Cortical resting motor threshold difference in asleep-awake craniotomy for motor eloquent gliomas: WHO grading influences motor pathway excitability

TY - JOUR

T1 - Cortical resting motor threshold difference in asleep-awake craniotomy for motor eloquent gliomas

T2 - WHO grading influences motor pathway excitability

AU - Pescador, Ana M

AU - Lavrador, José P

AU - Baamonde, Alba D

AU - Soumpasis, Christos

AU - Ghimire, Prajwal

AU - Mosquera, José D S

AU - Fiandeiro, Carlos

AU - Jones, Holly

AU - Gosavi, Smita

AU - Lejarde, Arjel

AU - Lawson, Emily

AU - Murace, Sian

AU - Gullan, Richard

AU - Ashkan, Keyoumars

AU - Bhangoo, Ranjeev

AU - Vergani, Francesco

N1 - © The Author(s) 2023. Published by Oxford University Press.

PY - 2024/1

Y1 - 2024/1

N2 - Developing neurophysiological tools to predict WHO tumor grade can empower the treating teams for a better surgical decision-making process. A total of 38 patients with supratentorial diffuse gliomas underwent an asleep-awake-sedated craniotomies for tumor removal with intraoperative neuromonitoring. The resting motor threshold was calculated for different train stimulation paradigms during awake and asleep phases. Receiver operating characteristic analysis and Bayesian regression models were performed to analyze the prediction of tumor grading based on the resting motor threshold differences. Significant positive spearman correlations were observed between resting motor threshold excitability difference and WHO tumor grade for train stimulation paradigms of 5 (R = 0.54, P = 0.00063), 4 (R = 0.49, P = 0.002), 3 (R = 0.51, P = 0.001), and 2 pulses (R = 0.54, P = 0.0007). Kruskal-Wallis analysis of the median revealed a positive significant difference between the median of excitability difference and WHO tumor grade in all paradigms. Receiver operating characteristic analysis showed 3 mA difference as the best predictor of high-grade glioma across different patterns of motor pathway stimulation. Bayesian regression found that an excitability difference above 3 mA would indicate a 75.8% probability of a glioma being high grade. Our results suggest that cortical motor excitability difference between the asleep and awake phases in glioma surgery could correlate with tumor grade.

AB - Developing neurophysiological tools to predict WHO tumor grade can empower the treating teams for a better surgical decision-making process. A total of 38 patients with supratentorial diffuse gliomas underwent an asleep-awake-sedated craniotomies for tumor removal with intraoperative neuromonitoring. The resting motor threshold was calculated for different train stimulation paradigms during awake and asleep phases. Receiver operating characteristic analysis and Bayesian regression models were performed to analyze the prediction of tumor grading based on the resting motor threshold differences. Significant positive spearman correlations were observed between resting motor threshold excitability difference and WHO tumor grade for train stimulation paradigms of 5 (R = 0.54, P = 0.00063), 4 (R = 0.49, P = 0.002), 3 (R = 0.51, P = 0.001), and 2 pulses (R = 0.54, P = 0.0007). Kruskal-Wallis analysis of the median revealed a positive significant difference between the median of excitability difference and WHO tumor grade in all paradigms. Receiver operating characteristic analysis showed 3 mA difference as the best predictor of high-grade glioma across different patterns of motor pathway stimulation. Bayesian regression found that an excitability difference above 3 mA would indicate a 75.8% probability of a glioma being high grade. Our results suggest that cortical motor excitability difference between the asleep and awake phases in glioma surgery could correlate with tumor grade.

KW - Humans

KW - Brain Neoplasms/surgery

KW - Wakefulness

KW - Bayes Theorem

KW - Glioma/surgery

KW - Craniotomy/adverse effects

KW - Efferent Pathways

KW - World Health Organization

KW - Brain Mapping/methods

UR - http://www.scopus.com/inward/record.url?scp=85182751756&partnerID=8YFLogxK

U2 - 10.1093/cercor/bhad493

DO - 10.1093/cercor/bhad493

M3 - Article

C2 - 38112581

SN - 1047-3211

VL - 34

JO - Cerebral Cortex

JF - Cerebral Cortex

IS - 1

M1 - bhad493

ER -