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Preoperative assessment of eloquence in neurosurgery: a systematic review

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Abstract

Background and objectives

Tumor location and eloquence are two crucial preoperative factors when deciding on the optimal treatment choice in glioma management. Consensus is currently lacking regarding the preoperative assessment and definition of eloquent areas. This systematic review aims to evaluate the existing definitions and assessment methods of eloquent areas that are used in current clinical practice.

Methods

A computer-aided search of Embase, Medline (OvidSP), and Google Scholar was performed to identify relevant studies. This review includes articles describing preoperative definitions of eloquence in the study’s Methods section. These definitions were compared and categorized by anatomical structure. Additionally, various techniques to preoperatively assess tumor eloquence were extracted, along with their benefits, drawbacks and ease of use.

Results

This review covers 98 articles including 12,714 participants. Evaluation of these studies indicated considerable variability in defining eloquence. Categorization of these definitions yielded a list of 32 brain regions that were considered eloquent. The most commonly used methods to preoperatively determine tumor eloquence were anatomical classification systems and structural MRI, followed by DTI-FT, functional MRI and nTMS.

Conclusions

There were major differences in the definitions and assessment methods of eloquence, and none of them proved to be satisfactory to express eloquence as an objective, quantifiable, preoperative factor to use in glioma decision making. Therefore, we propose the development of a novel, objective, reliable, preoperative classification system to assess eloquence. This should in the future aid neurosurgeons in their preoperative decision making to facilitate personalized treatment paradigms and to improve surgical outcomes.

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Data availability

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

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Acknowledgements

We would like to thank W. Bramer, biomedical information specialist at the Erasmus MC Library, for his assistance in the computer-aided systematic search.

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  1. Arnaud Jean Pierre Edouard Vincent and Jasper Kees Wim Gerritsen shares last authorship.

Authors and Affiliations

  1. Department of Neurosurgery, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands

    Emma Rammeloo, Joost Willem Schouten, Keghart Krikour, Eelke Marijn Bos, Arnaud Jean Pierre Edouard Vincent & Jasper Kees Wim Gerritsen

  2. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA

    Mitchel Stuart Berger

  3. Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Brian Vala Nahed

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Contributions

JKWG, AJPEV, MSB, ER, KK: Study concept and design. ER, KK: Acquisition, analysis, or interpretation of data. ER, JKWG: Drafting of manuscript. JWS, EMB, MSB, BVN, AJPEV, JKWG: Critical revision of the manuscript for important intellectual content. Bramer: Administrative, technical, or material support. JKWG, AJPEV, MSB: Study supervision.

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Rammeloo, E., Schouten, J.W., Krikour, K. et al. Preoperative assessment of eloquence in neurosurgery: a systematic review. J Neurooncol 165, 413–430 (2023). https://doi.org/10.1007/s11060-023-04509-x

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