Overview
Focal brain lesions can result in a variety of neurological and psychiatric symptoms, including addictive behaviors, obsessive-compulsive symptoms, language deficits, and motor impairments, depending on the lesion's location and extent 135.Diagnosis
Neuroimaging: Essential for identifying lesion location and extent (CT, MRI) 7.
Functional Imaging: FDG-PET useful in assessing metabolic changes, particularly in conditions like hippocampal sclerosis 2.
Intraoperative Mapping: Techniques such as functional MRI (fMRI) and electrocorticography (ECoG) aid in localizing eloquent cortex in awake patients 34.
Language Testing: Critical for lesions near language areas, especially in bilingual patients to prevent postoperative deficits 3.Management
Surgical Resection: Under local anesthesia with monitored conscious sedation for lesions near eloquent cortex to minimize deficits 5.
Brain Mapping: Utilize intraoperative brain mapping techniques to optimize resection while preserving function 53.
Postoperative Monitoring: Consider subdural grids for extraoperative monitoring in complex cases 4.Special Populations
Pediatrics: Passive range of motion under conscious sedation can be used for sensorimotor cortex localization in presurgical evaluations 4.
Elderly: Awake craniotomy techniques are adaptable but require careful assessment of sedation and patient tolerance 5.Key Recommendations
Utilize intraoperative brain mapping techniques during awake craniotomy to optimize resection and minimize postoperative deficits (Evidence: Strong 5).
Employ functional imaging modalities like fMRI and ECoG for precise localization of eloquent cortex in pediatric and adult patients undergoing neurosurgery (Evidence: Moderate 34).
Consider the use of conscious sedation over general anesthesia for lesions near language areas to preserve neurological function, particularly in bilingual patients (Evidence: Moderate 3).References
1 Müri RM, Cazzoli D. Addictive (Non-Drug) and Obsessive-Compulsive Symptoms after Focal Brain Lesions. Frontiers of neurology and neuroscience 2018. link
2 Gordon BA. Measures of metabolism provide insights into hippocampal sclerosis. Brain : a journal of neurology 2018. link
3 Bilotta F, Stazi E, Delfini R, Rosa G. Language testing during awake "anesthesia" in a bilingual patient with brain lesion adjacent to Wernicke's area. Anesthesia and analgesia 2011. link
4 Ogg RJ, Laningham FH, Clarke D, Einhaus S, Zou P, Tobias ME et al.. Passive range of motion functional magnetic resonance imaging localizing sensorimotor cortex in sedated children. Journal of neurosurgery. Pediatrics 2009. link
5 Amorim RL, Almeida AN, Aguiar PH, Fonoff ET, Itshak S, Fuentes D et al.. Cortical stimulation of language fields under local anesthesia: optimizing removal of brain lesions adjacent to speech areas. Arquivos de neuro-psiquiatria 2008. link
6 Lind M. Objective symmetry detector method for gammaencephalography. V. Variation in the subjective analysis of brain scintigrams. Acta radiologica: diagnosis 1976. link
7 Norman D, Newton TH. Localization with the EMI scanner. The American journal of roentgenology, radium therapy, and nuclear medicine 1975. link