Arnaud J P E Vincent

• Erasmus MC

Introduction Awake craniotomy (AC) is a technique that balances maximum resection and minimal postoperative deficits in patients with intracranial pathology. To aid in comparability of functional outcomes after awake surgery, this study investigated its international practice and aimed to define categories of postoperative deficits. Methods A surv...

BACKGROUND To this day, the mainstay of human neuroimaging remains (functional) Magnetic Resonance Imaging (fMRI), where subjects are asked to lie completely still and silent in a noisy scanner. Many key questions in clinical care and neuroscience remain poorly studied because of fMRI’s inability to facilitate natural behavior such as locomotion or...

BACKGROUND Overall survival (OS) of glioblastoma patients remains poor, even with surgical treatment and adjuvant therapy. Gross-total resection is preferred whenever possible; when this cannot be achieved due to e.g. age or critical tumour localization, biopsy is often performed. To date, no objective guidelines are available to determine what typ...

BACKGROUND The clinical course and management of non-contrast enhancing glioblastomas that also lack the classic high grade histological features (non-CE GBMs) is unclear. Data on survival, clinical management including surgical therapies are sparse and conflicting. In this study we therefore investigated tumor volumes, surgical and postsurgical th...

Background: Patients with glioma often report language complaints with devastating effect on daily life. Analysing spontaneous speech can help to understand underlying language problems. Spontaneous speech monitoring is also of importance during awake brain surgery: it can guide tumour resection and contributes to maintaining language function. We...

BACKGROUND Neurosurgical resection of brain tumors resembles a balancing act between maximing extent of tumor resection (efficacy) and minimizing the risk of post-operative neurological deficits (safety). Given the difficulty of this trade-off, it is surprising how limited the neurosurgeon’s intra-operative tools are. To this day, neurosurgeons sti...

BACKGROUND Patients with glioblastoma have poor overall survival (OS), even with surgical treatment and adjuvant therapy. However, up to a quarter of patients with presumed glioblastoma does not receive any form of treatment and not much is known in the literature about this population. Their OS is estimated to be around 1.2 months. Generally, pati...

BACKGROUND Tumor location and eloquence are two crucial factors when deciding on the optimal surgical strategy in glioma management. Consensus is currently lacking on the assessment and definition of eloquent areas. This systematic review aims to evaluate the existing definitions and assessment methods of eloquent areas used in current clinical pra...

BACKGROUND In the 2021 revised WHO CNS, IDH1/2-wildtype (IDHwt) gliomas with histological features of lower grade glioma, but with a TERT-promotor (TERTp) mutation, and/or EGFR amplification, and/or combined gain of chromosome 7 and loss of chromosome 10 (7+/10-), are now classified as IDHwt glioblastoma. These formerly labeled “molecular glioblast...

BACKGROUND Minimizing residual tumor volume and preventing functional loss are the primary goal in glioblastoma resections in eloquent areas. However, their combined impact on patient outcomes remains poorly understood. We therefore developed a novel onco-functional outcome (OFO) classification and evaluated its benefit in subgroups based on age, p...

BACKGROUND The occurrence of seizures is the most common comorbidity in malignant brain tumors. Recent advancements in the field of cancer neuroscience indicate that seizures can potentially influence brain tumor progression through intricate neuron-glioma interactions in the peritumoral infiltrated cortex of glioma patients. Therefore, understandi...

Background The standard treatment for patients with eloquent gliomas is awake craniotomy (AC) with direct electrical stimulation, which results in a larger extent of resection while maintaining language function. Intraoperative language monitoring includes different standardized tasks and spontaneous speech elicitation. Despite careful monitoring,...

Background Awake craniotomy is used to resect tumor while preserving language. However, differences between patients in post-operative speech/language outcome are observed despite careful intra-operative monitoring. Literature describes improved performance in language tasks during cognitive tests in musicians. Moreover increased white matter conne...

Background The goal of awake craniotomy is to safely optimize the extent-of-resection in patients with glioma. Lower postoperative tumor volume is associated with better overall survival, emphasizing the importance of optimal surgical resection. Awake craniotomy causes less postoperative neurological deficits than surgery under general anesthesia,...

Background Glioma patients often suffer from cognitive deficits, such as in language and executive functioning (EF). A sensitive test to identify these deficits is verbal fluency (VF). In VF, participants are asked to generate as many unique words within a given semantic category (category fluency - CF) or starting with a given letter (letter fluen...

