{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T22:58:29Z","timestamp":1771973909202,"version":"3.50.1"},"reference-count":58,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"16","license":[{"start":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T00:00:00Z","timestamp":1728864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,10,14]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Resection of glioblastoma (GBM) in eloquent regions depends on functional mapping to limit perioperative neurological morbidity. When neurological deficits preclude reliable mapping, neurosurgeons should explore potential mitigation strategies. The authors present the case of a patient with a large left cystic temporoinsular GBM and aphasia, for whom the authors used intraoperative language mapping and a staged approach to enable safe tumor resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 49-year-old female presented with progressive mixed aphasia for 1 month and new-onset right facial droop. Magnetic resonance imaging (MRI) revealed a large, heterogeneously enhancing, left temporoinsular tumor with a significant cystic component. Her aphasia was profound, and resection without reliable language mapping was deemed unsafe. An initial stereotactic tumoral cyst aspiration was performed, which reduced local mass effect and improved her language function. Cyst decompression thereby enabled both task-based functional MRI and intraoperative awake speech mapping, resulting in a safe resection of her GBM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Safe resection of eloquently localized GBM is compromised when neurological deficits prohibit intraoperative functional mapping. This case demonstrates a mitigation strategy specific to cystic lesions in which an initial-stage stereotactic cyst aspiration is aimed at generating sufficient interval neurological improvement, such that intraoperative functional mapping can be performed during a second-stage resection.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24362\">https:\/\/thejns.org\/doi\/10.3171\/CASE24362<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24362","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T02:44:45Z","timestamp":1728873885000},"source":"Crossref","is-referenced-by-count":3,"title":["Staged intervention to enable the resection of a large left temporoinsular cystic glioblastoma with language preservation: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Hayley","family":"Donaldson","sequence":"first","affiliation":[{"name":"Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle","family":"Golub","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Northwell Health, Manhasset, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitris G","family":"Placantonakis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Grossman School of Medicine, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"J Neurosurg","first-page":"3","article-title":"An extent of resection threshold for newly diagnosed glioblastomas","volume":"115","author":"Sanai","year":"2011","unstructured":"Sanai NPolley MYMcDermott MWParsa ATBerger MS. An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg. 2011;115(1):3-8."},{"issue":"18","key":"bib2","series-title":"J Clin Med","first-page":"5354","article-title":"Surgical treatment of glioblastoma: state-of-the-art and future trends","volume":"11","author":"Sales","year":"2022","unstructured":"Sales AHABeck JSchnell OFung CMeyer BGempt J. Surgical treatment of glioblastoma: state-of-the-art and future trends. J Clin Med. 2022;11(18):5354."},{"issue":"1","key":"bib3","series-title":"Neurosurg Rev","first-page":"1","article-title":"Current and future strategies for treatment of glioma","volume":"40","author":"Bush","year":"2017","unstructured":"Bush NAChang SMBerger MS. Current and future strategies for treatment of glioma. 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Resting-state functional magnetic resonance imaging for surgical neuro-oncology planning: towards a standardization in clinical settings. Brain Sci. 2021;11(12):1613."},{"key":"bib12","series-title":"Neuroimage","first-page":"231","article-title":"Fingerprinting Orientation Distribution Functions in diffusion MRI detects smaller crossing angles","volume":"198","author":"Baete","year":"2019","unstructured":"Baete SHCloos MALin YCPlacantonakis DGShepherd TBoada FE. Fingerprinting Orientation Distribution Functions in diffusion MRI detects smaller crossing angles. Neuroimage. 2019;198:231-241."},{"issue":"1","key":"bib13","series-title":"Magn Reson Med","first-page":"418","article-title":"Performance of orientation distribution function-fingerprinting with a biophysical multicompartment diffusion model","volume":"88","author":"Filipiak","year":"2022","unstructured":"Filipiak PShepherd TLin YCPlacantonakis DGBoada FEBaete SH. 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Reconstruction of the arcuate fasciculus for surgical planning in the setting of peritumoral edema using two-tensor unscented Kalman filter tractography. NeuroImage Clin. 2015;7:815-822."},{"issue":"1","key":"bib28","series-title":"Top Magn Reson Imaging","first-page":"1","article-title":"Language mapping using fMRI and direct cortical stimulation for brain tumor surgery: the good, the bad, and the questionable","volume":"25","author":"Brennan","year":"2016","unstructured":"Brennan NPPeck KKHolodny A. Language mapping using fMRI and direct cortical stimulation for brain tumor surgery: the good, the bad, and the questionable. 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Reconstruction of the arcuate fasciculus for surgical planning in the setting of peritumoral edema using two-tensor unscented Kalman filter tractography. NeuroImage Clin. 2015;7:815-822."},{"issue":"1","key":"bib28","series-title":"Top Magn Reson Imaging","first-page":"1","article-title":"Language mapping using fMRI and direct cortical stimulation for brain tumor surgery: the good, the bad, and the questionable","volume":"25","author":"Brennan","year":"2016","unstructured":"Brennan NPPeck KKHolodny A. Language mapping using fMRI and direct cortical stimulation for brain tumor surgery: the good, the bad, and the questionable. 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