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Awake surgery for right frontal lobe glioma can preserve visuospatial cognition and spatial working memory

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Abstract

Purpose

Awake surgery is the standard treatment to preserve motor and language functions. This longitudinal study aimed to evaluate the resection rate and preservation of neurocognitive functions in patients with right frontal lobe glioma who underwent awake surgery.

Methods

Thirty-three patients (mean age, 48.0 years) with right frontal lobe glioma who underwent awake surgery at our hospital between 2013 and 2019 were included. Fourteen, thirteen, and six cases had WHO classification grades of II, III, and IV, respectively. We evaluated visuospatial cognition (VSC) and spatial working memory (SWM) before and three months after surgery. Relevant brain areas for VSC and SWM were intraoperatively mapped, whenever the task was successfully accomplished. Therefore, patients were divided into an intraoperative evaluation group and a non-evaluation group for each function, and the resection rate and functional outcomes were compared.

Results

The removal rate in the evaluation group for VSC and SWM were similar to that in the non-evaluation group. Chronic impairment rate of VSC was significantly lower in the evaluation than in the non-evaluation group (5.6% vs. 33.3%, p = 0.034). No patient showed postoperative SWM impairment in the evaluation group as opposed to the non-evaluation group (16.7%, p = 0.049). The probability of resection of the deeper posterior part of the middle frontal gyrus, the relevant area of VSC, was higher in the non-evaluation group than in the evaluation group.

Conclusions

We statistically verified that awake surgery for right frontal lobe glioma results in successful preservation of VSC and SWM with satisfying resection rates.

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Funding

This work was supported by JSPS KAKENHI Grant Number 18K19606, 19K22801 and 20K21649.

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Authors and Affiliations

  1. Department of Neurosurgery, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Mitsutoshi Nakada, Shingo Tanaka & Masashi Kinoshita

  2. Department of Occupational therapy, Faculty of health science, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan

    Riho Nakajima

  3. Department of Physical Medicine and Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan

    Hirokazu Okita

  4. Department of Clinical Laboratory, Kanazawa University Hospital, Kanazawa, Japan

    Yusuke Nakade & Takeo Yuno

Authors
  1. Mitsutoshi Nakada
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  2. Riho Nakajima
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  4. Yusuke Nakade
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  7. Masashi Kinoshita
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Contributions

Conception and design: MN. Acquisition of data: MK, HO, YN, TY, ST, RN. Analysis and interpretation of data: MN, RN. Drafting article: MN, RN. Critically revising the article: all authors. Reviewed final version of the manuscript and approved it for submission: all authors. Study supervision: MN.

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Correspondence to Mitsutoshi Nakada.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Electronic Supplementary Material

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Supplementary Fig. 1 Inclusion criteria for patient selection (tiff 351 kb)

11060_2020_3656_MOESM2_ESM.tiff

Supplementary Fig. 2 Schema of intraoperative functional assessment. A, visuospatial cognition; B, spatial working memory; DES, direct electrical stimulation (tiff 749 kb)

11060_2020_3656_MOESM3_ESM.tiff

Supplementary Fig. 3 Overlap map of resection cavities showing that the dorsolateral prefrontal cortex to the posterior medial prefrontal cortex and its deep part had the greatest degree of overlap. Numbers at the upper left of the slice images indicate coordinates of the MNI template (tiff 6527 kb)

11060_2020_3656_MOESM4_ESM.tiff

Supplementary Fig. 4 Postoperative neuropsychological function including visuospatial cognition (A) and spatial working memory (B) were compared between low- and high- grade gliomas with and without postoperative treatment, respectively. Using the chi-squared test, no significant (ns) differences were observed. Red, impaired patients; blue, unimpaired patients (tiff 286 kb)

(DOCX 14 kb)

Supplementary video 1. Method for assessing visuospatial cognition via intraoperative line bisection test is shown. The audio has been translated into English (mp4 8917)

Supplementary video 2. Intraoperative assessment of spatial working memory using spatial 2-back test is shown. The audio has been translated into English (mp4 21385)

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Nakada, M., Nakajima, R., Okita, H. et al. Awake surgery for right frontal lobe glioma can preserve visuospatial cognition and spatial working memory. J Neurooncol 151, 221–230 (2021). https://doi.org/10.1007/s11060-020-03656-9

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