====== Cingulate gyrus glioma case series ====== ===== 2022 ===== 95 consecutive adult cases of primary [[cingulate gyrus glioma]]s that all underwent craniotomies and [[tumor resection]]. The patients were classified into unitary sub-region based on the four-division model. The information on clinical symptoms, pathology, EOR, postoperative neurological outcome, and survival was analyzed through group comparison. [[Low-grade glioma]]s (LGGs) were more prevalent (69.47%) for the [[cingulate gyrus]]. [[Diffuse astrocytoma]] (40.00%) was the most common histopathological diagnosis in total. Regarding sub-regions tumor involvement, midcingulate cortex (MCC) glioma was most prevalent (54.74%) followed by anterior cingulate cortex (ACC) glioma. Among all patients, 83 patients (87.37%) received EOR ≥ 90%. In the LGG group, 58 patients (87.88%) received EOR ≥ 90%. The achievement of EOR significantly correlated with [[survival]] (P = 0.006). MCC cases were significantly associated with short-term morbidity in either language or motor function (P = 0.02). The majority of ACC cases (80.65%) escaped from any short-term deficits and nearly 90% were free of permanent morbidity. Tumors in the dominant hemisphere were significantly associated with language dysfunction or cognition dysfunction, either short-term (P=0.0006) or long-term morbidity (P=0.0111). Age was the only postoperative susceptible predictor for all types of transient (P=0.021) and permanent (P=0.02) neurological deficits. Regarding cingulate gyrus glioma, the management of surgical plans could be carried out in four sub-region levels. Despite short-term neurological dysfunction caused by surgical procedures, the majority of transient dysfunction could be relieved or recovered in long term. The necessary effort to prolong overall survival is still to achieve advisable EOR ((Gong F, Jin L, Song Q, Yang Z, Chen H, Wu J. Surgical techniques and function outcome for cingulate gyrus glioma, how we do it. Front Oncol. 2022 Sep 26;12:986387. doi: 10.3389/fonc.2022.986387. PMID: 36226056; PMCID: PMC9549335.)). ===== 2013 ===== Posterior gyrus cinguli tumors are a well-defined group of tumors that pose considerable challenges in creating surgical access and manipulating adjacent eloquent areas (visual and motor). Here we report our 5-year experience in the surgical treatment of these tumors and describe tumor characteristics, surgical steps, critical aspects, and prognostic factors. This series comprises 37 patients operated on for glioma (high-grade in 28, low-grade in 9), often presenting with motor impairment (n=20), intracranial hypertension (n=15), seizures (n=11), and/or hemianopia (n=9). Preoperative assessment was performed with magnetic resonance imaging. Half of the tumors were more than 4 cm in size, and the majority presented secondary extension into the fronto-parieto-occipital area, the temporo-mesial area, and/or the corpus callosum. Positioning and assisted surgery were optimized in each patient based on preoperative planning. The ipsilateral interhemispheric approach was elected in all cases. Tumor size and extension were significantly associated with the degree of tumor removal. Total removal was achieved in 25 patients (65%); 4 (10%) had persistent morbidity (visual or motor deficits). The occurrence of local and systemic complications was negligible. Surgical treatment of posterior gyrus cinguli tumors can be safely approached via the interhemispheric route as it permits several beneficial operative maneuvers in selected cases ((Talacchi A, Hasanbelliu A, Fasano T, Gerosa M. Interhemispheric approach to tumors of the posterior gyrus cinguli. Clin Neurol Neurosurg. 2013 May;115(5):597-602. doi: 10.1016/j.clineuro.2012.07.020. Epub 2012 Aug 4. PubMed PMID: 22871382. )). ===== 2012 ===== A series of 65 patients with gliomas between 06/1999 and 07/2010. The [[extent of resection]] (complete, subtotal, or partial) was based on early postoperative MRI. Eighty-six percent of the gliomas were located in the anterior part of the [[gyrus cinguli]] (GC), and 14 % in the posterior part. Fifty-five percent of the patients presented with [[seizure]]s and 17 % with hemiparesis (mean preoperative KPI = 86 ± 17, NIHSS = 1.4 ± 1.7). Histologically, the tumors were WHO Grade II in 25 %, Grade III in 26 %, and Grade IV in 49 %. Complete [[resection]] was achieved for 59 %, [[subtotal resection]] for 32%, and [[partial resection]] for 9 %. Postoperative transient deficits included SMA lesion (14 %) and new or worsened hemiparesis (8 %), which resolved within 30 days (NIHSS early postoperatively 1.7 ± 1.4, late postoperatively 0.8 ± 1.4, and after 6 months 0.6 ± 1.4). According to histopathological grading, median survival was 67 months (WHO°II), 87 months (WHO°III), and 16.5 months (WHO°IV), and overall survival was 34 months. Microsurgical resection of gliomas arising from the GC is feasible; [[gross total resection]] can be achieved for 90 % of gliomas arising from the GC with 5 % long-term morbidity ((Oszvald Á, Quick J, Franz K, Güresir E, Szelényi A, Vatter H, Seifert V. Resection of gliomas in the cingulate gyrus: functional outcome and survival. J Neurooncol. 