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Article ; Online: Central Nervous System Plasticity Influences Language and Cognitive Recovery in Adult Glioma.

Krishna, Saritha / Kakaizada, Sofia / Almeida, Nyle / Brang, David / Hervey-Jumper, Shawn

2021 Volume 89, Issue 4, Page(s) 539–548

Abstract: Gliomas exist within the framework of complex neuronal circuitry in which network dynamics influence both tumor biology and cognition. The generalized impairment of cognition or loss of language function is a common occurrence for glioma patients. The ... ...

Abstract	Gliomas exist within the framework of complex neuronal circuitry in which network dynamics influence both tumor biology and cognition. The generalized impairment of cognition or loss of language function is a common occurrence for glioma patients. The interface between intrinsic brain tumors such as gliomas and functional cognitive networks are poorly understood. The ability to communicate effectively is critically important for receiving oncological therapies and maintaining a high quality of life. Although the propensity of gliomas to infiltrate cortical and subcortical structures and disrupt key anatomic language pathways is well documented, there is new evidence offering insight into the network and cellular mechanisms underpinning glioma-related aphasia and aphasia recovery. In this review, we will outline the current understanding of the mechanisms of cognitive dysfunction and recovery, using aphasia as an illustrative model.
MeSH term(s)	Adult ; Brain Mapping ; Brain Neoplasms/complications ; Central Nervous System ; Cognition ; Glioma/complications ; Humans ; Language ; Quality of Life
Language	English
Publishing date	2021-01-21
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1093/neuros/nyaa456
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Article ; Online: Balancing task sensitivity with reliability for multimodal language assessments.

Aabedi, Alexander A / Kakaizada, Sofia / Young, Jacob S / Ahn, EunSeon / Weissman, Daniel H / Berger, Mitchel S / Brang, David / Hervey-Jumper, Shawn L

Journal of neurosurgery

2021 Volume 135, Issue 6, Page(s) 1817–1824

Abstract: Objective: Intraoperative tasks for awake language mapping are typically selected based on the language tracts that will likely be encountered during tumor resection. However, diminished attention and arousal secondary to perioperative sedatives may ... ...

Abstract	Objective: Intraoperative tasks for awake language mapping are typically selected based on the language tracts that will likely be encountered during tumor resection. However, diminished attention and arousal secondary to perioperative sedatives may reduce a task's usefulness for identifying eloquent cortex. For instance, accuracy in performing select language tasks may be high preoperatively but decline in the operating room. In the present study, the authors sought to identify language tasks that can be performed with high accuracy in both situational contexts so the neurosurgical team can be confident that speech errors committed during awake language mapping result from direct cortical stimulation to eloquent cortex, rather than from poor performance in general. Methods: We administered five language tasks to 44 patients: picture naming (PN), text reading (TR), auditory object naming (AN), repetition of 4-syllable words (4SYL), and production of syntactically intact sentences (SYNTAX). Performance was assessed using the 4-point scale of the quick aphasia battery 24 hours preoperatively and intraoperatively. We next determined whether or not accuracy on each task was higher preoperatively than intraoperatively. We also determined whether 1) intraoperative accuracy on a given task predicted intraoperative performance on the other tasks and 2) low preoperative accuracy on a task predicted a decrease in accuracy intraoperatively. Results: Relative to preoperative accuracy, intraoperative accuracy declined on PN (3.90 vs 3.82, p = 0.0001), 4SYL (3.96 vs 3.91, p = 0.0006), and SYNTAX (3.85 vs 3.67, p = 0.0001) but not on TR (3.96 vs 3.94, p = 0.13) or AN (3.70 vs 3.58, p = 0.058). Intraoperative accuracy on PN and AN independently predicted intraoperative accuracy on the remaining language tasks (p < 0.001 and p < 0.01, respectively). Finally, low preoperative accuracy on SYNTAX predicted a decrease in accuracy on this task intraoperatively (R2 = 0.36, p = 0.00002). Conclusions: While TR lacks sensitivity in identifying language deficits at baseline, accuracy on TR is stable across testing settings. Baseline accuracy on the other four of our five language tasks was not predictive of intraoperative performance, signifying the need to repeat language tests prior to stimulation mapping to confirm reliability.
Language	English
Publishing date	2021-05-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	3089-2
ISSN	1933-0693 ; 0022-3085
ISSN (online)	1933-0693
ISSN	0022-3085
DOI	10.3171/2020.10.JNS202947
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Article ; Online: Correlation of natural language assessment results with health-related quality of life in adult glioma patients.