Background IDH1/2 wildtype (IDHwt) glioma WHO grade 2 and 3 patients with pTERT mutation and/or EGFR amplification and/or +7/−10 chromosome gain/loss have a similar overall survival time as IDHwt glioblastoma patients, and are both considered glioblastoma IDHwt according to the WHO 2021 classification. However, differences in seizure onset have bee...

BACKGROUND Although the standard procedure to treat adult patients with lesions in eloquent brain areas is awake craniotomy with direct electrical stimulation, this procedure is not often used in children because of feasibility concerns. Some studies have shown that the procedure is feasible in children. They reported the postoperative language abi...

The value of mapping musical function during awake craniotomy is unclear. Hence, this systematic review was conducted to examine the feasibility and added value of music mapping in patients undergoing awake craniotomy. An extensive search, on the 26st of March 2021, in four electronic databases (Medline, Embase, Web of Science and Cochrane CENTRAL...

BACKGROUND Awake craniotomy with direct electrical stimulation (DES) is the standard treatment for patients with eloquent area gliomas. Language errors (paraphasias) are detected with DES and they indicate functional boundaries that need to be maintained to preserve quality of life. However, it is not fully clear in which brain locations paraphasia...

BACKGROUND Low-grade glioma (LGG) patients typically suffer from mild aphasia that often cannot be detected with standard aphasia tests. The Diagnostic Instrument for Mild Aphasia (DIMA) is the first standardized test-battery to assess mild language disorders. We investigate pre- and postoperative linguistic abilities of LGG and high-grade glioma (...

BACKGROUND Onco-neurosurgical practice still relies heavily on pre-operatively acquired images to guide intra-operative decision-making for safe tumor removal, a practice with inherent pitfalls such as registration inaccuracy due to brain shift, and lack of real-time (functional) feedback. Exploiting the opportunity for real-time imaging of the exp...

BACKGROUND Post-operative delirium (POD) is a frequent and severe complication after neurosurgical operations. Good prediction of POD after craniotomy in neuro-oncologic patients is important to install prophylactic measures, increase recognition and apply early treatment. Hence, we compared logistic regression with machine learning to build an acc...

Introduction: The main surgical dilemma during glioma resections is the surgeon's inability to accurately identify eloquent areas when the patient is under general anaesthesia without mapping techniques. Intraoperative stimulation mapping (ISM) techniques can be used to maximise extent of resection in eloquent areas yet simultaneously minimise the...

Background Intraoperative MRI and 5-aminolaevulinic acid guided surgery are useful to maximize the extent of glioblastoma resection. Intraoperative ultrasound is used as a time-and cost-effective alternative, but its value has never been assessed in a trial. The goal of this randomized controlled trial was to assess the value of intraoperative B-mo...

OBJECTIVE In the early 20th century, Dr. Cushing first demonstrated the use of electrical stimulation mapping (ESM) to define motor and sensory cortices during neurosurgical procedures. Essentially, little has changed in what guides a neurosurgeon’s intra-operative decision-making since. Inherent limitations of ESM such as limited depth penetration...

Background: The association between contrast enhanced (CE) and non-contrast enhanced (NCE) tumor resection and survival in patients with glioblastoma in relation to molecular subtypes is poorly understood. The aim of this study was to assess the association between CE and NCE tumor resection and survival in light of MGMT promoter methylation in new...

Low grade glioma patients report word finding difficulties during the anamnesis. However, these are often not objectified with naming tests used in clinical practice. The aim of the current study was to develop a sensitive speeded naming test for word finding difficulties in low grade glioma patients. Reaction times on a picture naming test were ob...

Introduction: O⁶-methylguanine-methyltransferase (MGMT) promoter methylation and isocitrate dehydrogenase (IDH) mutation status are important prognostic factors for patients with glioblastoma. There are conflicting reports about a differential topographical distribution of glioblastoma with vs. without MGMT promoter methylation, possibly caused by...

Background: Patients with 1p/19q co-deleted low grade glioma (LGG) have longer overall survival and better treatment response than patients with 1p/19q intact tumors. Therefore, it is relevant to know the 1p/19q status. To investigate whether the 1p/19q status can be assessed prior to tumor resection, we developed a machine learning algorithm to p...

BACKGROUND Comparative studies of dynamic susceptibility contrast (DSC) based measurement of cerebral blood volume (CBV) or cerebral blood flow (CBF) and arterial spin labelling (ASL) based measurement of CBF have previously shown good correlation of these parameters in human glioma. However, these studies were mostly done before inclusion of the m...

Background: High-grade glioma cells consume mainly glucose and cannot compensate for glucose restriction. Apoptosis may potentially occur under carbohydrate restriction by a ketogenic diet (KD). We explored the feasibility and safety of KD during standard treatment of chemoradiation in patients with glioblastoma multiforme. Methods: A full liqui...

