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Performance of intraoperative neurocognitive tests during awake surgery for patients with diffuse low-grade glioma

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Abstract

Despite great advancements and the diffusion of awake surgery for brain tumors, the literature shows that the tests applied during the procedure are heterogeneous and non-standardized. This prospective, observational, descriptive study collected data on intraoperative brain mapping and the performance of multiple neurocognitive tests in 51 awake surgeries for diffuse low-grade glioma. Frequency of use and rate of intraoperative findings of different neurocognitive tests were analyzed. Patients mean age at the time of surgery was 35.1 (20–57) years. We performed 26 (51.0%) surgeries on the left hemisphere (LH) and 25 (49.0%) on the right hemisphere (RH). Significant differences were observed between the total number of functional findings (cortical and subcortical) identified in the LH and RH (p = 0.004). In subcortical findings alone, the differences remained significant (p = 0.0004). The RH subcortical region showed the lowest number of intraoperative findings, and this was correlated with functional outcome: Karnofsky performance scale at five days (p = 0.022), three months (p = 0.002) and one year (p = 0.002) post-surgery. On average, more tests were used to map the RH, with a lower frequency of both cortical and subcortical functional findings. Even though subcortical findings were less frequent than cortical findings, they were crucial to defining the resection margins. Based on the intraoperative findings, frequency of use, and rate of findings per use of the tests analyzed, the most relevant tests for each hemisphere for awake brain mapping were identified.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil

    Lucas Alverne F. Albuquerque

  2. Department of Neurology, Universidade de Campinas, Campinas, São Paulo, Brazil

    Lucas Alverne F. Albuquerque

  3. Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    Leonardo José Monteiro de Macêdo Filho

  4. Department of Anesthesiology, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil

    Felipe Silva Borges

  5. Neuropsychologist, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil

    Gabryella S. Diógenes & Cicera Jairlly Veras Rocha

  6. Speech Therapist, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil

    Fátima C. Pessoa

  7. Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA

    João Paulo Almeida

  8. Division of Neurosurgery, Department of Neurology, Universidade de Campinas, Campinas, São Paulo, Brazil

    Enrico Ghizoni & Andrei F. Joaquim

Authors
  1. Lucas Alverne F. Albuquerque
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  2. Leonardo José Monteiro de Macêdo Filho
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  3. Felipe Silva Borges
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  4. Gabryella S. Diógenes
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  5. Fátima C. Pessoa
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  6. Cicera Jairlly Veras Rocha
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  7. João Paulo Almeida
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  8. Enrico Ghizoni
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  9. Andrei F. Joaquim
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Contributions

All authors whose names appear on the submission: 1. made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; 2. drafted the work or revised it critically for important intellectual content; 3. approved the version to be published; and 4. agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Lucas Alverne F. Albuquerque.

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Competing interests

The authors declare no competing interests.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Hospital Geral de Fortaleza (Date: 07/24/2017, number 2.216.138).

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Informed consent was obtained from all individual participants included in the study.

Competing of interests

The authors declare no competing interests.

Author Disclosures

The authors of the article “Performance of intraoperative neurocognitive tests during awake surgery for patients with diffuse low-grade glioma” declare that this is an original unpublished article that does not transgress any copyright or intellectual property rights of other people and it is not being evaluated for publication in other journals. Every author has contributed substantially to achieving this work. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. None of the authors have conflicts of interest to report.

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Albuquerque, L.A.F., de Macêdo Filho, L.J.M., Borges, F.S. et al. Performance of intraoperative neurocognitive tests during awake surgery for patients with diffuse low-grade glioma. Neurosurg Rev 47, 129 (2024). https://doi.org/10.1007/s10143-024-02364-6

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