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Lönnemark, O., Ryttlefors, M. & Sundblom, J. (2023). Cranioplasty in Brain Tumor Surgery: A Single-Center Retrospective Study Investigating Cranioplasty Failure and Tumor Recurrence. World Neurosurgery, 170, e313-e323
Open this publication in new window or tab >>Cranioplasty in Brain Tumor Surgery: A Single-Center Retrospective Study Investigating Cranioplasty Failure and Tumor Recurrence
2023 (English)In: World Neurosurgery, ISSN 1878-8750, E-ISSN 1878-8769, Vol. 170, p. e313-e323Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Cranioplasty with synthetic implant can be performed to restore function and form of the skull after resection of malignancy infiltrating the bone. The aim of this study was to examine the rate of implant failure and tumor recurrence in patients undergoing nonautologous cranioplasty and tumor resection.

METHODS: In this retrospective single-center study, 48 patients were identified who had undergone cranioplasty with synthetic implants after tumor resection between 2010 and 2020. The medical records were analyzed to investigate patient demographics, surgery data, cranioplasty failure rates, and rate of tumor recurrence.

RESULTS: Cranioplasty failed in 8 patients. The median time to implant failure was 220 days with most failures occurring within 1 year (5 of 8). There was no significant difference in rate or time to failure between the different cranioplasty materials (P = 0.39). Low body mass index (P < 0.05), previous craniectomy/cranioplasty (P < 0.05), previous radiation therapy to the brain/skull (P < 0.05), and skin closure with sutures (P < 0.05) were associated with an increased risk of implant failure. Tumors recurred in 15 patients.

CONCLUSIONS: Cranioplasty surgery with synthetic implants carries a relatively high risk of failure, regardless of type of cranioplasty material used. Skin closure with staples may be beneficial in these patients.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
CNS tumors, Cranioplasty, Cranioplasty failure, Postoperative complications, Synthetic implant
National Category
Surgery Biomaterials Science
Identifiers
urn:nbn:se:uu:diva-490861 (URN)10.1016/j.wneu.2022.11.010 (DOI)000946199900001 ()36356841 (PubMedID)
Available from: 2022-12-15 Created: 2022-12-15 Last updated: 2023-04-14Bibliographically approved
Axelson, H., Latini, F., Jemstedt, M., Ryttlefors, M. & Zetterling, M. (2022). Continuous subcortical language mapping in awake glioma surgery. Frontiers in Oncology, 12, Article ID 947119.
Open this publication in new window or tab >>Continuous subcortical language mapping in awake glioma surgery
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2022 (English)In: Frontiers in Oncology, E-ISSN 2234-943X, Vol. 12, article id 947119Article in journal (Refereed) Published
Abstract [en]