Background Several studies reported a correlation between anatomic location and genetic background of low-grade gliomas (LGG’s). As such, tumor location may contribute to pre-surgical clinical decision-making. Our purpose was to visualize and compare the spatial distribution of different WHO 2016 gliomas, frequently aberrated single genes and DNA c...

Objective: To the best of our knowledge, the present study is the first to assess the safety and feasibility of a modified encephalo-galeo-duro-synangiosis operation in patients with atherosclerotic carotid artery occlusion. Methods: Eight patients who had experienced new ipsilateral cerebrovascular events after the diagnosis of carotid artery occl...

Background: Gross total resection (GTR) of the contrast enhancing (CE) area will improve the survival of patients with glioblastoma (GBM). However, GBM can infiltrate into the brain parenchyma, beyond the CE margins. It remains unclear whether resection beyond the CE area (supratotal resection [SPTR]) can improve survival without causing additiona...

Background: Patients undergoing neurosurgery frequently exhibit hyperlactatemia. The aim of this study was to identify factors associated with hyperlactatemia and assess how hyperlactatemia impacts survival and hospital length of stay after intracranial tumor surgery. Materials and methods: This retrospective cohort study included 496 adult pati...

Introduction: The headache phase of migraine could in selected cases potentially be treated by surgical decompression of one or more “trigger sites,” located at frontal, temporal, nasal, and occipital sites. This systematic review with subsequent meta-analysis aims at critically evaluating the currently available evidence for the surgical treatment...

Overview of search terms used per database. Database search performed on February 17th 2018.

Adverse events. Adverse events reported based on their prevalence reported in the included studies. Superscripted numbers refer to the respective studies at the bottom of the table. Small numbering used for respective studies, studies reported as author (year of publication). F, frontal; T, temporal; N, nasal; O, occipital.

Funnel plots for assessment of publication bias. (A) Funnel plot for Figure 2-Proportion of patients with elimination of MH at follow-up. X-axis represents the logit transformed proportion of patients with elimination of headache for each included study. Y-axis represents standard error of study based on number of included study participants. Outli...

Background Awake craniotomy with electrocortical and subcortical mapping (AC) has become the mainstay of surgical treatment of supratentorial low-grade gliomas in eloquent areas, but not as much for glioblastomas. Objective This retrospective controlled-matched study aims to determine whether AC increases gross total resections (GTR) and decreases...

Background Intraoperative stimulation mapping (ISM) using electrocortical mapping (awake craniotomy, AC) or evoked potentials has become a solid option for the resection of supratentorial low-grade gliomas in eloquent areas, but not as much for high-grade gliomas. This meta-analysis aims to determine whether the surgeon, when using ISM and AC, is a...

Low grade gliomas in cerebral cortex often cause symptoms related to higher cerebral functions such as attention, memory and executive function before treatment is initiated. Interestingly, focal tumors residing in one cortical region can lead to a diverse range of symptoms, indicating that the impact of a tumor is extended to multiple brain region...

INTRODUCTION Several studies reported a correlation between the anatomic location of gliomas and the genetic background of the tumor. As such, tumor location may contribute to pre-surgical clinical decision-making. Current evidence is mainly derived from smaller series and report single genes or copy numbers, but not the integrated WHO 2016 classif...

Background According to the 2016 WHO classification low grade glioma can be classified into three groups based on molecular profile. A non-invasive method to identify these molecular profiles has yet to be established. There is evidence MRI perfusion and diffusion imaging might aid in the differentiation of the molecular profiles. Our aim is to ide...

Background: At current prognostication of low grade glioma remains suboptimal and might be improved with additional markers. These may guide treatment decisions, in particular on early adjuvant therapy versus wait and see after surgery. Methods: We used a targeted Next-Generation Sequencing panel to assess mutational and copy number status of se...

Objective: Neuronavigation systems are routinely used during neurosurgical procedures. Currently, new imaging technologies are emerging, such as virtual, augmented, and mixed reality. With mixed-reality devices, the user can analyze and interact with the real environment using virtual objects. The aim of this prospective pilot study was to offer a...

OBJECTIVE The authors conducted a study to determine whether cognitive functioning of patients with presumed low-grade glioma is associated with white matter (WM) tract changes. METHODS The authors included 77 patients with presumed low-grade glioma who underwent awake surgery between 2005 and 2013. Diffusion tensor imaging with deterministic trac...

Objectives: The diagnosis and the surgical removal of a brain tumor can have serious impact on the quality of life of a patient. The question rises, whether having more or just less memories of the procedure is better for coping with such an event. Furthermore, for preoperative information of future patients it is important to know how patients pr...

