Intraoperative mapping and preservation of executive functions in awake craniotomy: a systematic review.

Awake craniotomy (AC) allows intraoperative brain mapping (ioBM) for maximum lesion resection while monitoring and preserving neurological function. Conventionally, language, visuospatial assessment, and motor functions are mapped, while the assessment of executive functions (EF) is uncommon. Impaired EF may lead to occupational, personal, and social limitations, thus, a compromised quality of life. A comprehensive literature search was conducted through Scopus, Medline, and Cochrane Library using a pre-defined search strategy. Articles were selected after duplicate removal, initial screening, and full-text assessment. The demographic details, ioBM techniques, intraoperative tasks, and their assessments, the extent of resection (EOR), post-op EF and neurocognitive status, and feasibility and potential adverse effects of the procedure were reviewed. The correlations of tumor locations with intraoperative EF deficits were also assessed. A total of 13 studies with intraoperative EF assessment of 351 patients were reviewed. Awake-asleep-awake protocol was most commonly used. Most studies performed ioBM using bipolar stimulation, with a frequency of 60 Hz, pulse durations ranging 1-2 ms, and intensity ranging 2-6 mA. Cognitive function was monitored with the Stroop task, spatial-2-back test, line-bisection test, trail-making-task, and digit-span tests. All studies reported similar or better EOR in patients with ioBM for EF. When comparing the neuropsychological outcomes of patients with ioBM of EF to those without it, all studies reported significantly better EF preservation in ioBM groups. Most authors reported EF mapping as a feasible tool to obtain satisfactory outcomes. Adverse effects included intraoperative seizures which were easily controlled. AC with ioBM of EF is a safe, effective, and feasible technique that allows satisfactory EOR and improved neurocognitive outcomes with minimal adverse effects.

Surviving (but not thriving) after cranial vault trauma: A case study from Transylvania.

OBJECTIVE: To link an antemortem cranial injury on the left parietal bone with potential neurocognitive consequences. MATERIALS: The skeleton of a male individual from a Székely archaeological site in Transylvania was examined. The skeleton was radiocarbon dated to Cal AD 1450 and AD 1640 and presented a well-healed antemortem penetrating cranial injury on the left parietal bone. METHODS: Macroscopic and radiographic analyses were conducted and the cranium was also archived digitally with a Faro FreeStyle3D scanner. In addition, well-known literature from neuroscience was synthesized in order to better understand the likely neurological consequences of the injury. RESULTS: The literature suggests that tasks of attention and working memory, sensory processing, language processing, and vision are affected when the parietal lobe of the brain is injured. CONCLUSIONS: Burial 195 did not likely return to a 'normal' life after he survived the cranial injury. SIGNIFICANCE: This study demonstrates that bioarcheological interpretations involving antemortem cranial injuries can be enhanced by collaboration with neuroscientists. Bioarcheological interpretations are improved when the consequences of soft tissue injuries are understood. LIMITATIONS: This study was limited by a lack of historical documents relevant to the region, time period, and specific case study. In addition, interpretations are cautionary because brain functioning cannot be assessed in vivo in the absence of life. SUGGESTIONS FOR FURTHER RESEARCH: Bioarcheologists who study antemortem cranial injuries should continue to collaborate with neuroscientists.

Clinical presentation of rapidly progressive familial Danish dementia.

Familial Danish dementia (FDD) is a rare, autosomal dominant neurodegenerative disorder characterized by progressive hearing loss, cataracts, progressive ataxia, and dementia. While multiple pathophysiological studies exist in the literature, clinical case presentations are currently limited. We present a case of young-onset dementia in a 47-year-old patient with Danish heritage who was subsequently diagnosed FDD through genetic testing. Cognitive impairment was his initial symptom, followed by Parkinsonian symptoms, and mood disturbances. The patient experienced rapid decline over only 19 months. Increased awareness and understanding of familial forms of dementia (i.e., FDD) can contribute to an enhanced provision of care for patients with such conditions.