Preoperative and intraoperative neuromonitoring and mapping techniques impact oncological and functional outcomes in supratentorial function-eloquent brain tumours: a systematic review and meta-analysisResearch in context
Summary: Background: Supratentorial function-eloquent brain tumour surgeries challenge the balance between maximal tumour resection and preservation of neurological function. This study aims to evaluate the efficacy of preoperative and intraoperative mapping techniques on resection outcomes and pos...
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Elsevier
2025-02-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537024006345 |
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| author | Asfand Baig Mirza Amisha Vastani Rishabh Suvarna Sami Rashed Aws Al-Omari Engelbert Mthunzi Feras Fayez Nicala Rampersad Josephine Jung Alba Díaz Baamonde José Siado Mosquera Ali Elhag Francesco Marchi Richard Gullan Keyoumars Ashkan Ranjeev Bhangoo Francesco Vergani Ana Mirallave-Pescador José Pedro Lavrador |
| author_facet | Asfand Baig Mirza Amisha Vastani Rishabh Suvarna Sami Rashed Aws Al-Omari Engelbert Mthunzi Feras Fayez Nicala Rampersad Josephine Jung Alba Díaz Baamonde José Siado Mosquera Ali Elhag Francesco Marchi Richard Gullan Keyoumars Ashkan Ranjeev Bhangoo Francesco Vergani Ana Mirallave-Pescador José Pedro Lavrador |
| author_sort | Asfand Baig Mirza |
| collection | DOAJ |
| description | Summary: Background: Supratentorial function-eloquent brain tumour surgeries challenge the balance between maximal tumour resection and preservation of neurological function. This study aims to evaluate the efficacy of preoperative and intraoperative mapping techniques on resection outcomes and post-operative deficits. Methods: This systematic review and meta-analysis examined literature up to March 2023, sourced from PubMed, Embase, and Medline. Criteria for inclusion were studies on patients undergoing surgery for supratentorial brain tumours, comparing preoperative mapping only (POM), intraoperative neuromonitoring and mapping (IONM), and combined techniques (POM&IONM), excluding non-randomized controlled trials. Data extraction focused on rates of gross total resection (GTR) and focal neurological deficits (FNDs). The main outcomes, assessed through a random-effects model and Cochran's Q-test for subgroup analysis. The study protocol is published on PROSPERO CRD42024512306. Findings: 19 studies involving 992 patients were included. Systematic review with meta-analysis revealed a non-significantly higher average GTR rates for POM&IONM (49.13%) and POM (50.79%) compared to IONM alone (41.23%). Highest rates of GTR were achieved with tractography-guided resection in POM group (66.59% versus fMRI–20.00%, p = 0.0004), multimodal stimulation in IONM group (54.16% versus low frequency stimulation (LFS)–13.29%, p < 0.0001) and in POM&IONM group (65.88% versus LFS–37.77%, p = 0.0036). Within the same tumour histology–metastasis, high grade and low grade glioma–there are no differences in the GTR rates achieved in the different groups (p > 0.05). In language-eloquent tumours and in awake craniotomy techniques regardless of tumour functional eloquence, POM&IONM group had higher GTR when compared to IONM groups (language eloquent tumours–POM&IONM 43.31% versus IONM–15.09%, p = 0.022; awake craniotomy technique–POM&IONM–41.22% versus IONM–12.08%, p = 0.0006). Permanent FNDs were higher in the IONM group (IONM-73.0%; POM-29.6%; POM&IONM-33.7% of immediate postoperative deficits, p = 0.0010). Interpretation: A combined POM&IONM approach is responsible for higher rates of GTR in patients with language eloquent tumours and in both awake and asleep craniotomy techniques regardless of the tumour functional eloquence. The tumour histology is not relevant for differences in GTR rates among different mapping and monitoring strategies. Permanent postoperative FNDs are more likely with standalone utilization of IONM. Funding: Not applicable. |
| format | Article |
