Papers by Barbara Santini
Childs Nervous System, Mar 25, 2022
Children undergoing surgical removal of tumors in the posterior cranial fossa can encounter a var... more Children undergoing surgical removal of tumors in the posterior cranial fossa can encounter a varied and complex constellation of neurological symptoms, called cerebellar mutism, defined as a disturbance in the planning and programming of motor language with preserved understanding, behavioral disorders such as inattention, visual-spatial disorganization, personality change, as well as ataxia and dysmetria. In the last years, several groups have been trying to establish risk factors or even predictive scores in order to be able at least in part to predict the appearance of speech disorders before surgery. We report on a child with pilocytic astrocytoma of the cerebellar vermis who had already been diagnosed with developmental linguistic delay two years earlier. This disorder initially worsened after surgery and later improved in the following 12 months. The aim of this paper is to emphasize the importance of preoperative neuropsychological evaluation. The present case, along with those reported in the literature, suggests that the risk of long-term cerebellar mutism is higher in children with preoperative speech disorders. In these patients a thorough assessment of cognitive and linguistic functions is therefore necessary to better evaluate the risk of cerebellar mutism after surgery.
Clinical settings for awake surgery: critical appraisal of methods, classifications and definitions
no abstract availabl
Cognitive outcome as part and parcel of clinical outcome in brain tumor surgery
Journal of Neuro-Oncology, 2012
Although validated tools (neuropsychological tests, patient reported outcomes, mood and psycholog... more Although validated tools (neuropsychological tests, patient reported outcomes, mood and psychological profile) were first introduced many years ago in clinical practice, the impact of the tumor itself on patient cognition has not been extensively studied. Furthermore, while outcome research is evolving in an attempt to adapt the use of different tools to the preoperative and postoperative phases, the standard guidelines for evaluating outcome after brain surgery, by neurological examination and complication assessment, are frequently neglected in the current literature. This article attempts to provide an appraisal of the evidence for the impact of surgical treatment on cognitive function of brain tumor patients within the context of general outcome.
Patient selection for awake surgery. A preliminary report from a psychological perspective
no abstract availabl
Selective involvement of posterior perisylvian regions in sublexical processing: Evidence from brain tumor patients
Multimodal approach to surgical treatment of high grade gliomas
Clinical assessment in brain tumor surgery: the role of neuropsychology. Preliminary experience
Nouns and verbs: perioperative comparisons in brain tumors
[no abstract available
Cognitive effects of tumour and surgical treatment in glioma patients
Journal of Neuro-Oncology, 2010
Quality of life in brain tumour patients is an emerging issue and has prompted neurosurgeons to r... more Quality of life in brain tumour patients is an emerging issue and has prompted neurosurgeons to reconsider the need for cognitive assessment in the course of treatment. In particular, to date there has been a lack of comprehensive neuropsychological assessment performed preoperatively and in the acute postoperative period. We examined 29 patients with glioma, analysing several functional domains-intelligence, executive functions, memory, language, praxis, gnosis and mood state-in order to establish the effect of tumour and surgery on cognition. At baseline, using test- and domain-based criteria, 79% and 38% of patients, respectively, were impaired, the former related to tumour factors such as oedema (P < 0.05), larger size (P < 0.05) and higher grade (P = 0.001). Verbal memory, visuospatial memory and word fluency were the most frequently affected functions, partly associated with depression. Postoperatively, again using test- and domain-based criteria, 38% and 55% of patients, respectively, were unchanged, 24% and 21% improved, and 38% and 24% worsened; 24% and 62% of patients were intact, respectively. The extent of removal did not influence the outcome. Improvement involved previously impaired functions and was correlated with high-grade tumours. Worsening regarded executive functions was related to tumour size and was partly explained by radiological findings on postoperative magnetic resonance imaging (MRI). This preliminary study, focussing on the effects of tumour and surgery, showed that tumour significantly affects cognitive functions, mainly due to the mass effect and higher grading. Surgical treatment improved the functions most frequently affected preoperatively and caused worsening of executive functions soon after operation, leaving the overall cognitive burden unchanged and capable of improvement prospectively.
Published Ahead-of-Print-Last Updated: April 11, 2012
The editors of this journal are pleased to offer electronic publication of accepted papers prior ... more The editors of this journal are pleased to offer electronic publication of accepted papers prior to print publication. These papers can be cited using the date of access and the unique DOI number. Any final changes in manuscripts will be made at the time of print publication and will be reflected in the final electronic version of the issue.
