Visual function is mainly located within the bilateral hemisphere of the occipital lobes of the brain. However, our functional magnetoencephalography (MEG) result has demonstrated the reorganization of brain activity in the occipital area in patients with left-sided brain tumour. The results showed that brain laterality changes from bilateral to unilateral activation of the occipital area. Right occipital area (contralateral areas to the tumour), shows increase intensity of activation. Diffusion tensor imaging (DTI) with fibre tracking was performed to further investigate this brain laterality modification and the findings confirmed there is an alteration in the left hemisphere fibre optic tracts. This functional modification and changes of the brain laterality and optic tracts in the brain is suspected to be the result of tumour growth induced changes. The present observation will be discussed in term of the mechanism of tumour induced reorganization and changes with the corroborating evidence from MEG, DTI and neuropsychological assessment.
Although the precise etiology of Glioblastoma multiforme (GBM, WHO grade IV) remains unknown, its progression
is believed to be driven by the accumulation of multiple genetic alterations. Here, we report a case of a patient who
developed GBM, and associated with dual alterations, particularly 4977-bp deletion in mtDNA (mtDNA4977) and
p.Arg132His (R132H) mutation in IDH1. A 35-year old Malaysian woman patient who primary diagnosed with astrocytoma WHO grade I and subsequently after four years developed a GBM, was detected with a mtDNA4977. This
deletion appears to be a sporadic mutation. Additionally, analysis of patient’s tumor tissue also found to harbor a heterozygous IDH1 R132H mutation. This represents the first case report of coexisting mtDNA4977 together with IDH1
R132H mutation in a Malaysian patient of GBM. The findings of dual alterations could be of therapeutic benefit if
these alterations were justified to be contributing to GBM growth and aggressiveness.
Introduction: Intracranial brain tumour like meningiomas and glioblastomas are most prevalent tumour. The metas- tasis to the brain is one of the major issues in the tumours of the central nervous system. The diagnosis of metastatic and primary brain tumour is incomprehensible with standard magnetic resonance imaging (MRI). The magnetic res- onance spectroscopy (MRS) is basically performed in standard clinical setting for diagnosing and tracking the brain tumour. Method: It is a retrospective study containing 53 patients with MRS. The patients with metastatic tumour (n=10), glioblastomas (n=8) and meningiomas (n=20) are included in the study. Single voxel technique is applied in the tumour core to determine the metabolites. The tumour N-acetyl aspartate (NAA), Choline (Cho), Creatine (Cr), Lactate, Alanine and lipids were analysed. The ratios of NAA/Cr, Cho/NAA and Cho/Cr were recorded and com- pared between the three tumours. The metabolites were detected between short echo time (TE) to long echo time (TE) during MRS. Results: There is a sharp fall of NAA peak in metastatic tumour. The resonance of creatine, lactate and alanine is higher in glioblastomas. A high lipid mean value of 3.13(0.17) is seen in metastatic tumour. The ROC curve shows a low NAA/Cr specificity of 46.7%, high sensitivity of 83.3% in Cho/NAA and Cho/Cr ratio. Conclusion: The metabolic profiles of metastatic brain tumour, glioblastomas and meningioma illustrate a divergence in their description that will assist in planning therapeutic and surgical intervention of these tumours.
Neuroplasticity has been subjected to a great deal of research in the last century. Recently, significant emphasis has been
placed on the global effect of localized plastic changes throughout the central nervous system, and on how these changes
integrate in a pathological context. The present study aimed to demonstrate the functional cortical reorganization before
and after surgery using magnetoencephalography (MEG) in a participant with brain tumor. Results of Visual Evoked
Magnetic Field (VEF) based on functional MEG study revealed significantly different of MEG N100 waveforms before and
after surgery. Larger and additional new locations for visual activation areas after the surgery were found suggesting
neuroplasticity. The present study highlight a physiological plasticity in a teenage brain and the alterations regarding
neural plasticity and network remodeling described in pathological contexts in higher-order visual association areas.
The present study discussed functional reorganization and alteration in respond to the slow-growing tumour,
hemangiopericytoma in the occipital cortex. Visual evoked field (VEF) and auditory evoked field (AEF) using
magnetoencephalography (MEG) was used to evaluate the source localization and brain activity. Results of VEF source
localization show a typical brain waves. Brain activity of the occipital lobe demonstrate low activation in the ipsilateral
to the tumour. However, result shows the activation on the contralateral hemisphere was high and bigger in activation
volume. AEF result shows an identical source localization and both side of the temporal lobe are activated. This result
suggests that there is a positive plasticity in auditory cortex and slow-growing tumour can induce functional reorganization
and alteration to the brain.
Awake craniotomy is a brain surgery in patients who are kept awake when it is indicated for certain intracranial pathologies. The anaesthetic management strategy is very important to achieve the goals of the surgery. We describe a series of our first four cases performed under a combination of scalp block and conscious sedation. Scalp block was performed using a mixture of ropivacaine 0.7% and adrenaline 5 5µg/ ml administered to the nerves that innervate the scalp. Conscious sedation was achieved with a combination of two recently available drugs in our country, dexmedetomidine (selective α 2-agonist) and remifentanil (ultra-short acting opioid). Remifentanil was delivered in a target controlled infusion (TCI) mode.
High grade gliomas, frequently with their infiltrative nature, often make the outcome from neurosurgical intervention alone unsatisfactory. It is recognized that adjuvant radiochemotherapy approaches offer an improved prognosis. For these reasons, we opted for surgical debulking, intraoperative radiation therapy (IORT) in combination with whole brain irradiation therapy and chemotherapy (temozolamide cycles) in the management of a 42 year-old lady with Glioblastoma Multiforme (GBM). Her troublesome symptoms improved after 3 months of this polymodal therapy and remained independently functional for more than two years.