Ammanuel, Simon G / Almeida, Nyle C / Kurteff, Garret / Kakaizada, Sofia / Molinaro, Annette M / Berger, Mitchel S / Chang, Edward F / Hervey-Jumper, Shawn L

Journal of neurosurgery

2021 Volume 136, Issue 2, Page(s) 343–349

Abstract: Objective: Impairments of speech are common in patients with glioma and negatively impact health-related quality of life (HRQoL). The benchmark for clinical assessments is task-based measures, which are not always feasible to administer and may miss ... ...

Abstract	Objective: Impairments of speech are common in patients with glioma and negatively impact health-related quality of life (HRQoL). The benchmark for clinical assessments is task-based measures, which are not always feasible to administer and may miss essential components of HRQoL. In this study, the authors tested the hypothesis that variations in natural language (NL) correlate with HRQoL in a pattern distinct from task-based measures of language performance. Methods: NL use was assessed using audio samples collected unobtrusively from 18 patients with newly diagnosed low- and high-grade glioma. NL measures were calculated using manual segmentation and correlated with Quality of Life in Neurological Disorders (Neuro-QoL) outcomes. Spearman's rank-order correlation was used to determine relationships between Neuro-QoL scores and NL measures. Results: The distribution of NL measures across the entire patient cohort included a mean ± SD total time speaking of 11.5 ± 2.20 seconds, total number of words of 27.2 ± 4.44, number of function words of 10.9 ± 1.68, number of content words of 16.3 ± 2.91, and speech rate of 2.61 ± 0.20 words/second. Speech rate was negatively correlated with functional domains (rho = -0.62 and p = 0.007 for satisfaction with social roles; rho = -0.74 and p < 0.001 for participation in social roles) but positively correlated with impairment domains (rho = 0.58 and p = 0.009 for fatigue) of Neuro-QoL. Conclusions: Assessment of NL at the time of diagnosis may be a useful measure in the context of treatment planning and monitoring outcomes for adult patients with glioma.
MeSH term(s)	Adult ; Cohort Studies ; Glioma/complications ; Humans ; Language ; Quality of Life ; Speech
Language	English
Publishing date	2021-07-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	3089-2
ISSN	1933-0693 ; 0022-3085
ISSN (online)	1933-0693
ISSN	0022-3085
DOI	10.3171/2021.1.JNS203387
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Article ; Online: Facial Nerve Preservation for Supraorbital Approaches: Anatomical Mapping Based on Consistent Landmarks.

García-García, Sergio / González-Sánchez, José Juan / Kakaizada, Sofia / Lawton, Michael T / Benet, Arnau

Operative neurosurgery (Hagerstown, Md.)

2019 Volume 18, Issue 1, Page(s) 52–59

Abstract: Background: The supraorbital keyhole approach (SOKA) provides a safe and advantageous access to the anterior cranial fossa. The implemented skin incision varies depending on surgeon's preferences and requirements. Facial nerve (FN) injury might appear ... ...

