ONLINE ADVANCED BRAIN MAPPING COURSE: ACQUIRING THE MENTAL IMAGERY NECESSARY TO OPERATE THE BRAIN

The classical approach to brain tumors consists in the surgical removal of a tumor located within a brain with a definitely fixed functional organization, while preserving structures commonly considered as crucial (e.g. the rolandic, Broca’s and Wernicke’s areas). However, in the last two decades, the integration of four new concepts to glioma management has dramatically changed the approach to these tumors. First, intraoperative electrical stimulation has become the gold standard mapping technique for resection of tumors within eloquent areas, as it had demonstrated to be a safe, accurate and reliable tool to identify and preserve the cortical and subcortical functional boundaries in each step of tumor resection. Second, the inter-individual anatomo-functional variability in the organization of eloquent areas, hence, the necessity to map the brain in order to identify the functional regions in an individual patient. Third, the application of network based models to understand complex cognitive brain functions such as language or memory, therefore, brain connectivity should be taken into account. Fourth, cerebral plasticity, which is the dynamic potential of the brain to reorganize itself following injury.

The acquisition, integration and application of these whole new perspective to treat brain tumors can be very challenging. The volume of information is overwhelming as there are thousands of scientific publications, books, meetings, courses, websites, etc. Some professionals decide to spend a long period in a brain mapping specialized center, however, not everyone has the time or resources to complete that training.

The present brain mapping program has been designed with the main objective to cover this gap, showing a step by step training in mapping surgery, which is done entirely online by reviewing videos and supplementary material.

It has been designed as an on-line experience with two types of activities; asynchronous learning using a Learning Management System, and a synchronous learning through webinars with the instructors.

The course has been designed by surgeons at the Hospital Universitario Marqués de Valdecilla and educators from Hospital Virtual Valdecilla in Santander, Spain.

The course director is Juan Martino, a neurosurgeon with extensive experience in glioma surgery in eloquent areas. The course also has important contributions from experienced groups in brain mapping around the world.

The course is structured into three sections, the fundamental steps to acquire the knowledge to perform brain mapping surgeries:

1-The first part of the course is oriented to the study of the anatomy of the brain white matter. A detailed knowledge of the architectural anatomy of the white matter tracts is paramount, for strategically planning for surgical management of parenchymal brain lesions, such as gliomas.

2-In the second part, the main concepts about brain mapping will be analyzed in detail. Questions such as how a bipolar stimulator works, how to position the patient for awake craniotomy, how to tailor the craniotomy, or how to map language or memory will be addressed in this section.

3-Finally, in the third part, surgical mapping challenging cases are presented. The cases will be reviewed step by step, from the initial diagnosis, surgical planning with tractography reconstruction, neuropsychological evaluation, surgical procedure with cortical and subcortical mapping, to the postoperative oncological and functional results.

Juan MartinoCourse director

Professor Rubén Martin-LáezNeurosurgery Department. Hospital Universitario Marqués de Valdecilla. Santander. Spain

CO-DIRECTORSDr. Carlos VelasquezNeurosurgery Department. Hospital Universitario Marqués de Valdecilla. Santander. Spain

Dr. Alejandro Fernández-CoelloNeurosurgery Department. Hospital Universitari de Bellvitge. Barcelona. Spain

Dr. Pablo González-LópezNeurosurgery Department. Hospital General de Alicante. Alicante. Spain

Dr. Emmanuel MandonnetNeurosurgery Department. Hospital Lariboisiere. Paris. France

SCIENTIFIC COMMITTEEProfessor Hugues DuffauNeurosurgery Department. Centre Hospitalier Universitaire de Montpellier. Montpellier. France

COURSE DIRECTORProfessor Juan MartinoNeurosurgery Department. Hospital Universitario Marqués de Valdecilla. Santander. SpainMail: juan.martino@hotmail.com

Dr. David MatoNeurosurgery Department. Hospital Universitario Marqués de Valdecilla. Santander. Spain

Dr. Roberto Ocón QuintialNeurophysiology Department. Hospital Universitario Marqués de Valdecilla. Santander. Spain.

Elsa GómezNeuropsychologist. Psychiatry Department. Hospital Universitario Marqués de Valdecilla. Santander. Spain.

