Rapid Passive Gamma Mapping as an Adjunct to Electrical Stimulation Mapping for Functional Localization in Resection of Primary Brain Neoplasms

Hao Tan; Joseph G. Nugent; Adeline Fecker; Emma A. Richie; Kayla A. Maanum; Caleb Nerison; Stephen G. Bowden; Ilker Yaylali; Seunggu J. Han; Dana D. Colgan; Barry Oken; Ahmed M. Raslan

doi:10.1016/j.wneu.2023.10.085

Rapid Passive Gamma Mapping as an Adjunct to Electrical Stimulation Mapping for Functional Localization in Resection of Primary Brain Neoplasms

Hao Tan, Joseph G. Nugent, Adeline Fecker, Emma A. Richie, Kayla A. Maanum, Caleb Nerison, Stephen G. Bowden, Ilker Yaylali, Seunggu J. Han, Dana D. Colgan, Barry Oken, Ahmed M. Raslan

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: We examined the utility of passive high gamma mapping (HGM) as an adjunct to conventional awake brain mapping during glioma resection. We compared functional and survival outcomes before and after implementing intraoperative HGM. Methods: This was a retrospective cohort study of 75 patients who underwent a first-time, awake craniotomy for glioma resection. Patients were stratified by whether their operation occurred before or after the implementation of a U.S. Food and Drug Administration−approved high-gamma mapping tool in July 2017. Results: The preimplementation and postimplementation cohorts included 28 and 47 patients, respectively. Median intraoperative time (261 vs. 261 minutes, P = 0.250) and extent of resection (97.14% vs. 98.19%, P = 0.481) were comparable between cohorts. Median Karnofsky performance status at initial follow-up was similar between cohorts (P = 0.650). Multivariable Cox regression models demonstrated an adjusted hazard ratio for overall survival of 0.10 (95% confidence interval: 0.02–0.43, P = 0.002) for the postimplementation cohort relative to the preimplementation cohort. Progression-free survival adjusted for insular involvement showed an adjusted hazard ratio of 1.00 (95% confidence interval: 0.49–2.06, P = 0.999) following HGM implementation. Falling short of statistical significance, prevalence of intraoperative seizures and/or afterdischarges decreased after HGM implementation as well (12.7% vs. 25%, P = 0.150). Conclusions: Our results tentatively indicate that passive HGM is a safe and potentially useful adjunct to electrical stimulation mapping for awake cortical mapping, conferring at least comparable functional and survival outcomes with a nonsignificant lower rate of intraoperative epileptiform events. Considering the limitations of our study design and patient cohort, further investigation is needed to better identify optimal use cases for HGM.

Original language	English (US)
Pages (from-to)	e483-e492
Journal	World Neurosurgery
Volume	181
DOIs	https://doi.org/10.1016/j.wneu.2023.10.085
State	Published - Jan 2024

Keywords

Awake
Electrocorticography
Gamma-band
Intraoperative
Mapping
Passive
Tumor

ASJC Scopus subject areas

Surgery
Clinical Neurology

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Tan, H., Nugent, J. G., Fecker, A., Richie, E. A., Maanum, K. A., Nerison, C., Bowden, S. G., Yaylali, I., Han, S. J., Colgan, D. D., Oken, B., & Raslan, A. M. (2024). Rapid Passive Gamma Mapping as an Adjunct to Electrical Stimulation Mapping for Functional Localization in Resection of Primary Brain Neoplasms. World Neurosurgery, 181, e483-e492. https://doi.org/10.1016/j.wneu.2023.10.085

Tan, H, Nugent, JG, Fecker, A, Richie, EA, Maanum, KA, Nerison, C, Bowden, SG, Yaylali, I, Han, SJ, Colgan, DD , Oken, B & Raslan, AM 2024, 'Rapid Passive Gamma Mapping as an Adjunct to Electrical Stimulation Mapping for Functional Localization in Resection of Primary Brain Neoplasms', World Neurosurgery, vol. 181, pp. e483-e492. https://doi.org/10.1016/j.wneu.2023.10.085

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title = "Rapid Passive Gamma Mapping as an Adjunct to Electrical Stimulation Mapping for Functional Localization in Resection of Primary Brain Neoplasms",

abstract = "Objective: We examined the utility of passive high gamma mapping (HGM) as an adjunct to conventional awake brain mapping during glioma resection. We compared functional and survival outcomes before and after implementing intraoperative HGM. Methods: This was a retrospective cohort study of 75 patients who underwent a first-time, awake craniotomy for glioma resection. Patients were stratified by whether their operation occurred before or after the implementation of a U.S. Food and Drug Administration−approved high-gamma mapping tool in July 2017. Results: The preimplementation and postimplementation cohorts included 28 and 47 patients, respectively. Median intraoperative time (261 vs. 261 minutes, P = 0.250) and extent of resection (97.14% vs. 98.19%, P = 0.481) were comparable between cohorts. Median Karnofsky performance status at initial follow-up was similar between cohorts (P = 0.650). Multivariable Cox regression models demonstrated an adjusted hazard ratio for overall survival of 0.10 (95% confidence interval: 0.02–0.43, P = 0.002) for the postimplementation cohort relative to the preimplementation cohort. Progression-free survival adjusted for insular involvement showed an adjusted hazard ratio of 1.00 (95% confidence interval: 0.49–2.06, P = 0.999) following HGM implementation. Falling short of statistical significance, prevalence of intraoperative seizures and/or afterdischarges decreased after HGM implementation as well (12.7% vs. 25%, P = 0.150). Conclusions: Our results tentatively indicate that passive HGM is a safe and potentially useful adjunct to electrical stimulation mapping for awake cortical mapping, conferring at least comparable functional and survival outcomes with a nonsignificant lower rate of intraoperative epileptiform events. Considering the limitations of our study design and patient cohort, further investigation is needed to better identify optimal use cases for HGM.",