Repetitive monopolar short-train stimulation (STS) delivered from a suction probe enables continuous mapping and distance assessment of corticospinal tracts during asleep glioma resection. In this study, we explored this stimulation technique in awake glioma surgery. Fourteen patients with glioma involving language-related tracts were prospectively included. Continuous (3-Hz) cathodal monopolar STS (five pulses, 250 Hz) was delivered via the tip of a suction probe throughout tumor resection while testing language performance. At 70 subcortical locations, surgery was paused to deliver STS in a steady suction probe position. Monopolar STS influence on language performance at different subcortical locations was separated into three groups. Group 1 represented locations where STS did not produce language disturbance. Groups 2 and 3 represented subcortical locations where STS produced language interference at different threshold intensities (>= 7.5 and <= 5 mA, respectively). For validation, bipolar Penfield stimulation (PS; 60 Hz for 3 s) was used as a "gold standard" comparison method to detect close proximity to language-related tracts and classified as positive or negative regarding language interference. There was no language interference from STS in 28 locations (Group 1), and PS was negative for all sites. In Group 2 (STS threshold >= 7.5 mA; median, 10 mA), there was language interference at 18 locations, and PS (median, 4 mA) was positive in only one location. In Group 3 (STS threshold <= 5 mA; median, 5 mA), there was language interference at 24 locations, and positive PS (median 4 mA) was significantly (p < 0.01) more common (15 out of 24 locations) compared with Groups 1 and 2. Despite the continuous stimulation throughout tumor resection, there were no seizures in any of the patients. In five patients, temporary current spread to the facial nerve was observed. We conclude that continuous subcortical STS is feasibly also in awake glioma surgery and that no language interference from STS or interference at >= 7.5 mA seems to indicate safe distance to language tracts as judged by PS comparisons. STS language interference at STS <= 5 mA was not consistently confirmed by PS, which needs to be addressed.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
awake craniotomy, subcortical electrical stimulation, short-train stimulation, monopolar stimulation, intraoperative language testing, tractography
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-486382 (URN)10.3389/fonc.2022.947119 (DOI)000861048900001 ()36033478 (PubMedID)
Available from: 2022-10-10 Created: 2022-10-10 Last updated: 2024-01-17Bibliographically approved
Svedung-Wettervik, T., Munkhammar, Å. A., Jemstedt, M., Ersson, M., Latini, F., Ryttlefors, M. & Zetterling, M. (2022). Dynamics in cognition and health-related quality of life in grade 2 and 3 gliomas after surgery. Acta Neurochirurgica, 164(12), 3275-3284
Open this publication in new window or tab >>Dynamics in cognition and health-related quality of life in grade 2 and 3 gliomas after surgery
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2022 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 164, no 12, p. 3275-3284Article in journal (Refereed) Published
Abstract [en]

Background

The focus of clinical management and research in gliomas has been on survival, but the interest in the treatment effects on cognition and health-related quality of life (HRQoL) is emerging. The primary aim of this study was to investigate the dynamics in cognition after brain tumor surgery for astrocytomas and oligodendrogliomas grade 2 and 3. The secondary aim was to investigate the association of postoperative changes in cognition with changes HRQoL.

Methods

In this observational study, 48 patients operated for an astrocytoma or oligodendrogliomas, grade 2 or 3, at the Department of Neurosurgery, Uppsala, Sweden, 2016–2021, were included. Cognitive and language skills were assessed with a selected test battery and HRQoL was patient-reported as assessed with RAND-36 pre- and approximately 3 months postoperatively.

Results

There was a significant postoperative decrease in attention span and verbal learning, but the patients improved in the test for visual memory. There was no change in visual attention, executive function, verbal memory, visual organization and construction, verbal fluency, and confrontation naming. The RAND-36 variables physical function, role physical, general health, vitality, and social functioning decreased significantly after surgery. Patients operated for tumor recurrence exhibited greater deterioration in attention and a greater extent of resection correlated with a less pronounced decrease in verbal memory, but there were otherwise weak associations between the dynamics in cognition and patient-, tumor-, and treatment-variables. A decline in cognitive variables was not associated with worse HRQoL.

Conclusions

Although both several cognitive and HRQoL domains deteriorated postoperatively, these changes did not correlate with each other. This highlights the complexity of cognitive and HRQoL dynamics in the early postoperative phase.

Place, publisher, year, edition, pages
Springer Nature, 2022
Keywords
Astrocytoma, Brain tumor, Cognition, Health-related quality of life, Low-grade glioma, Oligodendroglioma
National Category
Neurology
Research subject
Neurosurgery
Identifiers
urn:nbn:se:uu:diva-491006 (URN)10.1007/s00701-022-05408-2 (DOI)000878977700001 ()36331612 (PubMedID)
Funder
Uppsala University
Available from: 2022-12-16 Created: 2022-12-16 Last updated: 2023-03-03Bibliographically approved
Uche, E. O., Sundblom, J., Uko, U. K., Kamalo, P., Doe, A. N., Eriksson, L., . . . Tisell, M. (2022). Global neurosurgery over a 60-year period: Conceptual foundations, time reference, emerging Co-ordinates and prospects for collaborative interventions in low and middle income countries. BRAIN AND SPINE, 2, Article ID 101187.
Open this publication in new window or tab >>Global neurosurgery over a 60-year period: Conceptual foundations, time reference, emerging Co-ordinates and prospects for collaborative interventions in low and middle income countries
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2022 (English)In: BRAIN AND SPINE, ISSN 2772-5294, Vol. 2, article id 101187Article in journal (Refereed) Published
Abstract [en]

Introduction: We evaluated salient initiatives invested in global neurosurgery over a 60-year period.