2012 Sep;109(2):341-8. doi: 10.1007/s11060-012-0898-0. Epub 2012 Jun 2. PubMed PMID: 22660921. )). ===== 2011 ===== Ninety consecutive patients with gliomas involving the CG were analyzed. Resections were classified by zones corresponding to functionally defined regions of the CG as follows: Zone I (perigenual, anterior), Zone II (midcingulate), Zone III (posterior), and Zone IV (retrosplenial). Basic demographic, imaging, operative details, and pre- and postoperative neurological examinations were recorded for each patient. Patients in whom neurological morbidity was documented during their initial postoperative examination who did not completely improve by the 6-month follow-up examination were considered to have a permanent deficit. For each patient with surgery-related morbidity, postoperative MR imaging and operative notes were reviewed, and the cortical regions incorporated in the surgical trajectory were recorded. The analysis was carried out for tumors confined to the CG (> 90% of tumor contained within the CG) as well as those involving the CG but extending into adjacent cortical structures. Results: Analysis of the entire patient cohort demonstrated that 29% of patients experienced a new or worsened neurological deficit immediately after surgery. The most common deficits were supplementary motor area (SMA) syndrome (20%), weakness (6%), and sensory changes (2%). All patients with an SMA syndrome in our series had intentional resection of SMA as part of the surgical approach. Patients with resections including Zone II or III had a higher rate of total morbidity and SMA syndrome than patients with Zone I resections (p < 0.05). Only 4% of patients had a persistent neurological deficit at 6 months postoperatively. A similar morbidity profile was observed in the subset analysis of patients with tumors confined to the CG, with no additional morbidity related to known cingulate-specific functions. Conclusions: Resection of gliomas involving the CG can be performed with minimal, predictable long-term morbidity (< 5%). Surgical morbidity is primarily a function of surgical trajectory rather than the particular cingulate region resected ((Tate MC, Kim CY, Chang EF, Polley MY, Berger MS. Assessment of morbidity following resection of cingulate gyrus gliomas. Clinical article. J Neurosurg. 2011 Mar;114(3):640-7. doi: 10.3171/2010.9.JNS10709. Epub 2010 Oct 8. PMID: 20932098.)). ===== 2010 ===== 38 patients with gliomas were compared the following variables: location (perigenual, prerolandic), pathology (glioblastoma, other gliomas), size (<4 cm, > or =4 cm), extension (unilateral, bilateral), and approach (unilateral interhemispheric, combined). The only significant association we found was between tumor location (perigenual) and bilateral extension (P < .01). However, combined approaches were adopted only slightly more frequently in this region than in the prerolandic area, and this resulted in a lower rate of total removal (33% vs 76%, P < .01). Gross total removal was achieved in 28 cases (66%) and was significantly associated with combined approaches (77% vs 50%, P < .05). The choice of a combined approach to anterior gyrus cinguli tumors is critical to improving the quality of resection in selected cases. Talacchi et al. recommend a combined approach in the surgical treatment of large tumors of the perigenual area ((Talacchi A, Corsini F, Gerosa M. Surgical approaches to tumors of the anterior gyrus cinguli. Neurosurgery. 2010 Jun;66(6 Suppl Operative):245-51. doi: 10.1227/01.NEU.0000369652.59204.99. PubMed PMID: 20489513.)). ===== 2009 ===== In 7 cases (18%) the [[tumor]] was located in the posterior ([[parietal]]) part of the [[cingulate gyrus]], and in 31 (82%) the tumor was in the anterior (frontal) part. In 10 cases (26%) the [[glioma]] was solely located in the cingulate gyrus, and in 28 cases (74%) the tumor extended to the supracingular frontal/parietal cortex. Most cases (23 [61%]) had [[seizure]]s as the presenting symptom, 8 patients (24%) suffered from hemiparesis/hemihypesthesia, and 4 patients (12%) had aphasic symptoms. The authors chose an [[interhemispheric approach]] for tumor resection in 11 (29%) and a [[transcortical approach]] in 27 (71%) cases; [[intraoperative electrophysiological monitoring]] was applied in 23 (61%) and [[neuronavigation]] in 15 (39%) cases. A > 90% resection was achieved in 32 (84%) and > 70% in another 5 (13%) cases. Tumors were classified as [[low-grade glioma]]s in 11 cases (29%). A [[glioblastoma multiforme]] ([[WHO Grade IV]], 10 cases [26%]) and [[oligoastrocytoma]] ([[WHO Grade III]], 9 cases [24%]) were the most frequent histopathological results. Postoperatively, patients in 13 cases suffered from a transient [[supplementary motor area syndrome]] (34%), all of whom had tumors in the anterior cingulate gyrus. In the early postoperative period (30 days) a new deficit occurred in 5 cases (13%, mild motor deficits or aphasic symptoms). One patient had a major bleeding episode 2 days after surgery and was in a persistent vegetative state. Gliomas arising from the cingulate gyrus are rare. A gross-total resection is often possible and acceptably safe; intraoperative monitoring and neuronavigation are helpful adjuncts. In case of resection of gliomas arising from the anterior cingulate gyrus, a [[supplementary motor area syndrome]] has to be considered, particularly when the tumor extends to the supracingular cortex ((von Lehe M, Schramm J. Gliomas of the cingulate gyrus: surgical management and functional outcome. Neurosurg Focus. 2009 Aug;27(2):E9. doi: 10.3171/2009.6.FOCUS09104. PubMed PMID: 19645564.)).