Surgical treatment of gangliogliomas in functional areas of the brain in child: a literature review and clinical cases

Surgical treatment of tumors located near functional areas involves the use of technologies such as awake craniotomy, cortical and subcortical stimulation. The introduction of these and other technologies makes it possible to achieve maximum resection of the tumor without compromising the functional status of the patient. The use of this technologies has been well studied in adults, but this not about pediatric patients.

Aim of the work is to present two clinical cases of successful treatment of low‑grade gliomas of functional areas of the brain in children and literature review.

In clinical cases, damage of functionally significant areas were noted: the sensory speech cortex and the corticospinal tract. The involving speech cortex in the first case was also confirmed by functional magnetic resonance imaging. In the first case, an operation was performed with awake craniotomy, using cortical and subcortical mapping, in the second, using subcortical mapping and metabolic navigation. Total tumor resection was achieved in both clinical cases with a good functional outcome.

Achieving an optimal balance of functional outcome and the degree of radical removal of low‑grade tumors of functional areas is possible using an integrated approach based on the analysis of multimodal data.

1. Hervey-Jumper S.L., Berger M.S. Introduction: surgical management of eloquent area tumors. Neurosurgery 2020;87(6):1076–7. DOI: 10.1093/neuros/nyaa358

2. Bandopadhayay P., Bergthold G., London W.B. et al. Long-term outcome of 4,040 children diagnosed with pediatric low-grade gliomas: an analysis of the Surveillance Epidemiology and End Results (SEER) database. Pediatr Blood Cancer 2014;61(7): 1173–9. DOI: 10.1002/pbc.24958

3. Diwanji T.P., Engelman A., Snider J.W., Mohindra P. Epidemiology, diagnosis, and optimal management of glioma in adolescents and young adults. Adolesc Health Med Ther 2017;8:99–113. DOI: 10.2147/AHMT.S53391

4. Van den Bent M.J., Snijders T.J., Bromberg J.E. Current treatment of low grade gliomas. Memo 2012;5(3):223–7. DOI: 10.1007/s12254-012-0014-3

5. Delion M., Terminassian A., Lehousse T. et al. Specificities of awake craniotomy and brain mapping in children for resection of supratentorial tumors in the language area. World Neurosurg 2015;84(6):1645–52. DOI: 10.1016/j.wneu.2015.06.073

6. Balogun J.A., Khan O.H., Taylor M. et al. Pediatric awake craniotomy and intra-operative stimulation mapping. J Clin Neurosci 2014;21(11):1891–4. DOI: 10.1016/j.jocn.2014.07.013

7. Kumirova E.V. New approaches in the diagnosis of tumors of the central nervous system in children. Rossijskij zhurnal detskoj onkologii i gematologii = Russian Journal of Pediatric Hematology and Oncology 2017;4:37–45. (In Russ.). DOI: 10.17650/2311-1267-2017-4-1-37-45

8. Blionas A., Giakoumettis D., Klonou A. et al. Paediatric gliomas: diagnosis, molecular biology and management. Ann Transl Med 2018;6(12):251. DOI: 10.21037/atm.2018.05.11

9. Aghi M.K., Nahed B.V., Sloan A.E. et al. The role of surgery in the management of patients with diffuse low grade glioma: a systematic review and evidence-based clinical practice guideline. J Neurooncol 2015;125(3):503–30. DOI: 10. 1007/s11060-015-1867-1

10. De Benedictis A., Moritz-Gasser S., Duffau H. Awake mappin optimizes the extent of resection for low-grade gliomas in eloquent areas. Neurosurgery 2010;66(6):1074–84; discussion 1084. DOI: 10.1227/01.NEU.0000369514.74284.78

11. Bello L., Gallucci M., Fava M. et al. Intraoperative subcortical language tract mapping guides surgical removal of gliomas involving speech areas. Neurosurgery 2007;60(1):67–80; discussion 80–2. DOI: 10.1227/01.NEU.0000249206.58601.DE

12. De Witt Hamer P.C., Robles S.G., Zwinderman A.H. et al. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol 2012;30(20):2559–65. DOI: 10.1200/jco.2011.38.4818