Research question: What are the Phases, Achievements, Challenges, and Lessons of Global Neurosurgery.

Methods: A 60-year retrospective study from 1960 to 2020 analyzing the major phases, lessons, and progress notes. We reviewed the foundational need questions and innovated tools used to answer them.

Results: Three phases defining our study period were identified. In the early phase, birthing academic units and the onset of individual volunteerism were dominant concepts. The 2nd phase is summarized by the rise of volunteerism and surgical camps. The third phase is heralded by advocacy and strategies for achieving care equity.The defining moment is the Lancet commission for global surgery summit in 2015. Lessons include the need for evaluation of the resources of recipient and donor locations using novel global surgery tools.

Conclusion: Global neurosurgery over the 60-year study period is summarized by indelible touchstones of personal and group efforts as well as triumphs derived from innovations in the face of formidable challenges.

Place, publisher, year, edition, pages
Elsevier BV, 2022
Keywords
Global neurosurgery, Grid references, Volunteerism, Collaboration, Advocacy, Global neurosurgery pro file
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-512199 (URN)10.1016/j.bas.2022.101187 (DOI)001050281200014 ()36506294 (PubMedID)
Available from: 2023-09-25 Created: 2023-09-25 Last updated: 2023-09-25Bibliographically approved
Svedung-Wettervik, T., Ersson, M., Latini, F., Ryttlefors, M. & Zetterling, M. (2022). Patient-reported quality of life in grade 2 and 3 gliomas after surgery, can we do more?. Clinical neurology and neurosurgery, 214, Article ID 107175.
Open this publication in new window or tab >>Patient-reported quality of life in grade 2 and 3 gliomas after surgery, can we do more?
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2022 (English)In: Clinical neurology and neurosurgery, ISSN 0303-8467, E-ISSN 1872-6968, Vol. 214, article id 107175Article in journal (Refereed) Published
Abstract [en]

Objective: To study the effects of surgery and the explanatory variables for patient-reported health-related quality of life (HRQoL) after brain tumor surgery for astrocytomas and oligodendrogliomas grade 2 and 3.

Methods: Patients operated for an astrocytoma or an oligodendrogliomas, grade 2 or 3, at the Department of Neurosurgery, Uppsala, Sweden, 2016-2021, were included. HRQoL was assessed with RAND-36 preoperatively and 4 months postoperatively. Demographic, tumor, and treatment data were prospectively collected.

Results: Sixty-two patients were included, 34 with an astrocytoma and 28 with an oligodendroglioma. Physical function, role physical, general health, vitality, and social functioning decreased significantly (p-values < 0.01) 4 months after surgery, whereas bodily pain, role emotional, and mental health remained unchanged. In Spearman analyses, younger patients deteriorated more in role physical, females worsened less often in general health but more often in social functioning than males, a higher level of education correlated with a more pronounced drop in social functioning, and a greater extent of resection corresponded to a worsening in physical function postoperatively (p-values < 0.05).

Conclusions: Several HRQoL domains deteriorated after glioma surgery in specific groups of patients, particularly general health, vitality, physical, and social functions. This was only weakly explained by surgical variables. Specific groups of patients may need closer follow-ups and tailored support/rehabilitation to detect and address these HRQoL deteriorations.

