Extended testing for cognition: has awake brain mapping moved to the next level?

Samandouras, George

doi:10.1007/s00701-021-05010-y

Cited by 4 publications

(1 citation statement)

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“…Glioma surgery with brain mapping is associated with fewer late and severe neurologic deficits and a more extensive tumour resection, with recommendations to instate mapping as a standard of care [54]. There are a high volume of case reports exploring the clinical utility of DCS contributing to a reduction in neurologic morbidity involving motor and speech-related tumours [46,47,[52][53][54][55]58,, with recent reports of multilingualism [76,[82][83][84], executive function [85][86][87][88][89], visuospatial attention [90][91][92] and working memory [93]. Paradigms have also been explored relating to higher order function such as singing [94], music performance [95], the integration of virtual reality-based tasks [96] and the prospect of cortico-cortical evoked potentials relating to speech function [97,98], which may permit asleep craniotomies for patients unsuited to awake surgery.…”

Section: Electrophysiologic Mechanisms and Techniques Relating To Inv...mentioning

confidence: 99%

Current Status of Neuromodulation-Induced Cortical Prehabilitation and Considerations for Treatment Pathways in Lower-Grade Glioma Surgery

Hamer

Yeo

2022

Life

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The infiltrative character of supratentorial lower grade glioma makes it possible for eloquent neural pathways to remain within tumoural tissue, which renders complete surgical resection challenging. Neuromodulation-Induced Cortical Prehabilitation (NICP) is intended to reduce the likelihood of premeditated neurologic sequelae that otherwise would have resulted in extensive rehabilitation or permanent injury following surgery. This review aims to conceptualise current approaches involving Repetitive Transcranial Magnetic Stimulation (rTMS-NICP) and extraoperative Direct Cortical Stimulation (eDCS-NICP) for the purposes of inducing cortical reorganisation prior to surgery, with considerations derived from psychiatric, rehabilitative and electrophysiologic findings related to previous reports of prehabilitation. Despite the promise of reduced risk and incidence of neurologic injury in glioma surgery, the current data indicates a broad but compelling possibility of effective cortical prehabilitation relating to perisylvian cortex, though it remains an under-explored investigational tool. Preliminary findings may prove sufficient for the continued investigation of prehabilitation in small-volume lower-grade tumour or epilepsy patients. However, considering the very low number of peer-reviewed case reports, optimal stimulation parameters and duration of therapy necessary to catalyse functional reorganisation remain equivocal. The non-invasive nature and low risk profile of rTMS-NICP may permit larger sample sizes and control groups until such time that eDCS-NICP protocols can be further elucidated.

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