Abstract	Background: The supraorbital keyhole approach (SOKA) provides a safe and advantageous access to the anterior cranial fossa. The implemented skin incision varies depending on surgeon's preferences and requirements. Facial nerve (FN) injury might appear in up to 5.6% of patients. There is a lack of validated tenets for avoiding FN injury. Objective: To define a safety area for FN preservation during a SOKA. Methods: Ten dried skulls and 5 injected cadaveric heads (10 sides) were used. A Cartesian frame was created with its horizontal axis at the level of the supraorbital notch and the vertical axis just lateral to the frontozygomatic junction (FZj). FNs were dissected and points along their course were registered and transferred to the Cartesian frame. Results: Ten microscopic dissections of the FN were performed preserving all branches. A safety area could be defined 8 mm superior and 10 mm inferior to the FZj extending medially to the supraorbital notch and beyond. A 20 mm2 area superior and lateral to the FZj provided low probability (≤10%) of injuring the FN. Similarly, starting 4 mm inferior to the FZj, a lateral safety area was also found. A probabilistic colored heat map was built to represent the results. Conclusion: We provide a "safety zone" for a SOKA incision in which the probability to encounter the FN is low. Clinical studies following our method may validate our findings and add evidence to the tenets for minimizing morbidity related to the SOKA incision.
MeSH term(s)	Craniotomy/methods ; Facial Nerve Injuries/prevention & control ; Humans ; Microdissection/methods ; Neurosurgical Procedures/methods
Language	English
Publishing date	2019-04-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2767575-0
ISSN	2332-4260 ; 2332-4252
ISSN (online)	2332-4260
ISSN	2332-4252
DOI	10.1093/ons/opz084
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Article ; Online: Letter to the Editor Regarding "Contralateral, Transfalcine Approach to Mesial Frontoparietal Region and Cingulate Gyrus: Cadaveric Feasibility Study".

Garcia-Garcia, Sergio / Gonzalez-Sanchez, Jose Juan / Kakaizada, Sofia / Lawton, Michael T / Benet, Arnau

World neurosurgery

2019 Volume 130, Page(s) 573

MeSH term(s)	Brain Mapping ; Cadaver ; Feasibility Studies ; Gyrus Cinguli ; Humans ; Neurosurgical Procedures
Language	English
Publishing date	2019-09-30
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2019.05.178
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Article ; Online: The pterygoclival ligament: a novel landmark for localization of the internal carotid artery during the endoscopic endonasal approach.

Tayebi Meybodi, Ali / Little, Andrew S / Vigo, Vera / Benet, Arnau / Kakaizada, Sofia / Lawton, Michael T

Journal of neurosurgery

2018 , Page(s) 1–11

Abstract: Objective: The transpterygoid extension of the endoscopic endonasal approach provides exposure of the petrous apex, Meckel's cave, paraclival area, and the infratemporal fossa. Safe and efficient localization of the lacerum segment of the internal ... ...

Abstract	Objective: The transpterygoid extension of the endoscopic endonasal approach provides exposure of the petrous apex, Meckel's cave, paraclival area, and the infratemporal fossa. Safe and efficient localization of the lacerum segment of the internal carotid artery (ICA) is a crucial part of such exposure. The aim of this study is to introduce a novel landmark for localization of the lacerum ICA. Methods: Ten cadaveric heads were prepared for transnasal endoscopic dissection. The floor of the sphenoid sinus was drilled to expose an extension of the pharyngobasilar fascia between the sphenoid floor and the pterygoid process (the pterygoclival ligament). Several features of the pterygoclival ligament were assessed. In addition, 31 dry skulls were studied to assess features of the bony groove harboring the pterygoclival ligament. Results: The pterygoclival ligament was identified bilaterally during drilling of the sphenoid floor in all specimens. The ligament started a few millimeters posterior to the posterior end of the vomer alae and invariably extended posterolaterally and superiorly to blend into the fibrous tissue around the lacerum ICA. The mean length of the ligament was 10.5 ± 1.7 mm. The mean distance between the anterior end of the ligament and midline was 5.2 ± 1.2 mm. The mean distance between the posterior end of the ligament and midline was 12.3 ± 1.4 mm. The bony pterygoclival groove was identified at the confluence of the vomer, pterygoid process of the sphenoid, and basilar part of the occipital bone, running from posterolateral to anteromedial. The mean length of the groove was 7.7 ± 1.8 mm. Its posterolateral end faced the anteromedial aspect of the foramen lacerum medial to the posterior end of the vidian canal. A clinical case illustration is also provided. Conclusions: The pterygoclival ligament is a consistent landmark for localization of the lacerum ICA. It may be used as an adjunct or alternative to the vidian nerve to localize the ICA during endoscopic endonasal surgery.
Language	English
Publishing date	2018-05-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	3089-2
ISSN	1933-0693 ; 0022-3085
ISSN (online)	1933-0693
ISSN	0022-3085
DOI	10.3171/2017.12.JNS172435
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Article ; Online: Convergence of heteromodal lexical retrieval in the lateral prefrontal cortex.