Place, publisher, year, edition, pages
ElsevierElsevier BV, 2022
Keywords
<p>Astrocytoma</p>, Brain tumor, Health-related quality of life, Low-grade glioma, Oligodendroglioma
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-474323 (URN)10.1016/j.clineuro.2022.107175 (DOI)000788161300003 ()35176634 (PubMedID)
Available from: 2022-05-18 Created: 2022-05-18 Last updated: 2024-01-15Bibliographically approved
Uche, E. O., Sundblom, J., Iloabachie, I., Ozoh, I. I., Alalade, A., Revesz, D., . . . Ryttlefors, M. (2022). Pilot application of Lecture-Panel-Discussion Model (LPDM) in global collaborative neurosurgical education: a novel training paradigm innovated by the Swedish African Neurosurgery Collaboration. Acta Neurochirurgica, 164(4), 967-972
Open this publication in new window or tab >>Pilot application of Lecture-Panel-Discussion Model (LPDM) in global collaborative neurosurgical education: a novel training paradigm innovated by the Swedish African Neurosurgery Collaboration
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2022 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 164, no 4, p. 967-972Article in journal (Refereed) Published
Abstract [en]

Background Disruptions in global surgery educational routines by the COVID-19 pandemic have elicited demands for alternative formats for rendering qualitative neurosurgical education. This study presents application of a novel model of online neurosurgical course, the Lecture-Panel-Discussion Model (LPDM). Methods This is a cross-sectional survey of participants who attended the Swedish African Neurosurgery Collaboration (SANC)-100A course. Participants evaluated the course through an online self-administered questionnaire using a 5-point Likert scale ranging from very poor-1, poor-2, average (fair)-3, good-4, to excellent-5. SANC-100A comprises a tripod of Lectures, Panel review, and interactive case Discussion. This model (LPDM) was innovated by SANC and applied at the Enugu International Neurosurgery course in February 2021. Results There were 71 attendees, 19 were course faculty, while 52 were participants. Thirty-five attended from Nigeria, 11 from Sweden, 3 from Malawi, 2 from Senegal, and 1 from the UK. Among 44 participants who completed the questionnaire, there were 9 fellows and 35 residents. The overall median course Likert rating was 4.65 +/- 0.1. The median overall rating for course events was similar between day 1 (Likert score = 4.45) and day 2 (Likert score = 4.55), U = 55, Z score = 1.10, P = 0.27. The median rating for lectures was 4.50 +/- 0.2 and varied from 4.40 on day 1 to 4.55 on day 2. The median rating for panel review was 4.60 +/- 0.1 and varied from 4.55 on day 1 to 4.65 on day 2. Interactive case discussions were rated 4.80 on both course days. There was a significant variability in the rating profiles of the course tripod: U = 24.5, P = 0.03. Fifty-one (98%) participants believe LPDM was COVID-19-compliant, while 90% believe the course was beneficial to training and practice. Conclusion Initial application of LPDM is rewarded with both high acceptance and high rating among participants.

Place, publisher, year, edition, pages
Springer Nature, 2022
Keywords
Andragogy, Global surgery, Lecture-Panel-Discussion Model, Neurosurgical education, Pedagogy
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-485427 (URN)10.1007/s00701-021-05071-z (DOI)000744771500001 ()35059854 (PubMedID)
Available from: 2022-09-29 Created: 2022-09-29 Last updated: 2022-09-29Bibliographically approved
Sundblom, J., Xheka, F., Casar Borota, O. & Ryttlefors, M. (2021). Bone formation in custom-made cranioplasty: evidence of early and sustained bone development in bioceramic calcium phosphate implants. Patient series. Journal of Neurosurgery: Case Lessons, 1(17)
Open this publication in new window or tab >>Bone formation in custom-made cranioplasty: evidence of early and sustained bone development in bioceramic calcium phosphate implants. Patient series
2021 (English)In: Journal of Neurosurgery: Case Lessons, E-ISSN 2694-1902, Vol. 1, no 17Article in journal (Refereed) Published
Abstract [en]

BACKGROUND

Implant failure (IF) rates in cranioplasty remain high despite efforts to reduce the incidence. New biomaterials may be part of the solution for this problem. Formation of autologous bone in implants may reduce rates of infection and subsequent failure.

OBSERVATIONS

Four patients with calcium phosphate implants supported by titanium mesh and undergoing surgery for reasons unrelated to IF were included in this series. Samples from the implants were microscopically examined. Pathological studies proved the formation of autologous bone in the calcium phosphate implants.

LESSONS

Bone and blood vessel formation in the implants and diminished foreign body reaction to autologous bone may reduce the rates of IF.