Dr. Cristian de Quintana SchmidtNeurosurgery Department. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain

Rosa Ayesa ArriolaNeuropsychologist. Psychiatry Department. Hospital Universitario Marqués de Valdecilla. Santander. Spain.

Dra. Carla MoraNeurosurgery Department. Hospital Universitario Marqués de Valdecilla. Santander. Spain.

Dra. Mª Angeles Martínez MartínezNeurophysiology Department. Hospital Universitario Marqués de Valdecilla. Santander. Spain.

Dr. Enrique Marco de Lucas Radiology Department. Hospital Universitario Marqués de Valdecilla. Santander. Spain.

Dr. Carlos SantosNeurosurgery Department. Hospital Universitario Marqués de Valdecilla. Santander. Spain

MAXIMAL NUMBER OF PARTICIPANTS PER COURSE: 20

COURSE DATES:• The course lasts 12 weeks.

• The course starts on Monday, January 11th, 2021, and finishes on Monday, April 5th 2021.

• First Webinar: Monday, January 11th, 2021 at 12:00 (GMT), (14:00 pm in Spain). The aim of this first webinar is to introduce the course, participants, and professors.

• Second Webinar: Monday, February 8th 2021 at 12:00 (GMT), (14:00 pm in Spain). Professors will answer questions of the first part of the course (Brain anatomy and surgical approaches in the cadaver).

• Third Webinar: Monday, March 8th 2021 at 12:00 (GMT), (14:00 pm in Spain). Professors will answer questions of the second part of the course (Brain mapping).

• Fourth Webinar: Monday, April 5th 2021 at 12:00 (GMT), (14:00 pm in Spain). Professors will answer questions of the third part of the course (Real surgical cases).

COURSE MATERIALS:• Around 60 hours of online videos with lectures, white matter dissections and surgical procedures.

• Surgical videos with a detail explanation of the procedure by the surgeon. In order to improve learning of brain anatomy, some of the videos are presented in three dimensions, however, the same videos will be available in two dimensions.

• Mentoring support: in order to improve your learning experience, a mentoring support through Slack platform will be provided by instructors.

• Four Webinars, with direct online interaction between participants and professors will be available.

• Supplementary material such as Power Point surgical tasks, that can be directly downloaded from the course website.

• In order to evaluate learning, test exams will be performed at the end of each section. The course certificate will be only issued if at least 60% of the questions are correctly answered.

ACCREDITATION:• This learning program is in process of accreditation by the Commission for Continuing Education of the Health Professions of

the Community of Cantabria.

• The scientific and educational content of this event has been endorsed by the Sociedad Española de Neurocirugía (SENEC).

TARGET AUDIENCE:This activity has been designed for Neurosurgeons, Neurologists, Neuroradiologists, Residents/Fellows in these specialties, and Neuro-nurses.

LEARNING OBJECTIVES:After the conclusion of this activity, participants will be able to: • Identify the anatomy of the white matter fiber tracts.

• Comprehensive understanding of the 3D anatomical relationships between the white matter connections.

• Understand in detail the basic elements to perform an awake brain mapping surgery.

• Understand the theoretical models that underlie complex cognitive functions such as language or memory and learn the technique to map them during surgery.

• Evaluate surgical approaches to challenging areas: the dominant insular lobe, the posterior left temporal lobe, or the superior parietal lobe.

• Discuss surgical cases and analyze different treatment options of tumors located within eloquent areas.

REGISTRATION FEES:Full hands-on registration: 950 €. Included full access to the course content for a 12 weeks period.

REGISTRATION PROCESS:Course registrationRebeca Ruiz: rruiz@hvvaldecilla.esHospital Virtual ValdecillaAv. Valdecilla s/n, 39008 Santander, CantabriaPhone: + 34 942 20 38 95http://www.hvvaldecilla.es

