Abstract
Abstract AIMS Evaluate how sensori-motor (SM) testing is performed in awake craniotomy (AC) in the literature. Compare SM testing methods and their related outcomes. METHOD Literature search from 1995- 2019 in OVID Medline, Embase, PsychInfo, CINAHL and Web Of Science using all permutations of MESH terms “brain tumour” “awake craniotomy” “sensory” “motor” “testing”. 11671 articles were screened and 28 included based on suffcient detail of the tasks and intraoperative processes that would allow for evaluation. RESULTS SM testing is used to preserve function in AC when tumours involve or neighbour eloquent cortical structures sub serving movement. It is also used to identify subcortical tracts such as corticospinal and frontostriatal, as well as and the negative motor network. There is broad variation in how SM testing is conducted in different centres, with no standardisation. The most common strategies were: •Simple gross movement of contralateral limbs (n= 17) e.g., hand open/closing. •Functional movement (n=5) e.g., grasping object •Standardised tests (n= 3) including the Hand Manipulation Task and Sensory-Motor Profile awake •Patient at rest observed for positive motor responses or patient reported sensory changes (n= 2). CONCLUSIONS Multiple different intra-operative strategies exist for the preservation of sensori-motor function in awake craniotomy. Benefits of the over-arching AC strategy for SM preservation is frequently demonstrated. However, comparison and optimisation between strategies is hindered by heterogenous study objectives and outcomes reported. A core testing and outcome set may be useful to standardise, optimise and compare so that maximal patient benefit and functional preservation can be achieved.
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