Keywords
cranioplasty, bone formation, calcium phosphate, implant failure
National Category
Dentistry
Research subject
Neurosurgery
Identifiers
urn:nbn:se:uu:diva-464161 (URN)10.3171/case20133 (DOI)
Available from: 2022-01-13 Created: 2022-01-13 Last updated: 2022-01-20Bibliographically approved
Latini, F., Trevisi, G., Fahlström, M., Jemstedt, M., Alberius Munkhammar, Å., Zetterling, M., . . . Ryttlefors, M. (2021). New Insights Into the Anatomy, Connectivity and Clinical Implications of the Middle Longitudinal Fasciculus. Frontiers in Neuroanatomy, 14, Article ID 610324.
Open this publication in new window or tab >>New Insights Into the Anatomy, Connectivity and Clinical Implications of the Middle Longitudinal Fasciculus
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2021 (English)In: Frontiers in Neuroanatomy, E-ISSN 1662-5129, Vol. 14, article id 610324Article in journal (Refereed) Published
Abstract [en]

The middle longitudinal fascicle (MdLF) is a long, associative white matter tract connecting the superior temporal gyrus (STG) with the parietal and occipital lobe. Previous studies show different cortical terminations, and a possible segmentation pattern of the tract. In this study, we performed a post-mortem white matter dissection of 12 human hemispheres and an in vivo deterministic fiber tracking of 24 subjects acquired from the Human Connectome Project to establish whether a constant organization of fibers exists among the MdLF subcomponents and to acquire anatomical information on each subcomponent. Moreover, two clinical cases of brain tumors impinged on MdLF territories are reported to further discuss the anatomical results in light of previously published data on the functional involvement of this bundle. The main finding is that the MdLF is consistently organized into two layers: an antero-ventral segment (aMdLF) connecting the anterior STG (including temporal pole and planum polare) and the extrastriate lateral occipital cortex, and a posterior-dorsal segment (pMdLF) connecting the posterior STG, anterior transverse temporal gyrus and planum temporale with the superior parietal lobule and lateral occipital cortex. The anatomical connectivity pattern and quantitative differences between the MdLF subcomponents along with the clinical cases reported in this paper support the role of MdLF in high-order functions related to acoustic information. We suggest that pMdLF may contribute to the learning process associated with verbal-auditory stimuli, especially on left side, while aMdLF may play a role in processing/retrieving auditory information already consolidated within the temporal lobe.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2021
Keywords
diffusion tensor tractography, verbal memory, visual-auditory integration, Human Connectome Project, verbal learning, auditory hallucinations, white matter, MdLF
National Category
Neurosciences Neurology
Identifiers
urn:nbn:se:uu:diva-437229 (URN)10.3389/fnana.2020.610324 (DOI)000617157500001 ()33584207 (PubMedID)
Available from: 2021-03-12 Created: 2021-03-12 Last updated: 2024-01-15Bibliographically approved
Uche, E. O., Eke, C. B., Okafor, O. C., Uche, N. J., Ajuzieogu, O. V., Amuta, D. S., . . . Ryttlefors, M. (2021). Pediatric brain tumor care in a Sub-Saharan setting: current poise of a precariously loaded dice. British Journal of Neurosurgery, 35(2), 174-180
Open this publication in new window or tab >>Pediatric brain tumor care in a Sub-Saharan setting: current poise of a precariously loaded dice
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2021 (English)In: British Journal of Neurosurgery, ISSN 0268-8697, E-ISSN 1360-046X, Vol. 35, no 2, p. 174-180Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the current status of pediatric brain tumor (PBT) care and identify determinants and profiles of survival and school attendance

Methods: An 8-year institution-based prospective longitudinal study. All cases investigated with neuroimaging and treated were enrolled. Data was analyzed with SPSS (Inc) Chicago IL, USA version 23. Chi Square test, One-way ANOVA and confidence limits were used to evaluate associations at the 95% level of significance. Ethical approval for our study was obtained Health Research Ethics Committee of our hospital.

