Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Department of Neurosurgery, Southmead Hospital, NHS North Bristol Trust, Bristol, UK.
Neurol Sci. 2024 Aug;45(8):3723-3735. doi: 10.1007/s10072-024-07475-y. Epub 2024 Mar 23.
Awake craniotomy (AC) allows intraoperative brain mapping (ioBM) for maximum lesion resection while monitoring and preserving neurological function. Conventionally, language, visuospatial assessment, and motor functions are mapped, while the assessment of executive functions (EF) is uncommon. Impaired EF may lead to occupational, personal, and social limitations, thus, a compromised quality of life. A comprehensive literature search was conducted through Scopus, Medline, and Cochrane Library using a pre-defined search strategy. Articles were selected after duplicate removal, initial screening, and full-text assessment. The demographic details, ioBM techniques, intraoperative tasks, and their assessments, the extent of resection (EOR), post-op EF and neurocognitive status, and feasibility and potential adverse effects of the procedure were reviewed. The correlations of tumor locations with intraoperative EF deficits were also assessed. A total of 13 studies with intraoperative EF assessment of 351 patients were reviewed. Awake-asleep-awake protocol was most commonly used. Most studies performed ioBM using bipolar stimulation, with a frequency of 60 Hz, pulse durations ranging 1-2 ms, and intensity ranging 2-6 mA. Cognitive function was monitored with the Stroop task, spatial-2-back test, line-bisection test, trail-making-task, and digit-span tests. All studies reported similar or better EOR in patients with ioBM for EF. When comparing the neuropsychological outcomes of patients with ioBM of EF to those without it, all studies reported significantly better EF preservation in ioBM groups. Most authors reported EF mapping as a feasible tool to obtain satisfactory outcomes. Adverse effects included intraoperative seizures which were easily controlled. AC with ioBM of EF is a safe, effective, and feasible technique that allows satisfactory EOR and improved neurocognitive outcomes with minimal adverse effects.
清醒开颅术 (AC) 允许在术中进行脑映射 (ioBM)，以便在监测和保留神经功能的同时最大限度地切除病变。传统上，语言、视空间评估和运动功能都被映射，而执行功能 (EF) 的评估并不常见。受损的 EF 可能导致职业、个人和社会限制，从而降低生活质量。通过 Scopus、Medline 和 Cochrane Library 进行了全面的文献检索，使用了预先定义的搜索策略。在去除重复项、初步筛选和全文评估后，选择了文章。回顾了人口统计学细节、ioBM 技术、术中任务及其评估、切除范围 (EOR)、术后 EF 和神经认知状态，以及该程序的可行性和潜在不良反应。还评估了肿瘤位置与术中 EF 缺陷的相关性。共回顾了 13 项研究，其中 351 例患者进行了术中 EF 评估。最常用的是清醒-睡眠-清醒方案。大多数研究使用双极刺激进行 ioBM，频率为 60 Hz，脉冲持续时间为 1-2 ms，强度为 2-6 mA。认知功能通过 Stroop 任务、空间-2 回测试、线二分测试、连线测试和数字跨度测试进行监测。所有研究都报告了在进行 EF ioBM 的患者中具有相似或更好的 EOR。当比较具有 EF ioBM 的患者的神经心理学结果与没有进行 EF ioBM 的患者的结果时，所有研究都报告了在 ioBM 组中 EF 保留明显更好。大多数作者报告 EF 映射是获得满意结果的可行工具。不良反应包括易于控制的术中癫痫发作。AC 联合 EF 的 ioBM 是一种安全、有效且可行的技术，可在最小不良反应的情况下获得满意的 EOR 和改善的神经认知结果。