Aabedi, Alexander A / Kakaizada, Sofia / Young, Jacob S / Kaur, Jasleen / Wiese, Olivia / Valdivia, Claudia / Krishna, Saritha / Weyer-Jamora, Christina / Berger, Mitchel S / Weissman, Daniel H / Brang, David / Hervey-Jumper, Shawn L

Scientific reports

2021 Volume 11, Issue 1, Page(s) 6305

Abstract: Lexical retrieval requires selecting and retrieving the most appropriate word from the lexicon to express a desired concept. Few studies have probed lexical retrieval with tasks other than picture naming, and when non-picture naming lexical retrieval ... ...

Abstract	Lexical retrieval requires selecting and retrieving the most appropriate word from the lexicon to express a desired concept. Few studies have probed lexical retrieval with tasks other than picture naming, and when non-picture naming lexical retrieval tasks have been applied, both convergent and divergent results emerged. The presence of a single construct for auditory and visual processes of lexical retrieval would influence cognitive rehabilitation strategies for patients with aphasia. In this study, we perform support vector regression lesion-symptom mapping using a brain tumor model to test the hypothesis that brain regions specifically involved in lexical retrieval from visual and auditory stimuli represent overlapping neural systems. We find that principal components analysis of language tasks revealed multicollinearity between picture naming, auditory naming, and a validated measure of word finding, implying the existence of redundant cognitive constructs. Nonparametric, multivariate lesion-symptom mapping across participants was used to model accuracies on each of the four language tasks. Lesions within overlapping clusters of 8,333 voxels and 21,512 voxels in the left lateral prefrontal cortex (PFC) were predictive of impaired picture naming and auditory naming, respectively. These data indicate a convergence of heteromodal lexical retrieval within the PFC.
MeSH term(s)	Adult ; Aged ; Aphasia/rehabilitation ; Brain Mapping ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/psychology ; Case-Control Studies ; Comprehension ; Female ; Glioma/diagnostic imaging ; Glioma/psychology ; Humans ; Language Tests ; Longitudinal Studies ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Prefrontal Cortex/diagnostic imaging ; Prefrontal Cortex/physiopathology ; Prospective Studies ; Reading ; Semantics ; Speech
Language	English
Publishing date	2021-03-18
Publishing country	England
Document type	Clinical Trial ; Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-85802-5
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Article ; Online: Functional alterations in cortical processing of speech in glioma-infiltrated cortex.

Aabedi, Alexander A / Lipkin, Benjamin / Kaur, Jasleen / Kakaizada, Sofia / Valdivia, Claudia / Reihl, Sheantel / Young, Jacob S / Lee, Anthony T / Krishna, Saritha / Berger, Mitchel S / Chang, Edward F / Brang, David / Hervey-Jumper, Shawn L

Proceedings of the National Academy of Sciences of the United States of America

2021 Volume 118, Issue 46

Abstract: Recent developments in the biology of malignant gliomas have demonstrated that glioma cells interact with neurons through both paracrine signaling and electrochemical synapses. Glioma-neuron interactions consequently modulate the excitability of local ... ...