13. Brown T., Shah A.H., Bregy A. et al. Awake craniotomy for brain tumor resection: the rule rather than the exception? J Neurosurg Anesthesiol 2013;25(3):240–7. DOI: 10.1097/ANA.0b013e318290c2300

14. Akay A., Rükşen M., Çetin H.Y. et al. Pediatric awake craniotomy for brain lesions. Pediatr Neurosurg 2016;51(2):103–8. DOI: 10.1159/000442988

15. Ojemann S.G., Berger M.S., Lettich E., Ojemann G.A. Localization of language function in children: results of electrical stimulation mapping. J Neurosurg 2003;98(3):465–70. DOI: 10.3171/jns. 2003.98.3.0465

16. Riquin E., Martin P., Duverger P. et al. A case of awake craniotomy surgery in an 8-year-old girl. Childs Nerv Syst 2017;33(7):1039–42. DOI: 10.1007/s00381-017-3463-5

17. Lohkamp L.N., Beuriat P.A., Desmurget M. et al. Awake brain surgery in children – a single-center experience. Childs Nerv Syst 2020;36(5):967–74. DOI: 10.1007/s00381-020-04522-9

18. Roth J., Korn A., Sala F. et al. Intraoperative neurophysiology in pediatric supratentorial surgery: experience with 57 cases. Childs Nerv Syst 2020;36(2):315–24. DOI: 10.1007/s00381-019-04356-0

19. Seidel K., Beck J., Stieglitz L. et al. The warning-sign hierarchy between quantitative subcortical motor mapping and continuous motor evoked potential monitoring during resection of supratentorial brain tumors. J Neurosurg 2013;118(2):287–96. DOI: 10.3171/2012.10.jns12895

20. Seidel K., Schucht P., Beck J., Raabe A. Continuous dynamic mapping to identify the corticospinal tract in motor eloquent brain tumors: an update. J Neurol Surg A Cent Eur Neurosurg 2020;81(2):105–10. DOI: 10.1055/s-0039-1698384

21. Raabe A., Beck J., Schucht P., Seidel K. Continuous dynamic mapping of the corticospinal tract during surgery of motor eloquent brain tumors: evaluation of a new method. J Neurosurg 2014;120(5):1015–24. DOI: 10.3171/2014.1.JNS13909

22. Keles G.E., Lundin D.A., Lamborn K.R. et al. Intraoperative subcortical stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients. J Neurosurg 2004;100(3):369–75. DOI: 10.3171/jns.2004.100.3.0369

23. Choi B.D., Mehta A.I., Batich K.A. et al. The use of motor mapping to aid resection of eloquent gliomas. Neurosurg Clin N Am 2012;23(2):215–25, vii. DOI: 10.1016/j.nec.2012.01.013

24. Bello L., Gambini A., Castellano A. et al. Motor and language DTI Fiber Tracking combined with intraoperative subcortical mapping for surgical removal of gliomas. Neuroimage 2008;39(1):369–82. DOI: 10.1016/j.neuroimage.2007.08.031

25. Berman J.I., Berger M.S., Chung S.W. et al. Accuracy of diffusion tensor magnetic resonance imaging tractography assessed using intraoperative subcortical stimulation mapping and magnetic source imaging. J Neurosurg 2007;107(3):488–94. DOI: 10.3171/JNS-07/09/0488

26. Kamada K., Todo T., Ota T. et al. The motor-evoked potential threshold evaluated by tractography and electrical stimulation. J Neurosurg 2009;111(4):785–95. DOI: 10.3171/2008.9.JNS08414

27. Ohue S., Kohno S., Inoue A. et al. Accuracy of diffusion tensor magnetic resonance imaging-based tractography for surgery of gliomas near the pyramidal tract: a significant correlation between subcortical electrical stimulation and postoperative tractography. Neurosurgery 2012;70(2):283–93; discussion 294. DOI: 10.1227/NEU.0b013e31823020e6

