Zigiotto Luca, Venturini Riccardo, Coletta Ludovico, Venturini Martina, Monte Domenico Dal, Vavassori Laura, Corsini Francesco, Annicchiarico Luciano, Avesani Paolo, Papagno Costanza, Sarubbo Silvio
Department of Neurosurgery, "S. Chiara" University-Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.
Department of Psychology, "S. Chiara" University-Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.
Neurosurgery. 2025 Jun 20. doi: 10.1227/neu.0000000000003591.
Patients with gliomas often experience neuropsychological deficits affecting their quality of life. Awake surgery (AwS) can reduce permanent cognitive deficits compared with asleep surgery (AsS), but it does not allow intraoperative mapping of all cognitive functions, including attention. Understanding how AwS and AsS affect attention is crucial, given its pivotal role in supporting various cognitive functions.
We conducted a retrospective analysis on 64 glioma patients treated with AwS or AsS. Attention was assessed with visual search tasks and Trail Making Test Part A before and 1 week and 1 month after surgery. Volumetric T1-weighted and T2/Fluid Attenuated Inversion Recovery MRI sequences before and after surgery were used to delineate the lesion and the surgical cavity. The extent of resection was calculated to determine supramaximal resection for both contrast-enhanced and non-contrast-enhanced tumor regions.
There was a significant decrease in attentional scores 1 week after surgery, followed by a complete recovery. AwS was the only significant predictor of postoperative attentional deterioration. Univariate lesion analysis revealed negative association between lesions in the default mode network and postoperative attentional scores, whereas a multivariate network approach highlighted the involvement of several large-scale functional systems in sustaining attentional processes. AwS patients exhibited more extensive supramaximal resections of non-contrast-enhanced areas, which correlated with immediate postoperative attentional deterioration. The Kaplan-Meier analysis showed significantly longer overall survival for AwS patients with isocitrate dehydrogenase wild-type glioblastomas (mean days = 887.73) compared with AsS patients (mean days = 553.71; P < .05).
Although AwS enables a more extensive resection and thus an improved oncological outcome with longer overall survival rate, it also leads to higher transient postoperative decline in attentional performance. These results emphasize the need for careful patient selection, especially for lesions that involve anterior anatomical regions of the left default mode network. Future developments of standardized, reliable, and quantitative intraoperative monitoring of attention may further optimize surgical outcomes.
胶质瘤患者常出现影响其生活质量的神经心理缺陷。与 asleep surgery（AsS，睡眠手术）相比，清醒手术（AwS）可减少永久性认知缺陷，但它无法对包括注意力在内的所有认知功能进行术中映射。鉴于注意力在支持各种认知功能中起关键作用，了解 AwS 和 AsS 如何影响注意力至关重要。
我们对 64 例接受 AwS 或 AsS 治疗的胶质瘤患者进行了回顾性分析。在手术前、术后 1 周和 1 个月，通过视觉搜索任务和连线测验 A 部分评估注意力。术前和术后的容积 T1 加权和 T2/液体衰减反转恢复 MRI 序列用于描绘病变和手术腔。计算切除范围以确定对比增强和非对比增强肿瘤区域的次全切除。
术后 1 周注意力评分显著下降，随后完全恢复。AwS 是术后注意力恶化的唯一显著预测因素。单变量病变分析显示默认模式网络中的病变与术后注意力评分呈负相关，而多变量网络方法强调了几个大规模功能系统在维持注意力过程中的参与。AwS 患者在非对比增强区域表现出更广泛的次全切除，这与术后立即出现的注意力恶化相关。Kaplan-Meier 分析显示，与 AsS 患者（平均天数 = 553.71；P <.05）相比，异柠檬酸脱氢酶野生型胶质母细胞瘤的 AwS 患者总生存期显著更长（平均天数 = 887.73）。
尽管 AwS 能够实现更广泛的切除，从而改善肿瘤学结局并提高总生存率，但它也会导致术后注意力表现出现更高的短暂下降。这些结果强调了仔细选择患者的必要性，特别是对于涉及左侧默认模式网络前部解剖区域的病变。未来标准化、可靠且定量的术中注意力监测的发展可能会进一步优化手术结果。