keywords = "Awake, Electrocorticography, Gamma-band, Intraoperative, Mapping, Passive, Tumor",

author = "Hao Tan and Nugent, {Joseph G.} and Adeline Fecker and Richie, {Emma A.} and Maanum, {Kayla A.} and Caleb Nerison and Bowden, {Stephen G.} and Ilker Yaylali and Han, {Seunggu J.} and Colgan, {Dana D.} and Barry Oken and Raslan, {Ahmed M.}",

note = "Publisher Copyright: {\textcopyright} 2023 Elsevier Inc.",

year = "2024",

month = jan,

doi = "10.1016/j.wneu.2023.10.085",

language = "English (US)",

volume = "181",

pages = "e483--e492",

journal = "World Neurosurgery",

issn = "1878-8750",

publisher = "Elsevier Inc.",

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TY - JOUR

T1 - Rapid Passive Gamma Mapping as an Adjunct to Electrical Stimulation Mapping for Functional Localization in Resection of Primary Brain Neoplasms

AU - Tan, Hao

AU - Nugent, Joseph G.

AU - Fecker, Adeline

AU - Richie, Emma A.

AU - Maanum, Kayla A.

AU - Nerison, Caleb

AU - Bowden, Stephen G.

AU - Yaylali, Ilker

AU - Han, Seunggu J.

AU - Colgan, Dana D.

AU - Oken, Barry

AU - Raslan, Ahmed M.

PY - 2024/1

Y1 - 2024/1

N2 - Objective: We examined the utility of passive high gamma mapping (HGM) as an adjunct to conventional awake brain mapping during glioma resection. We compared functional and survival outcomes before and after implementing intraoperative HGM. Methods: This was a retrospective cohort study of 75 patients who underwent a first-time, awake craniotomy for glioma resection. Patients were stratified by whether their operation occurred before or after the implementation of a U.S. Food and Drug Administration−approved high-gamma mapping tool in July 2017. Results: The preimplementation and postimplementation cohorts included 28 and 47 patients, respectively. Median intraoperative time (261 vs. 261 minutes, P = 0.250) and extent of resection (97.14% vs. 98.19%, P = 0.481) were comparable between cohorts. Median Karnofsky performance status at initial follow-up was similar between cohorts (P = 0.650). Multivariable Cox regression models demonstrated an adjusted hazard ratio for overall survival of 0.10 (95% confidence interval: 0.02–0.43, P = 0.002) for the postimplementation cohort relative to the preimplementation cohort. Progression-free survival adjusted for insular involvement showed an adjusted hazard ratio of 1.00 (95% confidence interval: 0.49–2.06, P = 0.999) following HGM implementation. Falling short of statistical significance, prevalence of intraoperative seizures and/or afterdischarges decreased after HGM implementation as well (12.7% vs. 25%, P = 0.150). Conclusions: Our results tentatively indicate that passive HGM is a safe and potentially useful adjunct to electrical stimulation mapping for awake cortical mapping, conferring at least comparable functional and survival outcomes with a nonsignificant lower rate of intraoperative epileptiform events. Considering the limitations of our study design and patient cohort, further investigation is needed to better identify optimal use cases for HGM.

AB - Objective: We examined the utility of passive high gamma mapping (HGM) as an adjunct to conventional awake brain mapping during glioma resection. We compared functional and survival outcomes before and after implementing intraoperative HGM. Methods: This was a retrospective cohort study of 75 patients who underwent a first-time, awake craniotomy for glioma resection. Patients were stratified by whether their operation occurred before or after the implementation of a U.S. Food and Drug Administration−approved high-gamma mapping tool in July 2017. Results: The preimplementation and postimplementation cohorts included 28 and 47 patients, respectively. Median intraoperative time (261 vs. 261 minutes, P = 0.250) and extent of resection (97.14% vs. 98.19%, P = 0.481) were comparable between cohorts. Median Karnofsky performance status at initial follow-up was similar between cohorts (P = 0.650). Multivariable Cox regression models demonstrated an adjusted hazard ratio for overall survival of 0.10 (95% confidence interval: 0.02–0.43, P = 0.002) for the postimplementation cohort relative to the preimplementation cohort. Progression-free survival adjusted for insular involvement showed an adjusted hazard ratio of 1.00 (95% confidence interval: 0.49–2.06, P = 0.999) following HGM implementation. Falling short of statistical significance, prevalence of intraoperative seizures and/or afterdischarges decreased after HGM implementation as well (12.7% vs. 25%, P = 0.150). Conclusions: Our results tentatively indicate that passive HGM is a safe and potentially useful adjunct to electrical stimulation mapping for awake cortical mapping, conferring at least comparable functional and survival outcomes with a nonsignificant lower rate of intraoperative epileptiform events. Considering the limitations of our study design and patient cohort, further investigation is needed to better identify optimal use cases for HGM.

KW - Awake

KW - Electrocorticography

KW - Gamma-band

KW - Intraoperative

KW - Mapping

KW - Passive

KW - Tumor

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SN - 1878-8750

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SP - e483-e492

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ER -

Rapid Passive Gamma Mapping as an Adjunct to Electrical Stimulation Mapping for Functional Localization in Resection of Primary Brain Neoplasms

Abstract

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