Language and Visual Deficits after Parietal Lobe Glioma Microsurgery

Authors

  • EJAZ HUSSAIN WADD Department of Neurosurgery, PGMI/Ameer-ud-din Medical College, Lahore General Hospital, Lahore
  • ASIF SHABIR Department of Neurosurgery, PGMI/ Ameer-ud-din Medical College, Lahore General Hospital Lahore
  • LIAQAT MEHMOOD AWAN Department of Neurosurgery, PGMI/ Ameer-ud-din Medical College, Lahore General Hospital Lahore
  • RIZWAN MASOOD BUTT Department of Neurosurgery, PGMI/Ameer-ud-din Medical College, Lahore General Hospital, Lahore
  • ANJUM HABIB VOHRA Department of Neurosurgery, PGMI/Ameer-ud-din Medical College, Lahore General Hospital, Lahore

Keywords:

parietal lobe glioma, Visual deficits, Language deficits, Supramarginal gyrus, Angular gyrus, Parietal lobe syndromes

Abstract

Objective: To see language and visual field outcome after high grade glioma excision of parietal lobe area.
Study Design: It was observational experimental study.
Setting: Department of neurosurgery unit 1, Lahore General Hospital, Lahore.
Duration: Three years from March 2015 to April 2018.
Inclusion Criteria: Both male and female of 13 to 56 yrs of age having intrinsic tumours in left or right parietal lobe area with midline shift, seizure and headache.
Exclusion Criteria: Butterfly glioma, gliomatosis cerebri, lymphoma suspected on MRI brain, patient unfit for anaesthesia and surgery. The patients on anticoagulants and with bleeding disorder were also excluded from the surgery. The patients with chronic systemil ailment like renal failure, liver failure and ischemic heart disease were also excluded from the study.
Material and Methods: Two hundred and forty one (241) patients were included in the study. All patients were prepared for the surgery and informed consent obtained from all patients. All patients under went microsurgical excision of the tumours and followed for 3 months. But forty patients lost to follow-up in three months.
Results: Maximum tumor resection was attempted up to 99 percent. Median age was 47 years (13 – 56 years) and kernofsky performance scale was 75 percent at presentation. Most common presentation was seizure 76 percent, only 3.5 percent presented with parietal lobe syndromes. The most common deficit was language disturbance, which was also noticed in patients with right parietal lobe gliomas. Parietal lobe gliomas produce language and visual deficits in addition to other neurological dysfunction.
Recommendations: Result can be improved by preoperative better localization with diffusion tensor tractography and peroperative cortical mapping.
Conclusions: Microsurgical resection would increase language and visual deficits in tumors located on supramarginal and angular gyri which are reduced in postoperative period and become fixed in three months.

References

1. Duffau H, Denvil D, Lopes M, Gasparini F, and Cohen L, Capelle L et al: intraoperative mapping of the corti-cal areas involved in multiplication subtractions: an electrostimulation study in a patient with a left parietal glioma. J Neurol Neurog Psychiatry.
2. Kurimoto M, Asahi T, Shibata T, Takahashi C, Nagai S, Hayashi N, et al: save removal of glioblastoma near the angular gyrus by awake surgery preserving calcu-lation ability case report. Neurol Medi Chir (Tokyo) 2006; 46: 46-50.
3. McGirt MJ, Mukherjee D, Chaichana KL, Weingart JD, Quinonas HA: Association of surgically acquired motor and language deficits on overall survival after resection of glioblastoma multiforme. Neurosurgery, 2009; 65: 463-470.
4. Nakano M, Tanaka S, Aria H, Ebato M, Ueno H: (a case of selective short-term memory disturbance due to a glioma in the left temporo-parietal lobe). No To Sheinkel. 1993; 45: 465-471, (JPN).
5. Nadir S, Juan Mand M. Morbidity profile following aggressive resection of parietal lobe gliomas. J Neuro-surgery, 2012; 116: 1182-1186.
6. Russell SM, Elliott R, Forshaw D, Kelly PJ, Folfinos JG. Resection of parietal lobe gliomas: incident and evolution of neurological deficits in 28 consecutive pat-ients correlated to the location and morphological cha-racteristics of the tumor. J Neurosurgery, 2005;103:1010-1017.
7. Sanai N, Mirzadeh Z, Berger MS: functional outcome after language mapping for glioma resection. N Engl J Med. 2008; 358: 18-17.
8. Scarone P, Gatignal P, Guillaume S, Denvil D, and Ca-pelle L, Duffau H: agraphia after awake surgery for brain tumors for brain tumor: new insight into the anatomy: functional network of writing. Sur Neurol. 2009; 72: 223-241.
9. Zangwill OL, Agraphia due to a left parietal glioma in a left handed man. Brain, 1954; 77: 510-520.
10. Odeku EL, Adeloye A. Gliomas of the brain among Nigerians. Afr J Med Med Sci. 1976; 5: 31-3.
11. Central Brain Tumour Registry of the United States (CBTRUS). CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumours Diagnosed in the United States in 2004–2007. Hinsdale, IL; 2011. p. 48.
12. Ohgaki H, Kleihues P. The definition of primary and secondary glioblastoma. Clin Cancer Res. 2013; 19: 764-72.
13. Wai-man L, Kan-suen JP. Astrocytomas. In: Greenberg MS, editor. Handbook of Neurosurgery. 8th ed. New York: Thieme Medical Publishers; 2016: p. 612-28.
14. Della Puppa A, De Pellegrin S, d'Avella E, Gioffrè G, Munari M, Saladini M, et al: Right parietal cortex and calculation processing: intraoperative functional map-ping of multiplication and addition in patients affected by a brain tumor. J Neurosurg. 2013; 119: 1107–1111.
15. Duffau H: Brain plasticity: from pathophysiological mechanisms to therapeutic applications. J Clin Neurosci 2006; 13: 885–897.
16. Duffau H: Cognitive assessment in glioma patients. J Neurosurg. 2013 ; 119: 1348–1349.
17. Lefaucheur JP: Transcranial magnetic stimulation in the management of pain. Suppl Clin Neurophysiol. 2004; 57: 737–748.
18. Lefaucheur JP, Drouot X, Ménard-Lefaucheur I, Ngu-yen JP: Neuropathic pain controlled for more than a year by monthly sessions of repetitive transcranial mag-netic stimulation of the motor cortex. Neurophysiol Clin. 2004; 34: 91–95.
19. Louis N, Perry A, Reifenberge RG, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization classification of tumors of the central nervous system: A summary. Acta Neuro-pathol. 2016; 131: 803–20.
20. Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y, et al. CBTRUS statistical report: Pri-mary brain and central nervous system tumors diag-nosed in the United States in 2006–2010. Neuro Oncol. 2013; 15 Suppl. 2ii–56.
21. Koshy M, Villano JL, Dolecek TA, Howard A, Mah-mood U, Chmura SJ, et al. Improved survival time tre-nds of glioblastoma using the SEER 17 population-bas-ed registries. J Neuro Oncol. 2012; 107 (1): 207–12.

Downloads

Published

2018-11-08