Abstract	Recent developments in the biology of malignant gliomas have demonstrated that glioma cells interact with neurons through both paracrine signaling and electrochemical synapses. Glioma-neuron interactions consequently modulate the excitability of local neuronal circuits, and it is unclear the extent to which glioma-infiltrated cortex can meaningfully participate in neural computations. For example, gliomas may result in a local disorganization of activity that impedes the transient synchronization of neural oscillations. Alternatively, glioma-infiltrated cortex may retain the ability to engage in synchronized activity in a manner similar to normal-appearing cortex but exhibit other altered spatiotemporal patterns of activity with subsequent impact on cognitive processing. Here, we use subdural electrocorticography to sample both normal-appearing and glioma-infiltrated cortex during speech. We find that glioma-infiltrated cortex engages in synchronous activity during task performance in a manner similar to normal-appearing cortex but recruits a diffuse spatial network. On a temporal scale, we show that signals from glioma-infiltrated cortex have decreased entropy, which may affect its ability to encode information during nuanced tasks such as production of monosyllabic versus polysyllabic words. Furthermore, we show that temporal decoding strategies for distinguishing monosyllabic from polysyllabic words were feasible for signals arising from normal-appearing cortex but not from glioma-infiltrated cortex. These findings inform our understanding of cognitive processing in chronic disease states and have implications for neuromodulation and prosthetics in patients with malignant gliomas.
MeSH term(s)	Adult ; Brain Neoplasms/physiopathology ; Cerebral Cortex/physiopathology ; Electrocorticography/methods ; Glioma/physiopathology ; Humans ; Neurons/physiology ; Speech/physiology ; Temporal Lobe/physiopathology
Language	English
Publishing date	2021-10-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	209104-5
ISSN	1091-6490 ; 0027-8424
ISSN (online)	1091-6490
ISSN	0027-8424
DOI	10.1073/pnas.2108959118
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Article ; Online: Presurgical simulation for neuroendoscopic procedures: Virtual study of the integrity of neurological pathways using diffusion tensor imaging tractography.

Garcia-Garcia, Sergio / Kakaizada, Sofia / Oleaga, Laura / Benet, Arnau / Rincon-Toroella, Jordina / González-Sánchez, José Juan

Neurology India

2019 Volume 67, Issue 3, Page(s) 763–769

Abstract: Background: White matter (WM) transgression is an unexplored concept in neuroendoscopy. Diffusion tensor image (DTI) tractography could be implemented as a planning and postoperative evaluation tool in functional disconnection procedures (FDPs), which ... ...

Abstract	Background: White matter (WM) transgression is an unexplored concept in neuroendoscopy. Diffusion tensor image (DTI) tractography could be implemented as a planning and postoperative evaluation tool in functional disconnection procedures (FDPs), which are, currently, the subject of technological innovations. We intend to prove the usefulness of this planning method focused on the assessment of WM injury that is suitable for planning FDPs. Methods: Ten cranial magnetic resonance studies (20 sides) without pathological findings were processed. Fascicles were defined by two regions of interest (ROIs) using the fiber assignment method by the continuous tracking approach. Using three-dimensional (3D) simulation and DTI tractography, we created an 8-mm virtual endoscope and an uninjured inferior fronto-occipital fasciculus (IFOF) from two ROIs. The injured tract was generated using a third ROI built from the 3D model of the intersection of the oriented trajectory of the endoscope with the fascicle. Data and images were quantitatively and qualitatively analyzed. Results: The average percentage of the injured fibers was 32.0% (range: 12.4%-70%). The average intersected volume was 1.1 cm3 (range: 0.3-2.3 cm3). Qualitative analysis showed the inferior medial quadrant of the inferior fronto-occipital fasciculus (IFOF) as the most frequently injured region. No hemispherical asymmetry was found (P > 0.5). Conclusion: DTI tractography is a useful surgical planning tool that could be implemented in several endoscopic procedures. Together with a functional atlas, the presented technique provides a noninvasive method to assess the potential sequelae and thus to optimize the surgical route. The suggested method could be implemented to analyze pathological WM fascicles and to assess the surgical results of FDP such as hemispherotomy or amygdalohippocampectomy. More studies are needed to overcome the limitations of the tractography based information and to develop more anatomically and functionally reliable planning systems.
MeSH term(s)	Brain Injuries/diagnostic imaging ; Brain Injuries/etiology ; Brain Injuries/prevention & control ; Diffusion Tensor Imaging ; Humans ; Neural Pathways/diagnostic imaging ; Neural Pathways/injuries ; Neuroendoscopy/adverse effects ; Postoperative Complications/diagnostic imaging ; Postoperative Complications/etiology ; Preoperative Care ; Preoperative Period ; Simulation Training ; Treatment Outcome ; White Matter/diagnostic imaging ; White Matter/injuries
Language	English
Publishing date	2019-07-26
Publishing country	India
Document type	Journal Article
ZDB-ID	415522-1
ISSN	1998-4022 ; 0028-3886
ISSN (online)	1998-4022
ISSN	0028-3886
DOI	10.4103/0028-3886.263199
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Article ; Online: Contralateral Transfalcine Versus Ipsilateral Anterior Interhemispheric Approach for Midline Arteriovenous Malformations: Surgical and Anatomical Assessment.

