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Published on: August 12, 2019
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Awake brain mapping paradigms for nondominant hemisphere gliomas
Justyna O Ekert1,2, David S Sabsevitz3, Isabel Martin Del Campo2,4
11Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, United Kingdom.
Neurosurgical Focus
|February 1, 2024
Summary
Awake brain mapping for nondominant hemisphere gliomas is increasingly used. Current paradigms primarily assess spatial attention and speech-motor functions, but broader cognitive testing is recommended to reduce postoperative deficits.
Area of Science:
- Neurosurgery
- Cognitive Neuroscience
Background:
- Resection of nondominant hemisphere brain tumors traditionally occurred under general anesthesia.
- Recent advancements recognize the right hemisphere's functional significance, shifting paradigms towards awake brain mapping.
- There is a growing interest in awake craniotomies for nondominant hemisphere tumor resections.
Purpose of the Study:
- To conduct a comprehensive review of current brain mapping paradigms for nondominant hemisphere gliomas during awake craniotomies.
- To identify commonly assessed cognitive domains and their mapping sites within the nondominant hemisphere.
Main Methods:
- Systematic literature search conducted across Medline, Embase, and PsycInfo databases adhering to PRISMA guidelines.
- Inclusion criteria focused on studies describing intraoperative mapping paradigms for cognitive assessment during awake craniotomy for nondominant hemisphere gliomas.
- Data extraction from 39 unique studies involving 788 patients.
Main Results:
- Spatial attention/neglect and speech-motor/language functions were the most frequently tested cognitive domains (43.6% each).
- Social cognition was also assessed in a significant portion of studies (23.1%).
- Positive mapping sites varied by lobe, with speech-motor/language and spatial attention/neglect frequently identified in the frontal and parietal lobes, respectively.
Conclusions:
- Current awake brain mapping for nondominant hemisphere gliomas predominantly focuses on spatial attention and speech-motor functions.
- An expanded range of cognitive functions should be considered during mapping to minimize postoperative deficits.
- This approach can yield crucial insights into the anatomo-functional organization of cognitive networks.
