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Awake Craniotomy for a Left Pan-Hippocampal Diffuse Low-Grade Glioma in a Deaf and Mute Patient Using Sign Language.
World Neurosurg. 2020 Feb; 134:629-634.e1.WN

Abstract

BACKGROUND

Awake craniotomy is becoming an essential technique, especially for intrinsic brain tumors which have no clear margins and where extent of resection (EOR) matters. However, intraoperative monitoring for awaken patients requires voice feedback in regular settings. Resection of hippocampal glioma is challenging because of its deep-seated location, its extension in an anterior-posterior axis, and being covered with eloquent cortex. We present a native deaf and mute patient, who has been diagnosed of a left pan-hippocampal glioma, who underwent an awake craniotomy using sign language during intraoperative monitoring.

CASE DESCRIPTION

The patient was a 58-year-old, right-handed, native deaf and mute woman who was diagnosed with a left pan-hippocampal glioma. Magnetic resonance imaging (MRI) revealed an intrinsic, nonenhanced, expansile lesion involving the pan-hippocampus. Functional MRI preferred a right hemisphere-dominant pattern. Neuropsychologic testing was normal. An awake craniotomy was successfully performed using sign language to preserve her remaining sole method of communication. A standard sleep-awake-sleep protocol with a transmiddle temporal gyrus (2.5 × 1 cm gyrectomy) approach was performed after a negative mapping result. More than 90% EOR was achieved with only a 0.7 cm3 residual tumor at the hippocampal tail. The pathology was anaplastic ganglioglioma, Ki-67 70%, and World Health Organization grade III. Her postoperative neuropsychologic status was the same as preoperative condition.

CONCLUSIONS

We demonstrated using sign language for intraoperative monitoring is feasible in a native deaf and mute patient. We also showed a navigation-assisted minimal transcortical approach to achieve >90% EOR for a pan-hippocampal glioma in a single-stage operation.

Authors+Show Affiliations

Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; PhD Program in Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan. Electronic address: chenkoting@gmail.com.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31790835

Citation

Chen, Po-An, et al. "Awake Craniotomy for a Left Pan-Hippocampal Diffuse Low-Grade Glioma in a Deaf and Mute Patient Using Sign Language." World Neurosurgery, vol. 134, 2020, pp. 629-634.e1.
Chen PA, Chen YC, Wei KC, et al. Awake Craniotomy for a Left Pan-Hippocampal Diffuse Low-Grade Glioma in a Deaf and Mute Patient Using Sign Language. World Neurosurg. 2020;134:629-634.e1.
Chen, P. A., Chen, Y. C., Wei, K. C., & Chen, K. T. (2020). Awake Craniotomy for a Left Pan-Hippocampal Diffuse Low-Grade Glioma in a Deaf and Mute Patient Using Sign Language. World Neurosurgery, 134, 629-e1. https://doi.org/10.1016/j.wneu.2019.11.129
Chen PA, et al. Awake Craniotomy for a Left Pan-Hippocampal Diffuse Low-Grade Glioma in a Deaf and Mute Patient Using Sign Language. World Neurosurg. 2020;134:629-634.e1. PubMed PMID: 31790835.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Awake Craniotomy for a Left Pan-Hippocampal Diffuse Low-Grade Glioma in a Deaf and Mute Patient Using Sign Language. AU - Chen,Po-An, AU - Chen,Yi-Chun, AU - Wei,Kuo-Chen, AU - Chen,Ko-Ting, Y1 - 2019/11/29/ PY - 2019/11/01/received PY - 2019/11/21/revised PY - 2019/11/22/accepted PY - 2019/12/4/pubmed PY - 2019/12/4/medline PY - 2019/12/3/entrez KW - Awake craniotomy KW - Functional magnetic resonance imaging KW - Hippocampal glioma KW - Sign language KW - Transcortical approach SP - 629 EP - 634.e1 JF - World neurosurgery JO - World Neurosurg VL - 134 N2 - BACKGROUND: Awake craniotomy is becoming an essential technique, especially for intrinsic brain tumors which have no clear margins and where extent of resection (EOR) matters. However, intraoperative monitoring for awaken patients requires voice feedback in regular settings. Resection of hippocampal glioma is challenging because of its deep-seated location, its extension in an anterior-posterior axis, and being covered with eloquent cortex. We present a native deaf and mute patient, who has been diagnosed of a left pan-hippocampal glioma, who underwent an awake craniotomy using sign language during intraoperative monitoring. CASE DESCRIPTION: The patient was a 58-year-old, right-handed, native deaf and mute woman who was diagnosed with a left pan-hippocampal glioma. Magnetic resonance imaging (MRI) revealed an intrinsic, nonenhanced, expansile lesion involving the pan-hippocampus. Functional MRI preferred a right hemisphere-dominant pattern. Neuropsychologic testing was normal. An awake craniotomy was successfully performed using sign language to preserve her remaining sole method of communication. A standard sleep-awake-sleep protocol with a transmiddle temporal gyrus (2.5 × 1 cm gyrectomy) approach was performed after a negative mapping result. More than 90% EOR was achieved with only a 0.7 cm3 residual tumor at the hippocampal tail. The pathology was anaplastic ganglioglioma, Ki-67 70%, and World Health Organization grade III. Her postoperative neuropsychologic status was the same as preoperative condition. CONCLUSIONS: We demonstrated using sign language for intraoperative monitoring is feasible in a native deaf and mute patient. We also showed a navigation-assisted minimal transcortical approach to achieve >90% EOR for a pan-hippocampal glioma in a single-stage operation. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31790835/Awake_Craniotomy_for_a_Left_Pan-Hippocampal_Diffuse_Low-Grade_Glioma_in_a_Deaf_and_Mute_Patient_Using_Sign_Language L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)32979-1 DB - PRIME DP - Unbound Medicine ER -