Sponsoring company

19M

K10

9

V

4-20

2009

1.1 WHITE MATTER AND CORTICAL ANATOMY1.1.1 How to prepare the brains for fiber dissection (David Mato)1.1.2 Hands-on dissection: brains preparation for fiber dissection (2D and 3D videos available) (Juan Martino)1.1.3 Cortical anatomy and dorsal associative tracts (Juan Martino)1.1.4 Functional role of the dorsal associative tracts (Alejandro Fernandez-Coello)1.1.5 Hands-on dissection of the dorsal associative tracts (2D and 3D videos available) (Juan Martino)1.1.6 Ventral associative tracts (Juan Martino)1.1.7 Functional roles of the ventral associative tracts (Alejandro Fernandez-Coello)1.1.8 Hands-on dissection of the ventral associative tracts (2D and 3D videos available) (Juan Martino)1.1.9 Intraoperative mapping of associative tracts (Hugues Duffau)1.1.10 Anatomy of the brain isthmus and the temporal stem: a crucial anatomical concept that is often forgotten (Dr. Carlos Velasquez and Dr. Pablo Gonzalez)1.1.11 Diffusion tensor imaging tractography (Christian de Quintana Schmidt)1.1.12 DTI tractography as an important tool to study the subcortical anatomy and presurgical planning of glioma surgery (Enrique Marco de Lucas)

1.2 SURGICAL APPROACHES IN THE CADAVER1.2.1 Surgical approaches to limbic and paralimbic tumors (Pablo Gonzalez)1.2.2 How to simulate a surgical approach in the laboratory (Emmanuel Mandonnet)1.2.3 Insula glioma surgery (Hugues Duffau)1.2.4 Insula glioma case 1: case presentation (2D and 3D videos available) (Juan Martino)1.2.5 Insula glioma case 1: surgical approach (Hugues Duffau)1.2.6 Insula glioma case 2: surgical approach. (2D and 3D videos available) (Hugues Duffau)1.2.7 Superior parietal glioma case: case presentation. (2D and 3D videos available) (Juan Martino)1.2.8 Superior parietal glioma case: surgical approach. (2D and 3D videos available) (Hugues Duffau)

1. BRAIN ANATOMY AND SURGICAL APPROACHES IN THE CADAVER

2.1 INITIAL INTRAOPERATIVE MAPPING CONCEPTS2.1.1 Basic mapping concepts (Patient position, local anesthesia infiltration, operating room setup, etc).2.1.2 Intraoperative task protocol2.1.3 Anesthesia management in brain mapping surgeries

2.2 NEUROPSYCHOLOGICAL EVALUATION2.2.1 Neuropsychological evaluation2.2.2 Preoperative neuropsychological evaluation: an example

2.3 MOTOR MAPPING2.3.1 Neural basis of motor mapping2.3.2 Intraoperative motor mapping

2.4 SENSORY AND SPATIAL COGNITION MAPPING2.4.1 Neural basis of sensory and spatial cognition function2.4.2 Intraoperative sensory and spatial cognition mapping

2.5 VISUAL MAPPING2.5.1 Neural basis of visual function2.5.2 Intraoperative visual mapping

2.6 LANGUAGE MAPPING2.6.1 The localizationist classical model of language2.6.2 The network based model of language2.6.3 Intraoperative language mapping

2.7 MEMORY MAPPING2.7.1 Neural basis of memory 2.7.2 Intraoperative memory mapping

2.8 SOCIAL AND EMOTIONAL COGNITION MAPPING2.8.1 Neural basis of social and emotional cognition2.8.2 Intraoperative social and emotional cognition mapping

2.9 DECISION MAKING MAPPING2.9.1 Neural basis of value based decision making

2.10 CALCULATION PROCESSING MAPPING2.10.1 Neural basis of calculation processing2.10.2 Intraoperative calculation mapping

2.11 MUSICAL PROCESSING MAPPING2.11.1 Neural basis of musical processing2.11.2 Intraoperative musical mapping

2. BRAIN MAPPING

3.1 SURGICAL POSITION3.1.1 Patient surgical position for awake surgery 1: left lateral decubitus 3.1.2 Patient surgical position for awake surgery 2: right lateral decubitus 3.1.3 Patient surgical position for awake surgery 3: supine position

3.2 LEFT FRONTO-INSULAR GLIOMA3.2.1 Case presentation and surgery planning3.2.2 Intraoperative awake mapping and tumor resection3.2.3 Postoperative evaluation

3.3 RIGHT PARIETAL GLIOMA3.3.1 Case presentation and surgery planning3.3.2 Intraoperative awake mapping and tumor resection3.3.3 Postoperative evaluation

3.4 RIGHT FRONTAL GLIOMA3.4.1 Case presentation and surgery planning3.4.2 Intraoperative awake mapping and tumor resection3.4.3 Postoperative evaluation

3. REAL SURGICAL CASES