescence diagnostics has been extensively applied in surgery of malignant brain gliomas. However, the use of this technique in surgery of intracranial meningiomas has remained controversial. OBJECTIVE: The study objective was to assess the sensitivity of 5-aminolevulinic acid-based (5-ALA) fluorescence diagnostics in surgery of brain meningiomas and to clarify the clinical and biological factors that may influence the fluorescent effect. MATERIAL AND METHODS: The study consistently included 101 patients with intracranial meningiomas of various locations who were operated on using 5-ALA. There were 28 (27.72%) males and 73 (72.27%) females (median age, 54 years). In all patients, surgery was performed using an operating microscope equipped with a fluorescent module; in 24 of these, laser spectroscopy was used. For comparison of chances to observe the fluorescent effect of 5-ALA in patients having meningiomas with different WHO histological grades (Grade I vs Grade II-III), we performed a meta-analysis that included 10 studies (the largest series) on outcomes of surgical treatment of meningiomas using intraoperative fluorescence diagnostics. RESULTS: Of 101 patients included in this series, observable fluorescence was detected in 95 (94.1%) patients: weak fluorescence in 12 (11.9%), moderate fluorescence in 23 (22.8%) cases, and strong fluorescence in 60 (59.4%) patients. There was no statistically significant relationship (p>0.05) between the rate and intensity of observable fluorescence and the tumor growth pattern (primary/continued), location, WHO grade of malignancy, and histological subtype. In the absence of intraoperative bleeding, tumor fluorescence was statistically significantly brighter (p=0.02). Of 26 patients with hyperostosis, bone fluorescence was observed in 11 (42.3%) cases. There was no statistically significant relationship between administration of dexamethasone, its dose, administration of anticonvulsants, gastrointestinal tract diseases, as well as diabetes mellitus and the fluorescence intensity. There was also no significant relationship between the extent of tumor resection (Simpson scale) and the presence of fluorescence as well as its intensity. Comparison of the observable fluorescence intensity and the laser spectroscopy indicators revealed a significant correlation (r=0.75; p=0.005). CONCLUSION: Meningioma is a well fluorescent tumor, with the technique sensitivity being 94.1%. In some cases, the use of fluorescence diagnostics in surgery of meningiomas improves identification of residual tumor fragments and enables correction of a surgical approach. To assess the effect of fluorescence diagnostics on the recurrence rate and disease-free duration, further research is required.