Identification of Preoperative Language Tracts for Intrinsic Frontotemporal Diseases: A Pilot Reconstruction Algorithm in a Middle-Income Country.

Autor: Ordóñez-Rubiano EG; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia. Electronic address: egordonez@fucsalud.edu.co., Valderrama-Arias FA; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia., Forbes JA; Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Johnson JM; Neuroradiology, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Younus I; Weill Cornell Medical College, New York, New York, USA., Marín-Muñoz JH; Diagnostic Imaging, Department of Diagnostic Radiology, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia., Sánchez-Montaño M; Neuroradiology, Department of Diagnostic Radiology, Instituto Nacional de Ciencias Médicas y Nutrición, Tlalpan, Ciudad de México, Mexico., Angulo DA; IMAGINE, Systems and Computing Engineering, Universidad de los Andes, Bogotá, Colombia; ImExHS, Imex-Research, Bogotá, Colombia., Cifuentes-Lobelo HA; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia., Cortes-Lozano W; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia., Pedraza-Ciro MC; Department of Neurological Surgery, Clínica Los Nogales, Bogotá, Colombia., Bello-Dávila ML; Department of Neurology, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia., Patiño-Gómez JG; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia., Ordóñez-Mora EG; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2019 May; Vol. 125, pp. e729-e742. Date of Electronic Publication: 2019 Feb 05.
DOI: 10.1016/j.wneu.2019.01.163
Abstrakt: Objective: Diffusion tensor imaging (DTI) tractography provides useful information that can be used to optimize surgical planning and help avoid injury during subcortical dissection of eloquent tracts. The objective is to provide a safe, timely, and affordable algorithm for preoperative DTI language reconstruction for intrinsic frontotemporal diseases.
Methods: We reviewed a prospectively acquired database of preoperative DTI reconstruction for resection of left frontotemporal lesions over 3 years at Hospital de San José and Hospital Infantil Universitario San José, Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia. Preoperative and postoperative clinical and radiographic features were determined from retrospective chart review. A comprehensive review of the structural and functional anatomy of the language tracts was performed. Separate reconstruction of both ventral (semantic) and dorsal (phonologic) stream pathways is described: arcuate fasciculus, superior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, and inferior longitudinal fasciculus.
Results: Between January 2015 and January 2018, 44 tumor cases were found to be resected with preoperative fiber tracking planning and neuronavigation-guided surgery. Ten patients (7 women, 3 men) aged 28-65 years underwent resection of an intrinsic frontotemporal lesion with preoperative DTI tractography reconstruction of language tracts. Eight cases (80%) were high-grade gliomas and 2 (20%) were cavernous malformations. In 5 cases (50%), the lesion was in the frontal lobe and in 5 (50%), it was in the temporal lobe. The extent of resection was classified as gross total resection (100%), subtotal resection (>90%), or partial resection (<90%). Gross total resection was achieved in 5 cases (50%), subtotal resection was achieved in 4 cases (40%), and partial resection in the remaining case (10%). Compromised tracts included superior longitudinal fasciculus in 7 (70%), inferior longitudinal fasciculus in 4 (40%), the arcuate fasciculus in 3 (30%), and uncinate fasciculus in 1 (10%). Language function was unchanged or improved in 90% of patients. New-onset postoperative language decline occurred in 1 patient, who recovered transient phonemic paraphasias 1 month after resection. The mean follow-up time was 7 months (range, 4-12 months). Residual tumors were treated with radiation and/or with chemotherapy as indicated in an outpatient setting.
Conclusions: We present a safe and efficacious preoperative DTI language reconstruction algorithm that could be used as a feasible treatment strategy in a challenging subset of tumors in low- to middle-income countries.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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