Monitoring of executive functions during awake glioma surgery: A standardized multicenter protocol

BACKGROUND AND OBJECTIVES: Currently, there are no standardized clinical mapping protocols for monitoring of executive functions during awake glioma surgery, primarily due to a lack of evidence-based data for cognitive mapping. By aligning procedures and documentation practices across institutions, clinicians can overcome the current fragmentation in the field and iteratively work toward generating reproducible, high-quality Data sets that will better clarify the clinical relevance of white matter pathways involved in executive functions. A previously conducted pilot study led to the development of a standardized monitoring protocol and demonstrated that pooling of data is feasible when surgical teams commit to the study requirements. The primary goal of this multicenter study protocol is to investigate whether using this standardized protocol can identify white matter tracts involved in executive functions.

METHODS: In this prospective, clinical observational study, we will continue data collection in 4 neurosurgical departments from the previously conducted pilot study and expand to other hospitals providing neurosurgical care. We aim to include adult patients that will undergo awake primary glioma surgery and undergo monitoring of executive functions with a uniform set of tasks for the following white matter tracts: frontal aslant tract, superior longitudinal fasciculus II and II, arcuate fasciculus, inferior fronto-occipital fasciculus. Data will be collected in a standardized manner for each patient before, during, and after surgery.

EXPECTED OUTCOMES: The primary objective of this study was to determine if executive functions can be effectively monitored using a standardized protocol during awake glioma surgery in multiple neurosurgical centers. DISCUSSION: Despite limitations inherent to multicenter and observational studies, this study represents a necessary step toward developing a validated uniform way of collecting intraoperative findings on mapping of executive functions. The generation of high-quality Data sets is highly needed to extend the scientific basis for monitoring of white matter pathways involved in executive functions.