Results: Among 103 patients enrolled, 92 satisfied our study criteria. There were 45 males and 39 females, M: F = 0.8. The mean age was 9.5 +/- 2.1 years 95%CI with a range of 7 months to 16 years. The most common symptom was headache for supratentorial lesions (73%) and gait disturbance (80.2%) for infratentorial lesions. More tumors were supratentorial in location 51 (55.4%), 35 (38.1%) were infratentorial and 6 (6.5%) were transtentorial. Craniopharyngiomas (n = 23), medulloblastomas (n = 22) and astrocytomas (n = 15) were the most common tumors. Hemoglobin genotype (AA and AS) had some influence on tumor phenotype FT,P = 0.033. 76 cases were microsurgically resected while 16 patients were treated with radiotherapy alone. The 30-day mortality for operated cases is 7.2 +/- 0.7%. Overall 1-year and 5-year survival was 66.7 and 52.3%, respectively. School attendance, performance and outcome varied among treatment subgroups.

Conclusion: Survival profile in this series suggests some improvement in comparison to previous studies from our region, Hemoglobin genotype profiles may signature paediatric brain tumor phenotypes in our setting.

Place, publisher, year, edition, pages
Taylor & FrancisTAYLOR & FRANCIS LTD, 2021
Keywords
Pediatric brain tumors, micro neurosurgery, radiotherapy, school performance, survival
National Category
Neurology Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-450615 (URN)10.1080/02688697.2020.1777259 (DOI)000547731700001 ()32657167 (PubMedID)
Available from: 2021-08-17 Created: 2021-08-17 Last updated: 2024-01-15Bibliographically approved
Latini, F., Axelson, H., Fahlström, M., Jemstedt, M., Alberius Munkhammar, å., Zetterling, M. & Ryttlefors, M. (2021). Role of Preoperative Assessment in Predicting Tumor-Induced Plasticity in Patients with Diffuse Gliomas. Journal of Clinical Medicine, 10(5), Article ID 1108.
Open this publication in new window or tab >>Role of Preoperative Assessment in Predicting Tumor-Induced Plasticity in Patients with Diffuse Gliomas
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2021 (English)In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, no 5, article id 1108Article in journal (Refereed) Published
Abstract [en]

When diffuse gliomas (DG) affect the brain's potential to reorganize functional networks, patients can exhibit seizures and/or language/cognitive impairment. The tumor-brain interaction and the individual connectomic organization cannot be predicted preoperatively. We aimed to, first, investigate the relationship between preoperative assessment and intraoperative findings of eloquent tumors in 36 DG operated with awake surgery. Second, we also studied possible mechanisms of tumor-induced brain reorganization in these patients. FLAIR-MRI sequences were used for tumor volume segmentation and the Brain-Grid system (BG) was used as an overlay for infiltration analysis. Neuropsychological (NPS) and/or language assessments were performed in all patients. The distance between eloquent spots and tumor margins was measured. All variables were used for correlation and logistic regression analyses. Eloquent tumors were detected in 75% of the patients with no single variable able to predict this finding. Impaired NPS functions correlated with invasive tumors, crucial location (A4C2S2/A3C2S2-voxels, left opercular-insular/sub-insular region) and higher risk of eloquent tumors. Epilepsy was correlated with larger tumor volumes and infiltrated A4C2S2/A3C2S2 voxels. Language impairment was correlated with infiltrated A3C2S2 voxel. Peritumoral cortical eloquent spots reflected an early compensative mechanism with age as possible influencing factor. Preoperative NPS impairment is linked with high risk of eloquent tumors. A systematic integration of extensive cognitive assessment and advanced neuroimaging can improve our comprehension of the connectomic brain organization at the individual scale and lead to a better oncological/functional balance.

Place, publisher, year, edition, pages
MDPIMDPI, 2021
Keywords
diffuse gliomas, eloquent tumors, awake surgery, neuropsychological assessment, language assessment, epilepsy, Brain-Grid
National Category
Neurology Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-440079 (URN)10.3390/jcm10051108 (DOI)000628270100001 ()33799925 (PubMedID)
Available from: 2021-04-19 Created: 2021-04-19 Last updated: 2024-01-15Bibliographically approved
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