Intraoperative Mapping and Preservation of Executive Functions in Awake Craniotomy: A Systematic Review | [Abstract Book on 9th Annual Neuroscience Conference (ANC-23) August 12-13, 2023 • 2023]

Author(s):

1. Rabeet Tariq: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

2. Hafiza Fatima Aziz: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

3. Shahier Paracha: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

4. Noman Ahmed: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

5. Muhammad Waqas: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

6. Saeed Baqai: Department of Neurosurgery, Southmead Hospital, NHS North Bristol Trust, UK

7. Saqib Kamran Bakhshi: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

8. Timothy J. Ainger: Kentucky Neuroscience Institute (KNI), Department of Neurosurgery, University of Kentucky, US

9. Farhan A. Mirza: Kentucky Neuroscience Institute (KNI), Department of Neurosurgery, University of Kentucky, US

10. Annabel McAtee: University of Kentucky, College of Medicine, US

11. Syed Ather Enam: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

Abstract:

Awake Craniotomy (AC) allows intraoperative brain mapping (ioBM) for maximum lesion resection while monitoring and preserving neurological function. Conventionally, language, visuospatial, and motor functions are mapped while assessment of Executive Functions (EF) are uncommon. Impaired EF may lead to occupational, personal, and social limitations, thus a compromised quality of life. A comprehensive literature search was conducted through Medline, Scopus, and Cochrane Library using a pre-defined search strategy. Articles were selected after duplicates removal, initial screening, and full-text assessment. Demographic details, ioBM tasks and their assessments, extent of resection (EOR), post-operative EF and neurocognitive status, 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 from 2 to 6 mA. The tasks used to monitor cognitive functions included the Stroop-task, line-bisection test, spatial-2-back 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. Adverse effects included intraoperative seizures which were easily controlled. AC with ioBM of EF is an effective and feasible technique that allows satisfactory EOR and improved neurocognitive outcomes with minimal adverse effects.

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Published: Journal: Abstract Book on 9th Annual Neuroscience Conference (ANC-23) August 12-13, 2023 , Volume: 0, Issue: 0, Year: 2023

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