Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis.

  title={Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis.},
  author={Philip C. de Witt Hamer and Santiago Gil Robles and Aeilko H. Zwinderman and Hugues Duffau and Mitchel S. Berger},
  journal={Journal of clinical oncology : official journal of the American Society of Clinical Oncology},
  volume={30 20},
PURPOSE Surgery for infiltrative gliomas aims to balance tumor removal with preservation of functional integrity. The usefulness of intraoperative stimulation mapping (ISM) has not been addressed in randomized trials. This study addresses glioma surgery outcome on the basis of a meta-analysis of observational studies. METHODS A systematic search retrieved 90 reports published between 1990 and 2010 with 8,091 adult patients who had resective surgery for supratentorial infiltrative glioma, with… 

Impact of intraoperative stimulation mapping on high-grade glioma surgery outcome: a meta-analysis

These findings suggest that surgeons using ISM and AC during their resections of high-grade glioma in eloquent areas experienced better surgical outcomes: a significantly longer overall postoperative survival, a lower rate of postoperative complications, and a higher percentage of GTR.

Resection Probability Maps for Quality Assessment of Glioma Surgery without Brain Location Bias

RPMs provide a quantitative volumetric method to compare resection results, which is presented as standard for quality assessment of resective glioma surgery because brain location bias is avoided.

Contribution of intraoperative stimulation mapping to glioblastoma surgery within or adjacent to descending motor pathways: survival analysis and functional outcome comparison between two series in a single institution

ISM was discovered to lead to higher quality of resection and delayed recurrence in patients with glioblastoma and the neurological outcome in the ISM group was thus superior, but the two differences were not significant.

Awake craniotomy for resection of supratentorial glioblastoma: a systematic review and meta-analysis

Limited current evidence suggests that the use of AC for resection of supratentorial GBM is associated with a low rate of persistent neurological deficits while achieving an acceptable rate of GTR.

Awake vs. asleep motor mapping for glioma resection: a systematic review and meta-analysis

Mapping during resection of gliomas located in or near the perirolandic area and descending motor tracts can be safely carried out with both awake craniotomy and under general anesthesia, and which anesthetic protocol provides better patient outcomes is determined.

Post-operative morbidity ensuing surgery for insular gliomas: a systematic review and meta-analysis

Awake craniotomy with DES is associated with a significantly lower rate of permanent neurological morbidity after an early increase of transient post-operative deficits, which support the use of awake mapping in insular glioma resection.

Linking late cognitive outcome with glioma surgery location using resection cavity maps

Cognitive decline after resective surgery of diffuse glioma is prevalent, in particular, in patients with a tumor located in the right hemisphere without cognitive function mapping, including the frontal pole and the corpus callosum.

Pushing the limits of glioma resection using electrophysiologic brain mapping.

  • P. LowensteinM. Castro
  • Medicine
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • 2012
proposes that intraoperative stimulatory mapping to determine the location of eloquent brain areas during glioma resection provides increased volume of resection and is associated with reduced late

Review of Intraoperative Adjuncts for Maximal Safe Resection of Gliomas and Its Impact on Outcomes

The reviewed studies demonstrate that intraoperative adjuncts such as iMRI, AC/GA mapping, fluorescence-guided imaging, and a combination of these modalities improve EOR, however, PFS/OS were underreported.



Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice.

The authors of this paper provide an overview for neurosurgeons, neurophysiologists, linguists, and anesthesiologists as well as those new to the field about the stimulation techniques currently being used for mapping sensorimotor, language, and cognitive function in awake surgery for low-grade glioma.

Functional mapping-guided resection of low-grade gliomas in eloquent areas of the brain: improvement of long-term survival. Clinical article.

Delineation of true functional and nonfunctional areas by intraoperative mapping in high-risk patients to maximize tumor resection can dramatically improve long-term survival.

Surgical management of World Health Organization Grade II gliomas in eloquent areas: the necessity of preserving a margin around functional structures.

A no-margin technique, based on the subpial dissection, and the repetition of both cortical and subcortical stimulation to preserve eloquent cortex as well as the white matter tracts allow optimization of the extent of resection while preserving the quality of life (despite transitory impairment) thanks to mechanisms of brain plasticity.


The present data provide Level 2b evidence (Oxford Centre for Evidence-based Medicine) that survival depends on complete resection of enhancing tumor in glioblastoma multiforme and treatment bias was demonstrated regarding resection and second-line therapies.

Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas.

Improved outcome among adult patients with hemispheric LGG is predicted by greater EOR, and progression-free survival was predicted by log preoperative tumor volume and postoperative volume.


Despite persistent limitations in the quality of data, mounting evidence suggests that more extensive surgical resection is associated with longer life expectancy for both low- and high-grade gliomas.

An extent of resection threshold for newly diagnosed glioblastomas.

For patients with newly diagnosed GBMs, aggressive EOR equates to improvement in overall survival, even at the highest levels of resection, and stepwise improvement in survival was evident even in the 95%-100% EOR range.