28. Wu J.-S., Zhou L.-F., Tang W.-J. et al. Clinical evaluation and follow-up outcome of diffusion tensor imaging-based functional neuronavigation: a prospective, controlled study in patients with gliomas involving pyramidal tract. Neurosurgery 2007;61(5):935–48; discussion 948–9. DOI: 10.1227/01.neu.0000303189.80049.ab

29. Romano A., D’Andrea G., Minniti G. et al. Pre-surgical planning and MR-tractography utility in brain tumour resection. Eur Radiol 2009;19(12):2798–808. DOI: 10.1007/s00330-009-1483-6

30. Alexander A.L., Lee J.E., Lazar M., Field A.S. Diffusion tensor imaging of the brain. Neurotherapeutics 2007;4(3):316–29. DOI: 10.1016/j.nurt.2007.05.011

31. Liang C., Li M., Gong J. et al. A new application of ultrasoundmagnetic resonance multimodal fusion virtual navigation in glioma surgery. Ann Transl Med 2019;7(23):736. DOI: 10.21037/atm.2019.11.113

32. Rutten G.J., Ramsey N.F. The role of functional magnetic resonance imaging in brain surgery. Neurosurg Focus 2010;28(2):E4. DOI: 10.3171/2009.12.FOCUS09251

33. Lee M.H., Miller-Thomas M.M., Benzinger T.L. et al. Clinical resting-state fMRI in the preoperative setting: are we ready for prime time? Top Magn Reson Imaging 2016;25(1):11–8. DOI: 10.1097/RMR.0000000000000075

34. Bukkieva T.A., Pospelova M.L., Efimtsev A.Yu. et al. Functional MRI in the assessment of changes in the brain connectome in patients with post-mastectomy syndrome. Luchevaya diagnostika i terapiya = Diagnostic Radiology and Radiotherapy 2021;12(4): 41–9. (In Russ.). DOI: 10.22328/2079-5343-2021-12-4-41-49

35. Stummer W., Molina E.S. Fluorescence imaging/agents in tumor resection. Neurosurg Clin N 2017;28:569–83. DOI: 10.1016/j.nec.2017.05.009

36. McGirt M.J., Chaichana K.L., Attenello F.J. et al. Extend of surgical resection is independently associated with survival in patients with hemispheric infiltraiting low-grade gliomas. Neurosurgery 2008;63(4):700–8. DOI: 10.1227/01.NEU.0000325729.41085.73

37. Jaber M., Wolfer J., Ewelt C. et al. The value of 5-aminolevulinic acid in low-grade gliomas and high-grade gliomas lacking glioblastoma imaging features: an analysis based on fluorescence, magnetic resonance imaging, 18F-fluoroethyl tyrosine positron emission tomography, and tumor molecular factor. Neurosurgery 2016;78(3):401–11; discussion 411. DOI: 10.1227/NEU.0000000000001020

38. Widhalm G., Wolfsberger S., Minchev G. et al. 5-Aminolevulinic acid is a promising marker for detection of anaplastic foci in diffusely infiltrating gliomas with nonsignificant contrast enhancement. Cancer 2010;116(6):1545–52. DOI: 10.1002/cncr.24903

39. Ewelt C., Floeth F.W., Felsberg J. et al. Finding the anaplastic focus in diffuse gliomas: the value of Gd-DTPA enhanced MRI, FETPET, and intraoperative, ALA-derived tissue fluorescence. Clin Neurol Neurosurg 2011;113(7):541–7. DOI: 10.1016/j.clineuro.2011.03.008

40. Goryaynov S.A., Widhalm G., Goldberg M.F. et al. The role of 5-ALA in low-grade gliomas and the influence of antiepileptic drugs on intraoperative fluorescence. Front Oncol 2019;9:423. DOI: 10.3389/fonc.2019.00423

41. Dragoy O., Chrabaszcz A., Tolkacheva V., Buklina S. Russian intraoperative naming test: a standardized tool to map noun and verb production during awake neurosurgeries. The Russian Journal of Cognitive Science 2016;3(4):4–25. DOI: 10.47010/16.4.1