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Indication and eligibility of glioma patients for awake surgery: A scoping review by a multidisciplinary perspective

BACKGROUND: Awake surgery (AS) permits intraoperative mapping of cognitive and motor functions, allowing neurosurgeons to tailor the resection according to patient functional boundaries thus preserving long-term patient integrity and maximizing extent of resection. Given the increased risks of the a...

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Autores principales: Fiore, Giorgio, Abete-Fornara, Giorgia, Forgione, Arianna, Tariciotti, Leonardo, Pluderi, Mauro, Borsa, Stefano, Bana, Cristina, Cogiamanian, Filippo, Vergari, Maurizio, Conte, Valeria, Caroli, Manuela, Locatelli, Marco, Bertani, Giulio Andrea
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9532968/
https://www.ncbi.nlm.nih.gov/pubmed/36212495
http://dx.doi.org/10.3389/fonc.2022.951246
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author Fiore, Giorgio
Abete-Fornara, Giorgia
Forgione, Arianna
Tariciotti, Leonardo
Pluderi, Mauro
Borsa, Stefano
Bana, Cristina
Cogiamanian, Filippo
Vergari, Maurizio
Conte, Valeria
Caroli, Manuela
Locatelli, Marco
Bertani, Giulio Andrea
author_facet Fiore, Giorgio
Abete-Fornara, Giorgia
Forgione, Arianna
Tariciotti, Leonardo
Pluderi, Mauro
Borsa, Stefano
Bana, Cristina
Cogiamanian, Filippo
Vergari, Maurizio
Conte, Valeria
Caroli, Manuela
Locatelli, Marco
Bertani, Giulio Andrea
author_sort Fiore, Giorgio
collection PubMed
description BACKGROUND: Awake surgery (AS) permits intraoperative mapping of cognitive and motor functions, allowing neurosurgeons to tailor the resection according to patient functional boundaries thus preserving long-term patient integrity and maximizing extent of resection. Given the increased risks of the awake scenario, the growing importance of AS in surgical practice favored the debate about patient selection concerning both indication and eligibility criteria. Nonetheless, a systematic investigation is lacking in the literature. OBJECTIVE: To provide a scoping review of the literature concerning indication and eligibility criteria for AS in patients with gliomas to answer the questions:1) "What are the functions mostly tested during AS protocols?" and 2) "When and why should a patient be excluded from AS?". MATERIALS AND METHODS: Pertinent studies were retrieved from PubMed, PsycArticles and Cochrane Central Register of Controlled Trials (CENTRAL), published until April 2021 according to the PRISMA Statement Extension for Scoping Reviews. The retrieved abstracts were checked for the following features being clearly stated: 1) the population described as being composed of glioma(LGG or HGG) patients; 2) the paper had to declare which cognitive or sensorimotor function was tested, or 2bis)the decisional process of inclusion/exclusion for AS had to be described from at least one of the following perspectives: neurosurgical, neurophysiological, anesthesiologic and psychological/neuropsychological. RESULTS: One hundred and seventy-eight studies stated the functions being tested on 8004 patients. Language is the main indication for AS, even if tasks and stimulation techniques changed over the years. It is followed by monitoring of sensorimotor and visuospatial pathways. This review demonstrated an increasing interest in addressing other superior cognitive functions, such as executive functions and emotions. Forty-five studies on 2645 glioma patients stated the inclusion/exclusion criteria for AS eligibility. Inability to cooperate due to psychological disorder(i.e. anxiety),severe language deficits and other medical conditions(i.e.cardiovascular diseases, obesity, etc.)are widely reported as exclusion criteria for AS. However, a very few papers gave scale exact cut-off. Likewise, age and tumor histology are not standardized parameters for patient selection. CONCLUSION: Given the broad spectrum of functions that might be safely and effectively monitored via AS, neurosurgeons and their teams should tailor intraoperative testing on patient needs and background as well as on tumor location and features. Whenever the aforementioned exclusion criteria are not fulfilled, AS should be strongly considered for glioma patients.