| id | doaj-art-0c7b7c3e80f64550a89a4437653cc3ad |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-0c7b7c3e80f64550a89a4437653cc3ad2025-01-09T06:14:26ZengElsevierEClinicalMedicine2589-53702025-02-0180103055Preoperative and intraoperative neuromonitoring and mapping techniques impact oncological and functional outcomes in supratentorial function-eloquent brain tumours: a systematic review and meta-analysisResearch in contextAsfand Baig Mirza0Amisha Vastani1Rishabh Suvarna2Sami Rashed3Aws Al-Omari4Engelbert Mthunzi5Feras Fayez6Nicala Rampersad7Josephine Jung8Alba Díaz Baamonde9José Siado Mosquera10Ali Elhag11Francesco Marchi12Richard Gullan13Keyoumars Ashkan14Ranjeev Bhangoo15Francesco Vergani16Ana Mirallave-Pescador17José Pedro Lavrador18Department of Neurosurgery, Queen's Hospital Barking, Havering and Redbridge NHS, Trust, London, UK; Department of Neurosurgery, King's College Hospital Foundation Trust, London, UK; Corresponding author. Queens hospital Romford, London, UK.Department of Neurosurgery, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UKSchool of Medicine, Worsley Building, University of Leeds, UKDepartment of Neurosurgery, Queen's Hospital Barking, Havering and Redbridge NHS, Trust, London, UKDepartment of Neurosurgery, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UKDepartment of Neurosurgery, King's College Hospital Foundation Trust, London, UKDepartment of Neurosurgery, King's College Hospital Foundation Trust, London, UKDepartment of Neurosurgery, Queen's Hospital Barking, Havering and Redbridge NHS, Trust, London, UKDepartment of Neurosurgery, King's College Hospital Foundation Trust, London, UKDepartment of Neurosurgery, King's College Hospital Foundation Trust, London, UK; Department of Clinical Neurophysiology, King's College Hospital Foundation Trust, London, UKDepartment of Neurosurgery, King's College Hospital Foundation Trust, London, UK; Department of Clinical Neurophysiology, King's College Hospital Foundation Trust, London, UKDepartment of Neurosurgery, King's College Hospital Foundation Trust, London, UKDepartment of Neurosurgery, King's College Hospital Foundation Trust, London, UK; Department of Clinical Neurophysiology, King's College Hospital Foundation Trust, London, UKDepartment of Neurosurgery, King's College Hospital Foundation Trust, London, UKDepartment of Neurosurgery, King's College Hospital Foundation Trust, London, UKDepartment of Neurosurgery, King's College Hospital Foundation Trust, London, UKDepartment of Neurosurgery, King's College Hospital Foundation Trust, London, UKDepartment of Neurosurgery, King's College Hospital Foundation Trust, London, UK; Department of Clinical Neurophysiology, King's College Hospital Foundation Trust, London, UKDepartment of Neurosurgery, King's College Hospital Foundation Trust, London, UKSummary: Background: Supratentorial function-eloquent brain tumour surgeries challenge the balance between maximal tumour resection and preservation of neurological function. This study aims to evaluate the efficacy of preoperative and intraoperative mapping techniques on resection outcomes and post-operative deficits. Methods: This systematic review and meta-analysis examined literature up to March 2023, sourced from PubMed, Embase, and Medline. Criteria for inclusion were studies on patients undergoing surgery for supratentorial brain tumours, comparing preoperative mapping only (POM), intraoperative neuromonitoring and mapping (IONM), and combined techniques (POM&IONM), excluding non-randomized controlled trials. Data extraction focused on rates of gross total resection (GTR) and focal neurological deficits (FNDs). The main outcomes, assessed through a random-effects model and Cochran's Q-test for subgroup analysis. The study protocol is published on PROSPERO CRD42024512306. Findings: 19 studies involving 992 patients were included. Systematic review with meta-analysis revealed a non-significantly higher average GTR rates for POM&IONM (49.13%) and POM (50.79%) compared to IONM alone (41.23%). Highest rates of GTR were achieved with