Initial Experience with Brain Mapping under Awake Craniotomy for Resection of Insular Gliomas of the Dominant Hemisphere

Background & Importance: Insular lobe is located at the depth of sylvian fissure and is hidden by frontal, temporal and parietal lobes in close vicinity of internal capsule and basal ganglia and adjacent to the speech centers in the dominant hemisphere. Thus, radical resection of insular gliomas can be even more difficult. Brain mapping techniques can be used to maximize the extent of tumor removal and minimize postoperative morbidities. Case Presentation: Patients with newly diagnosed gliomas of dominant insula were enrolled. The exclusion criteria were severe cognitive and/or psychological disturbances, those with difficulty in communication, older than 65 years, severely obese patients, those with difficult airways for intubation and severe cardiovascular or respiratory diseases. All patients were evaluated by contrast enhanced brain MRI, functional brain MRI and diffusion tensor tractography of language and motor systems preoperatively. All were operated under awake craniotomy with the same anesthesiology protocol. Intraoperative monitoring included continuous motor evoked potential, electromyography, electrocorticography, direct electrical stimulation of cortex and subcortical tracts. They were followed with serial neurological examination and imaging. Conclusion: Seven patients were enrolled including 3 man and 4 women with mean age of 44.4 years. 5 patients suffered from low grade and 2 from high grade glioma. The most common clinical presentation was seizure followed by speech disturbance, hemiparesis and memory loss. Extent of tumor resection ranged from 73 to 100%. No mortality or major postoperative neurological deficit was encountered. Seizure control improved in 3/4 of patients with medical refractory epilepsy. One patient suffered from permanent deterioration of speech after surgery. Brain mapping under awake craniotomy may be considered a safe method to maximize the extent of tumor resection, while preserving neurological function in patients with gliomas of the dominant insular lobe

Feasibility and Data Quality of the National Spinal Cord Injury Registry of Iran (NSCIR-IR): A Pilot Study.

BACKGROUND: Spinal cord injury (SCI) is one of the most disabling consequences of trauma with unparalleled economic, social, and personal burden. Any attempt aimed at improving quality of care should be based on comprehensive and reliable data. This pilot investigation studied the feasibility of implementing the National Spinal Cord and Column Injury Registry of Iran (NSCIR-IR) and scrutinized the quality of the registered data. METHODS: From October 2015 to May 2016, over an 8-month period, 65 eligible trauma patients who were admitted to hospitals in three academic centers in mainland Iran were included in this pilot study. Certified registered nurses and neurosurgeons were in charge of data collection, quality verification, and registration. RESULTS: Sixty-five patients with vertebral column fracture dislocations were registered in the study, of whom 14 (21.5%) patients had evidence of SCI. Mechanisms of injury included mechanical falls in 30 patients (46.2%) and motor vehicle accidents in 29 (44.6%). The case identification rate i.e. clinical and radiographic confirmation of spine and SCI, ranged from 10.0% to 88.9% in different registry centers. The completion rate of all data items was 100%, except for five data elements in patients who could not provide clinical information because of their medical status. Consistency i.e. identification of the same elements by all the registrars, was 100% and accuracy of identification of the same pathology ranged from 66.6% to 100%. CONCLUSIONS: Our pilot study showed both the feasibility and acceptable data quality of the NSCIR-IR. However, effective and successful implementation of NSCIR-IR data use requires some modifications such as presence of a dedicated registrar in each center, verification of data by a neurosurgeon, and continuous assessment of patients\u27 neurological status and complications