García-García, Sergio / González-Sánchez, José Juan / Gandhi, Sirin / Tabani, Halima / Meybodi, Ali Tayebi / Kakaizada, Sofia / Lawton, Michael T / Benet, Arnau

World neurosurgery

2018 Volume 119, Page(s) e1041–e1051

Abstract: Background: The contralateral anterior interhemispheric approach (CAIA) is considered to provide surgical advantages to access deep midline lesions: wider working angle, gravity enhanced dissection and retraction, more efficient lighting, and ergonomics. ...

Abstract	Background: The contralateral anterior interhemispheric approach (CAIA) is considered to provide surgical advantages to access deep midline lesions: wider working angle, gravity enhanced dissection and retraction, more efficient lighting, and ergonomics. Our team has previously published on the merits of using a contralateral trajectory for medial frontoparietal arteriovenous malformations (AVMs) compared with the conventional anterior interhemispheric approach (IAIA). In this article, we compare the IAIA and CAIA for the resection of medial frontoparietal AVMs using quantitative surgical and anatomical analysis. Methods: Two models were designed mimicking the most common features of midline AVMs. The CAIA and IAIA were performed bilaterally in 10 specimens. Variables to compare technical feasibility (surgical window [SW] and surgical freedom [SF], target exposure, and angle of attack) were independently assessed using stereotactic navigation. The average SW, SF, and angle of attack were compared with the Student t test. Significance threshold was set at 0.05. Results: The CITA and IAIA were similar in terms of SW, target exposure, and SF in the superior aspect of the AVM. In the depth of the interhemispheric fissure, the CAIA was significantly superior to IAIA in both AVM models: 77% wider AA for the inferior aspect of the AVM (P < 0.01) and greater SF for the draining vein (54%, P = 0.01), ipsilateral (98%, P = 0.02), and contralateral ACA (117%, P < 0.01). Conclusions: This study suggests technical superiority of the CAIA for the resection of deep midline AVMs. No objective difference was noted in the superficial areas of our models, denoting that IAIA is a safer choice for superficial AVMs. Our results set the foundation for further clinical analysis comparing both approaches.
MeSH term(s)	Female ; Functional Laterality ; Humans ; Intracranial Arteriovenous Malformations/diagnostic imaging ; Intracranial Arteriovenous Malformations/pathology ; Intracranial Arteriovenous Malformations/surgery ; Male ; Middle Aged ; Neurosurgical Procedures/methods ; Treatment Outcome
Language	English
Publishing date	2018-08-23
Publishing country	United States
Document type	Case Reports ; Comparative Study ; Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2018.08.074
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