Intraoperative language mapping: a two-task approach
Section of Neurosurgery, Department of Neurological Sciences and Vision, University of Verona, It... more Section of Neurosurgery, Department of Neurological Sciences and Vision, University of Verona, Italy * Unit of Anaesthesia and Neurosurgical Intensive Care, University Hospital of Verona, Italy ** Section of Physiology, Department of Neurological Sciences and Vision, University of Verona, Italy *** Center for Mind/Brain Sciences, University of Trento, Italy ✧ Section of Neurological Rehabilitation, Department of Neurological Sciences and Vision, University of Verona, Italy
The quality of measurement properties of neurocognitive assessment in brain tumor clinical trials over the last 30 years: a COSMIN checklist-based approach
Neurological Sciences
Purpose To provide an exhaustive review of the neuropsychological examination as conducted in bra... more Purpose To provide an exhaustive review of the neuropsychological examination as conducted in brain tumor clinical trials over the last 30 years and to provide objective ratings about the reliability and suitability of such tests in neurooncological research and clinical practice. Methods Methodologies and tools provided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) were exploited in order to assess the measurement properties of questionnaires and performance-based instruments used to evaluate cognitive functioning in brain tumor clinical trials from 1997 to 2017. Results Twenty-six brain tumor clinical trials were analyzed and an overall set of 10 neuropsychological tests was identified. A list of 24 studies concerning the reliability of such tests was analyzed. Reliability and level of evidence scores for each study and for each test were obtained. The results revealed relevant faults about the quality of measurements and the suitability of the neurocognitive assessment batteries most commonly used in brain tumor clinical trials. Conclusion Our findings suggest that the cognitive assessment in brain tumor clinical trials should be implemented according to specific endpoints and should be addressed to investigate all the cognitive domains known to be affected by brain tumor and treatment.
Language in individuals with left hemisphere tumors: Is spontaneous speech analysis comparable to formal testing?
Journal of clinical and experimental neuropsychology, 2018
The relationship between spontaneous speech and formal language testing in people with brain tumo... more The relationship between spontaneous speech and formal language testing in people with brain tumors (gliomas) has been rarely studied. In clinical practice, formal testing is typically used, while spontaneous speech is less often evaluated quantitatively. However, spontaneous speech is quicker to sample and may be less prone to test/retest effects, making it a potential candidate for assessing language impairments when there is restricted time or when the patient is unable to undertake prolonged testing. To assess whether quantitative spontaneous speech analysis and formal testing detect comparable language impairments in people with gliomas. Specifically, we addressed (a) whether both measures detected comparable language impairments in our patient sample; and (b) which language levels, assessment times, and spontaneous speech variables were more often impaired in this subject group. Five people with left perisylvian gliomas performed a spontaneous speech task and a formal language...
Mapping nouns and finite verbs in left hemisphere tumors: a direct electrical stimulation study
Neurocase, 2017
Neurosurgical mapping studies with nouns and finite verbs are scarce and subcortical data are non... more Neurosurgical mapping studies with nouns and finite verbs are scarce and subcortical data are nonexistent. We used a new task that uses finite verbs in six Italian-speaking patients with gliomas in the left language-dominant hemisphere. Language-relevant positive areas were detected only with nouns in four patients, with both tasks yet in distinct cortical areas in one patient, and only with finite verbs in another patient. Positive areas and types of errors varied across participants. Finite verbs provide complementary information to nouns, and permit more accurate mapping of language production when nouns are unaffected by electrical stimulation.
Lexico-semantic dissociations in patients with brain tumors in the posterior temporal lobe
Language role of the frontal terminations of the inferior fronto-occipital fascicle in awake pati... more Language role of the frontal terminations of the inferior fronto-occipital fascicle in awake patient Adrià Rofes1,2, Andrea Talacchi3, Barbara Santini3, Giada Zocatelli3, Franco Alessandrini3, Lyndsey Nickels4, and Gabriele Miceli2 1. International Doctorate in Experimental and clinical Approaches to Language And the Brain (IDEALAB); 2. Center for Mind/Brain Sciences (CIMeC) and Center for Neurocognitive Rehabilitation (CeRIN), University of Trento, Italy; 3. Section of Neurosurgery, Department of Neurosciences, University of Verona, Italy; 4. ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, NHMRC Centre, Macquarie University, Sydney, NSW, Australia The inferior fronto-occipital fascicle (IFOF) is an associative white matter pathway that connects to structures in the posterior and anterior cortices. Specifically to language, its functions have been related to object and action naming, single word reading, and spontaneous speech. Based on curr...
Awake surgery between art and science. Part I: clinical and operative settings
Functional neurology
Awake surgery requires coordinated teamwork and communication between the surgeon and the anesthe... more Awake surgery requires coordinated teamwork and communication between the surgeon and the anesthesiologist, as he monitors the patient, the neuroradiologist as he interprets the images for intraoperative confirmation, and the neuropsychologist and neurophysiologist as they evaluate in real-time the patient's responses to commands and questions. To improve comparison across published studies on clinical assessment and operative settings in awake surgery, we reviewed the literature, focusing on methodological differences and aims. In complex, interdisciplinary medical care, such differences can affect the outcome and the cost-benefit ratio of the treatment. Standardization of intraoperative mapping and related controversies will be discussed in Part II.
Direct cortical and subcortical stimulation has been claimed to be the gold standard for explorin... more Direct cortical and subcortical stimulation has been claimed to be the gold standard for exploring brain function. In this field, efforts are now being made to move from intraoperative naming-assisted surgical resection towards the use of other language and cognitive tasks. However, before relying on new protocols and new techniques, we need a multi-staged system of evidence (low and high) relating to each step of functional mapping and its clinical validity. In this article we examine the possibilities and limits of brain mapping with the aid of a visual object naming task and various other tasks used to date. The methodological aspects of intraoperative brain mapping, as well as the clinical and operative settings, were discussed in Part I of this review.
Uploads
Papers by Barbara Santini