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Intraoperative Monitoring of an Aspect of Executive Functions: Administration of the Stroop Test in 9 Adult Patients During Awake Surgery for Resection of Frontal Glioma

Wager, Michel MD, PhD*; Du Boisgueheneuc, Foucaud MD; Pluchon, Claudette ST; Bouyer, Coline ST; Stal, Veronique MD§; Bataille, Benoit MD, PhD*; Guillevin, Carole Menuel PhD; Gil, Roger MD, PhD

doi: 10.1227/NEU.0b013e31827bf1d6
Technique Assessment

BACKGROUND: Awake brain surgery allows extensive intraoperative monitoring of not only motor and sensory functions and language but also executive functions.

OBJECTIVE: To administer the Stroop test intraoperatively to avoid dramatic side effects such as akinetic mutism and to monitor executive functions in an attempt to optimize the benefit/risk balance of surgery.

METHODS: A series of 9 adult patients with frontal glioma were operated on for gross tumor resection under local anesthesia. All procedures involved the anterior cingulate cortex (ACC).

RESULTS: Three types of response to the Stroop test were observed: 3 patients had a Stroop effect only for stimulation of the contralateral ACC; 3 patients had a Stroop effect for stimulation of the ipsilateral ACC; and 3 patients had no Stroop effect. Preoperative and postoperative neuropsychological and surgical results are presented and discussed. Stimulation sites eliciting a Stroop effect are compared with published image-based data, and insight provided by these surgical data regarding ACC function and plasticity is discussed. No operative complication related to intraoperative administration of the Stroop test was observed.

CONCLUSION: Administration of the Stroop test during resection of gliomas involving the ACC in adult patients is an option for intraoperative monitoring of executive functions during awake surgery. Globally, these results suggest functional compensation, mediated by plasticity mechanisms, by contralateral homologous regions of the ACC in adult patients with frontal glioma.

ABBREVIATIONS: ACC, anterior cingulate cortex

SE, Stroop effect

*Department of Neurosurgery,

Department of Neurology, Neuropsychology and Speech Therapy Unit,

§Department of Clinical Neurophysiology, and

Department of Radiology. Imaging Laboratory, University Hospital, Poitiers, France

Correspondence: Michel Wager, MD, PhD, Department of Neurosurgery. Hôpital La Miletrie, CHU Poitiers, 2, Rue de La Miletrie, BP 577. 86021 Poitiers Cedex, France. E-mail:

Received April 22, 2012

Accepted October 17, 2012

Copyright © by the Congress of Neurological Surgeons