tractography-guided resection in POM group (66.59% versus fMRI–20.00%, p = 0.0004), multimodal stimulation in IONM group (54.16% versus low frequency stimulation (LFS)–13.29%, p < 0.0001) and in POM&IONM group (65.88% versus LFS–37.77%, p = 0.0036). Within the same tumour histology–metastasis, high grade and low grade glioma–there are no differences in the GTR rates achieved in the different groups (p > 0.05). In language-eloquent tumours and in awake craniotomy techniques regardless of tumour functional eloquence, POM&IONM group had higher GTR when compared to IONM groups (language eloquent tumours–POM&IONM 43.31% versus IONM–15.09%, p = 0.022; awake craniotomy technique–POM&IONM–41.22% versus IONM–12.08%, p = 0.0006). Permanent FNDs were higher in the IONM group (IONM-73.0%; POM-29.6%; POM&IONM-33.7% of immediate postoperative deficits, p = 0.0010). Interpretation: A combined POM&IONM approach is responsible for higher rates of GTR in patients with language eloquent tumours and in both awake and asleep craniotomy techniques regardless of the tumour functional eloquence. The tumour histology is not relevant for differences in GTR rates among different mapping and monitoring strategies. Permanent postoperative FNDs are more likely with standalone utilization of IONM. Funding: Not applicable.http://www.sciencedirect.com/science/article/pii/S2589537024006345Intraoperative neuromonitoringHigh-frequency stimulationLow- frequency stimulationNavigated transcranial magnetic stimulationFunctional magnetic resonance imagingTractography |
| spellingShingle | Asfand Baig Mirza Amisha Vastani Rishabh Suvarna Sami Rashed Aws Al-Omari Engelbert Mthunzi Feras Fayez Nicala Rampersad Josephine Jung Alba Díaz Baamonde José Siado Mosquera Ali Elhag Francesco Marchi Richard Gullan Keyoumars Ashkan Ranjeev Bhangoo Francesco Vergani Ana Mirallave-Pescador José Pedro Lavrador Preoperative and intraoperative neuromonitoring and mapping techniques impact oncological and functional outcomes in supratentorial function-eloquent brain tumours: a systematic review and meta-analysisResearch in context EClinicalMedicine Intraoperative neuromonitoring High-frequency stimulation Low- frequency stimulation Navigated transcranial magnetic stimulation Functional magnetic resonance imaging Tractography |
| title | Preoperative and intraoperative neuromonitoring and mapping techniques impact oncological and functional outcomes in supratentorial function-eloquent brain tumours: a systematic review and meta-analysisResearch in context |
| title_full | Preoperative and intraoperative neuromonitoring and mapping techniques impact oncological and functional outcomes in supratentorial function-eloquent brain tumours: a systematic review and meta-analysisResearch in context |
| title_fullStr | Preoperative and intraoperative neuromonitoring and mapping techniques impact oncological and functional outcomes in supratentorial function-eloquent brain tumours: a systematic review and meta-analysisResearch in context |
| title_full_unstemmed | Preoperative and intraoperative neuromonitoring and mapping techniques impact oncological and functional outcomes in supratentorial function-eloquent brain tumours: a systematic review and meta-analysisResearch in context |
| title_short | Preoperative and intraoperative neuromonitoring and mapping techniques impact oncological and functional outcomes in supratentorial function-eloquent brain tumours: a systematic review and meta-analysisResearch in context |
| title_sort | preoperative and intraoperative neuromonitoring and mapping techniques impact oncological and functional outcomes in supratentorial function eloquent brain tumours a systematic review and meta analysisresearch in context |
| topic | Intraoperative neuromonitoring High-frequency stimulation Low- frequency stimulation Navigated transcranial magnetic stimulation Functional magnetic resonance imaging Tractography |
| url | http://www.sciencedirect.com/science/article/pii/S2589537024006345 |
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