Objective: Glioma patients often complain about problems in daily conversation with a negative impact on quality of life. Disorders in standardized language tests (e.g. naming and fluency), are frequently observed. Most studies claim recovery of language functions within 3 months. However, long-term effects of surgery on spontaneous speech remain u...

Objective: To investigate differences in outcomes in patients who underwent surgery for insular glioma using an awake craniotomy (AC) vs. a craniotomy under general anesthesia (GA). Methods: Data from patients treated at our hospital between 2005 and 2015 were analyzed retrospectively. The preoperative, intraoperative, postoperative, and longer...

INTRODUCTION The WHO classification of gliomas has been revised completely and is now predominantly based on molecular criteria. This requires re-evaluation of the impact of surgery in molecularly defined low-grade glioma subtypes. We performed a retrospective study to assess the interaction between molecular markers and postoperative tumor volume...

Background: Extensive resections in low-grade glioma are associated with improved overall survival. However, WHO classification of gliomas has been completely revised and is now predominantly based on molecular criteria. This requires re-evaluation of the impact of surgery in molecularly defined low-grade glioma subtypes. Methods: We included 22...

Awake surgery with electrocorticosubcortical stimulation is the golden standard treatment for gliomas in eloquent areas. Preoperatively, mostly mild cognitive disturbances are observed with postoperative deterioration. We describe pre- and postoperative profiles of 4 patients (P1–P4) with gliomas in “critical” language areas (“Broca,” “Wernicke,” a...

Early resection is standard of care for presumed low-grade gliomas. This is based on studies including only tumors that were post-surgically confirmed as low-grade glioma. Unfortunately this does not represent the clinicians’ situation wherein he/she has to deal with a lesion on MRI that is suspect for low-grade glioma (i.e. without prior knowledge...

INTRODUCTION Diagnosing glioma and monitoring tumour progression and treatment efficacy is usually invasive (biopsy or operation) and often needs extensive and time-consuming MRI imaging. Alternative easy, quick and minimally-invasive diagnostic methods are therefore highly warranted. Novel insights in the role of several immune subsets in tissue d...

Awake surgery is the gold standard for eloquent area low-grade gliomas (LGG) to preserve cognition and Quality of Life (QoL). LGG patients often report mild language disturbances which cannot always be captured with “classical” language tests (e.g. Boston Naming Test). Therefore a sensitive protocol was designed: Dutch Linguistic Intraoperative Pro...

Introduction Early resection has been put forward as standard of care for presumed diffuse low-grade gliomas (LGGs) that are eligible for extensive resection. This is based on studies that selected for histologically confirmed LGG and therefore those studies included enhancing lesions and discarded non-enhancing high grade lesions. This selection d...

Purpose To present an updated prevalence estimate for incidental findings on brain magnetic resonance (MR) images and provide information on clinical relevance, including natural course, over a period of up to 9 years. Materials and Methods This study was approved by the institutional review board and all participants gave informed consent. In a pr...

Een wakkere hersenoperatie is een teamtaak: patiënt, anesthesioloog, neurochirurg en neurolinguïst/neuropsycholoog werken intensief samen om een kwaadaardige hersentumor zonder functionele schade voor de patiënt te verwijderen. Dit artikel beschrijft details van het anesthesiologische en het neurochirurgische beleid omtrent deze operatie. Van de pa...

Background: Cognitive preservation is crucial in glioma surgery, as it is an important aspect of daily life functioning. Several studies claimed that surgery in eloquent areas is possible without causing severe cognitive damage. However, this conclusion was relatively ungrounded due to the lack of extensive neuropsychological testing in homogenous...

Purpose: Exercise may be associated with increased health-related quality of life (QoL) in patients with cancer, but it is not prescribed as standard care during or after cancer treatment. We systematically reviewed the methodological quality of, and summarised the evidence from, randomised controlled trials (RCTs). A meta-analysis was performed t...

To systematically review the literature for studies on cognitive functioning in patients with low-grade glioma to evaluate assessment methods and prevalence of cognitive dysfunction. A search was made in PubMed, Embase, and PsycINFO for articles published between January 2002 and June 2012 using cognition, memory, attention, executive functioning,...

Introduction: Deficits in cognition, i.e. language memory, attentional and executive functions are common in patients with primary brain tumors in eloquent areas (Papagno et al., 2011; Santini et al., 2012; Satoer et al., 2012). Tumor resection may aggravate these deficits, which can recover 1 year postoperatively (Satoer et al., 2014). This findin...

