Glioma surgery with awake language mapping versus generalized anesthesia: a systematic review

Bu, Linghao; Zhang, Jie; Lu, Junfeng; Wu, Jinsong

doi:10.1007/s10143-020-01418-9

Cited by 41 publications

(41 citation statements)

References 56 publications

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“…There is much debate on whether AC improves the resection rate. Some reports have stated that the removal rate is improved, [12,13,16,21,23,24,27] while others reported a decrease or no signi cant difference. [14, 15, 18-20, 22, 26] The best way to address this issue is to con rm that the resection rate correlates with prognosis.…”

Section: Eor and Osmentioning

confidence: 99%

“…Although there is little objection that AC is superior to general anesthesia (GA) for functional preservation, its ability to improve the EOR is controversial. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] One reason making such validation di cult is that many studies have not evaluated the OS, despite the proven strong correlation between EOR and OS, owing to the di culty of adjusting the bias induced by the eloquent areas. The lack of an objective de nition of eloquent areas on the image is a factor, but the most critical one is the selection bias of patients who underwent surgery performed under GA despite eloquent lesions.…”

Section: Introductionmentioning

confidence: 99%

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Impact of awake mapping on overall survival and extent of resection in patients with adult diffuse gliomas within or near eloquent areas: a retrospective propensity score-matched analysis of awake craniotomy vs. general anesthesia

et al. 2021

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Introduction: Awake craniotomy (AC) with intraoperative mapping is the best approach to preserve neurological function for glioma surgery in eloquent or near eloquent areas, but whether AC improves the extent of resection (EOR) is controversial. Furthermore, there is less evidence of improved overall survival (OS) in glioma patients. This study aimed to compare the long-term clinical outcomes of glioma resection under AC with those under general anesthesia (GA).Methods: Data of 335 patients who underwent surgery with intraoperative magnetic resonance imaging for newly diagnosed gliomas of World Health Organization (WHO) grades II-IV between 2000 and 2013 were reviewed. EOR and OS were quantitatively compared between the AC and GA groups after 1:1 propensity score matching. The two groups were matched for age, preoperative Karnofsky performance status, tumor location, and pathology based on the WHO 2007 classi cation.Results: After propensity score matching, 91 pairs were obtained. The median EOR were 96.1% (interquartile range[IQR] 7.3) and 97.4% (IQR 14.4) in the AC and GA groups, respectively (p=0.31). The median survival times were 163.3 months (95% con dence interval [CI] 77.9-248.7) and 143.5 months (95% CI 94.4-192.7) in the AC and GA groups, respectively (p=0.585).Conclusions: Even if the glioma was within or close to the eloquent area, AC was comparable with GA in terms of EOR and OS. In case of di culties in randomizing patients with eloquent or near eloquent glioma, our propensity score-matched analysis provides retrospective evidence that AC can obtain EOR and OS equivalent to removing glioma under GA.

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Section: Eor and Osmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of awake mapping on overall survival and extent of resection in patients with adult diffuse gliomas within or near eloquent areas: a retrospective propensity score-matched analysis of awake craniotomy vs. general anesthesia

et al. 2021

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“…However, there are also reports of only mild performance differences between pre-and postoperative linguistic and cognitive profiles regarding awake surgery [50,51]. Moreover, the results of a recent meta-analysis point out that functional testing and concordant DCS even minimizes the risk for long-term neurological and language deficits [1].…”

Section: Discussionmentioning

confidence: 99%

“…An awake craniotomy with language mapping in patients with brain tumors or metastasis in language-critical brain areas represents the gold standard for maximizing the resection of brain tumors and metastases in language-critical brain areas while minimizing the risk for postoperative functional deficits [1][2][3]. Both aspects improve postsurgical treatment responses, overall survival, and increase patients' health-related quality of life [4,5].…”

Section: Introductionmentioning

confidence: 99%

A Novel Language Paradigm for Intraoperative Language Mapping: Feasibility and Evaluation

Rosengarth

Pai

Dodoo‐Schittko

et al. 2021

JCM

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(1) Background—Mapping language using direct cortical stimulation (DCS) during an awake craniotomy is difficult without using more than one language paradigm that particularly follows the demand of DCS by not exceeding the assessment time of 4 s to prevent intraoperative complications. We designed an intraoperative language paradigm by combining classical picture naming and verb generation, which safely engaged highly relevant language functions. (2) Methods—An evaluation study investigated whether a single trial of the language task could be performed in less than 4 s in 30 healthy subjects and whether the suggested language paradigm sufficiently pictured the cortical language network using functional magnetic resonance imaging (fMRI) in 12 healthy subjects. In a feasibility study, 24 brain tumor patients conducted the language task during an awake craniotomy. The patients’ neuropsychological outcomes were monitored before and after surgery. (3) Results—The fMRI results in healthy subjects showed activations in a language-associated network around the (left) sylvian fissure. Single language trials could be performed within 4 s. Intraoperatively, all tumor patients showed DCS-induced language errors while conducting the novel language task. Postoperatively, mild neuropsychological impairments appeared compared to the presurgical assessment. (4) Conclusions—These data support the use of a novel language paradigm that safely monitors highly relevant language functions intraoperatively, which can consequently minimize negative postoperative neuropsychological outcomes.

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“…Remarkably, awake ESM guiding the resection until the individual eloquent cortico-subcortical networks have been encountered resulted in an improvement of both neurological and oncological outcomes ( 41 ). Functionally speaking, a connectome-based resection allowed for a significant decrease of neurological morbidity ( 42 – 44 ) with preservation of conation, language, and higher-cognitive functions (e.g., complex movement control, verbal and non-verbal semantics, executive functions, mentalizing or metacognition) ( 45 – 48 ) making it possible to resume a normal life, including return to work in 97% of patients ( 49 )—even for tumors involving areas presumed to be “eloquent” in a rigid localizationist framework ( 23 , 24 ). Oncologically speaking, functional mapping-guided surgery has enabled a significant increase of extent of resection and overall survival, both in low-grade and high-grade gliomas ( 50 – 53 ).…”

Section: How To Integrate a Better Understanding Of The Cerebral Connectome Into Neurosurgical Practice?mentioning

confidence: 99%

Neural Connectivity: How to Reinforce the Bidirectional Synapse Between Basic Neuroscience and Routine Neurosurgical Practice?

Duffau

2021

Front. Neurol.

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Glioma surgery with awake language mapping versus generalized anesthesia: a systematic review

Cited by 41 publications

References 56 publications

Impact of awake mapping on overall survival and extent of resection in patients with adult diffuse gliomas within or near eloquent areas: a retrospective propensity score-matched analysis of awake craniotomy vs. general anesthesia

Impact of awake mapping on overall survival and extent of resection in patients with adult diffuse gliomas within or near eloquent areas: a retrospective propensity score-matched analysis of awake craniotomy vs. general anesthesia

A Novel Language Paradigm for Intraoperative Language Mapping: Feasibility and Evaluation

Neural Connectivity: How to Reinforce the Bidirectional Synapse Between Basic Neuroscience and Routine Neurosurgical Practice?

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