Intraoperative monitoring of inhibitory control

Vollständiger Abstract

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Abstract Purpose Impairments in executive functioning (EF) and inhibitory control (IC) negatively affect patients’ health-related quality of life. We introduced an intraoperative Stroop task (iST) as means of monitoring IC. This study summarizes lessons learned over the past decade since implementation of iST. We focus on its feasibility, potential in preserving EF and anatomical correlates of intraoperative errors. Methods We retrospectively examined 119 treatment-naïve WHO grade II-IV glioma patients, undergoing awake surgery and perioperative neuropsychological testing between 2010–2020. We compared clinical characteristics between iST and non-iST patients. We examined EF including IC at both group and individual level. Patients underwent magnetic resonance scanning according to clinical routine, from which preoperative glioma location and iST error type maps were constructed. Results The iST appeared feasible where it was planned to be performed in a broad glioma population (118/119; 99%) with minimal impact on patient and surgical procedure burden. Stimulation elicited inhibition errors ( n = 64; 54%) and excessive slowing ( n = 71, 60%) on the iST. IC and EF were preserved similarly across subgroups. Individual performances declined (< -1.5SD) more frequently in patients with high-grade than low-grade gliomas at 3–6 months post-surgery. Gliomas in the left frontal lobe were associated with increased odds of slowing and inhibition errors, contrary to right frontal and parietal lobe involvement. Five patients (4%) developed new postoperative EF or IC impairments, despite iST monitoring. Conclusion Our findings indicate that iST is a feasible tool for intraoperative monitoring of IC in glioma patients, imposing minimal additional burden on both patient and surgical procedure preserving EF and IC among iST patient subgroups. The iST can elicit errors in various brain regions, with a predilection for the left frontal lobe. The overall low incidence of cognitive decline leading to cognitive impairments supports the efficacy of iST in preserving EF and specifically IC during awake surgery.