How many patients require brain mapping in an adult neuro-oncology service?

Abstract

Intraoperative mapping and neuromonitoring is an established technique to maximise tumour resection while minimising the risk of inducing permanent postoperative deficit. However, very little is known on how many patients require brain mapping within a general adult neuro-oncology service. A prospective study of all neuro-oncology patients operated over a 12months' period (January-December 2017) was performed. All patients were seen in a dedicated neuro-oncology pre-assessment clinic after discussion in a neuro-oncology multidisciplinary team meeting. Inclusion criteria for brain mapping were age more than 18, performance status less than 2, tumour location in an eloquent area. Age, sex, histology, surgical technique, extent of resection and operative complications were analysed. Two hundred thirty-five craniotomies were performed in the study period. Intraoperative mapping was used for 57 (24%) cases. There were 22 females and 35 males; median age was 52years (22-73).17 (30%) patients were operated awake for speech and 40 (70%) asleep for motor mapping. One hundred fifteen patients had a diagnosis of glioma; of these, 48 (42%) were operated with intraoperative mapping. Age (48.92 ± 2.18versus 58.43 ± 1.63, p = 0.001) and WHO grading were significantly lower in the mapping group and the extent of resection was significantly higher (GTR-81.25% versus 37.3%, p < .001). Within the mapping group, the awake subgroup had a better performance status (p = 0.039), less glioblastomas as histological diagnosis (p < 0.05) and an increased proportion of tumours in both temporal and insular locations (p < 0.05). Intraoperative mapping was employed in almost one quarter of our general adult neuro-oncology population. Four in 10 gliomas were operated with intraoperative mapping. This percentage reflects the need for specialised training in brain mapping and budget allocation within the neuro-oncology department.