Neurochirurgie 4 Functionele mapping binnen wakkere neurochirurgie Pre-, intra- and postoperative mapping techniques in awake brain tumour surgery Mw. E. De Witte1, mw. dr. D. Satoer2,3, H. Colle4, E. Robert4, dr. A. Vincent2, mw. dr. E. Visch-Brink2, dr. P. Mariën1,5 Samenvatting Neurochirurgie bij patiënten met hersentumoren in eloquente zones be...

BACKGROUND: Monocyte subset distribution in blood, based on expression of CD14 and CD16, has been shown to correlate with cancer, auto-immune and infectious disease. Consequently, analysis of monocyte subsets in glioma patients could lead to new insights in diagnosis and monitoring of disease and therapy. We investigated the expression pattern of 5...

Background and purpose: Determining language dominance with fMRI is challenging in patients with brain tumor, particularly in cases of suspected atypical language representation. Supratentorial activation patterns must be interpreted with great care when the tumor is in or near the presumed language areas, where tumor tissue or mass effect can lea...

Preservation of cognition is an important outcome measure in eloquent area glioma surgery. Glioma patients may have pre-operative deficits in one or more cognitive domains which could deteriorate post-operatively. It is assumed that these impairments recover within 3 months; some studies however, still detected cognitive decline. Longer follow-up i...

We describe a patient (KO) with reduced spontaneous speech, resembling dynamic aphasia, after awake glioma surgery in the proximity of the supplementary motor area. Naming, repetition, and comprehension were intact. He was tested with an extensive neuropsychological test-battery and a protocol for dynamic aphasia at 1 year. He presented with postop...

Literature data indicate that glioma stem cells may give rise to both tumor cells and EPCs. Malignant glioma patients usually have increased levels of circulating endothelial progenitor cells (EPCs) and these cells are known to contribute to the glioma neovasculature. In this study we compared the intratumoral and circulating EPCs of glioma patient...

Background Glioma patients often complain about problems in daily conversation. A detailed spontaneous speech analysis could provide more insight in these communicative problems; no previous studies are reported. Objective To select sensitive parameters in spontaneous speech pre- and post-operatively in patients with gliomas in eloquent areas. Meth...

Intraoperative direct electrical stimulation (DES) is increasingly used in patients operated on for tumours in eloquent areas. Although a positive impact of DES on postoperative linguistic outcome is generally advocated, information about the neurolinguistic methods applied in awake surgery is scarce. We developed for the first time a standardised...

Object: The goal of awake neurosurgery is to maximize resection of brain lesions with minimal injury to functional brain areas. Laser speckle imaging (LSI) is a noninvasive macroscopic technique with high spatial and temporal resolution used to monitor changes in capillary perfusion. In this study, the authors hypothesized that LSI can be useful a...

Object: Patients with gliomas frequently have cognitive deficits, and surgery can exacerbate these deficits. Preoperative assessment is therefore crucial in patients undergoing surgery for glioma in eloquent areas, because the proximity of functional areas increases the risk of permanent postoperative cognitive disturbances. Although pre- and post...

Somatic mutation of Isocitrate dehydrogenase 1 (IDH1) at the locus of R132 (IDH1 (R132H)) occurs in > 70% of WHO grade II-III gliomas and secondary glioblastomas. To date it remains unknown whether the mutation is restricted to glial tumor cells. Microglial cells are the resident macrophages in the central nervous system. Tumor-infiltrating microgl...

INTRODUCTION: Cancer-related fatigue is the most frequently reported symptom of patients with cancer. The National Cancer Institute describes it as “an extreme tiredness, one that decreases a patient's ability to function, causing them distress.” The National Comprehensive Cancer Network defines distress as “a continuum, ranging from common normal...

The numbers of awake craniotomies performed worldwide are rising. The technique allows a maximum of brain tumor resection with a minimal risk of functional damage in patients, where the tumor is growing close to functional relevant brain areas. The maximal resection improves the long-term outcome of these patients. For the anaesthetist awake cranio...

We report the occurrence of a primary intracranial extraosseous Ewing sarcoma/peripheral primitive neuroectodermal tumor (EES/pPNET) in the cerebellopontine angle in a child. A 10-year-old girl presented with symptoms and signs of an infratentorial space-occupying lesion that was confirmed by magnetic resonance imaging and followed up by subtotal s...

Previously, we reported on our single centre results regarding the diagnostic yield of stereotactic needle biopsies of brain lesions. The yield then (1996-2006) was 89.4%. In the present study, we review and evaluate our experience with intraoperative frozen-section histopathologic diagnosis on-demand in order to improve the diagnostic yield. One h...