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spelling pubmed-95329682022-10-06 Indication and eligibility of glioma patients for awake surgery: A scoping review by a multidisciplinary perspective Fiore, Giorgio Abete-Fornara, Giorgia Forgione, Arianna Tariciotti, Leonardo Pluderi, Mauro Borsa, Stefano Bana, Cristina Cogiamanian, Filippo Vergari, Maurizio Conte, Valeria Caroli, Manuela Locatelli, Marco Bertani, Giulio Andrea Front Oncol Oncology BACKGROUND: Awake surgery (AS) permits intraoperative mapping of cognitive and motor functions, allowing neurosurgeons to tailor the resection according to patient functional boundaries thus preserving long-term patient integrity and maximizing extent of resection. Given the increased risks of the awake scenario, the growing importance of AS in surgical practice favored the debate about patient selection concerning both indication and eligibility criteria. Nonetheless, a systematic investigation is lacking in the literature. OBJECTIVE: To provide a scoping review of the literature concerning indication and eligibility criteria for AS in patients with gliomas to answer the questions:1) "What are the functions mostly tested during AS protocols?" and 2) "When and why should a patient be excluded from AS?". MATERIALS AND METHODS: Pertinent studies were retrieved from PubMed, PsycArticles and Cochrane Central Register of Controlled Trials (CENTRAL), published until April 2021 according to the PRISMA Statement Extension for Scoping Reviews. The retrieved abstracts were checked for the following features being clearly stated: 1) the population described as being composed of glioma(LGG or HGG) patients; 2) the paper had to declare which cognitive or sensorimotor function was tested, or 2bis)the decisional process of inclusion/exclusion for AS had to be described from at least one of the following perspectives: neurosurgical, neurophysiological, anesthesiologic and psychological/neuropsychological. RESULTS: One hundred and seventy-eight studies stated the functions being tested on 8004 patients. Language is the main indication for AS, even if tasks and stimulation techniques changed over the years. It is followed by monitoring of sensorimotor and visuospatial pathways. This review demonstrated an increasing interest in addressing other superior cognitive functions, such as executive functions and emotions. Forty-five studies on 2645 glioma patients stated the inclusion/exclusion criteria for AS eligibility. Inability to cooperate due to psychological disorder(i.e. anxiety),severe language deficits and other medical conditions(i.e.cardiovascular diseases, obesity, etc.)are widely reported as exclusion criteria for AS. However, a very few papers gave scale exact cut-off. Likewise, age and tumor histology are not standardized parameters for patient selection. CONCLUSION: Given the broad spectrum of functions that might be safely and effectively monitored via AS, neurosurgeons and their teams should tailor intraoperative testing on patient needs and background as well as on tumor location and features. Whenever the aforementioned exclusion criteria are not fulfilled, AS should be strongly considered for glioma patients. Frontiers Media S.A. 2022-09-21 /pmc/articles/PMC9532968/ /pubmed/36212495 http://dx.doi.org/10.3389/fonc.2022.951246 Text en Copyright © 2022 Fiore, Abete-Fornara, Forgione, Tariciotti, Pluderi, Borsa, Bana, Cogiamanian, Vergari, Conte, Caroli, Locatelli and Bertani https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Fiore, Giorgio
Abete-Fornara, Giorgia
Forgione, Arianna
Tariciotti, Leonardo
Pluderi, Mauro
Borsa, Stefano
Bana, Cristina
Cogiamanian, Filippo
Vergari, Maurizio
Conte, Valeria
Caroli, Manuela
Locatelli, Marco
Bertani, Giulio Andrea
Indication and eligibility of glioma patients for awake surgery: A scoping review by a multidisciplinary perspective
title Indication and eligibility of glioma patients for awake surgery: A scoping review by a multidisciplinary perspective
title_full Indication and eligibility of glioma patients for awake surgery: A scoping review by a multidisciplinary perspective
title_fullStr Indication and eligibility of glioma patients for awake surgery: A scoping review by a multidisciplinary perspective
title_full_unstemmed Indication and eligibility of glioma patients for awake surgery: A scoping review by a multidisciplinary perspective
title_short Indication and eligibility of glioma patients for awake surgery: A scoping review by a multidisciplinary perspective
title_sort indication and eligibility of glioma patients for awake surgery: a scoping review by a multidisciplinary perspective
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9532968/
https://www.ncbi.nlm.nih.gov/pubmed/36212495
http://dx.doi.org/10.3389/fonc.2022.951246
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