title: 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.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Imaging Laboratory, University Hospital Poitiers, 2 Rue de La Miletrie, Poitiers Cedex, France. m.wager@chu-poitiers.fr
authors.forename: Michel
authors.initials: M
authors.lastname: Wager
authors.forename: Foucaud
authors.initials: F
authors.lastname: Du Boisgueheneuc
authors.forename: Claudette
authors.initials: C
authors.lastname: Pluchon
authors.forename: Coline
authors.initials: C
authors.lastname: Bouyer
authors.forename: Veronique
authors.initials: V
authors.lastname: Stal
authors.forename: Benoit
authors.initials: B
authors.lastname: Bataille
authors.forename: Carole Menuel
authors.initials: CM
authors.lastname: Guillevin
authors.forename: Roger
authors.initials: R
authors.lastname: Gil
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D003243:Consciousness; D056344:Executive Function; D005260:Female; D005910:Glioma / Q000601:surgery*; D006179:Gyrus Cinguli / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D057190:Stroop Test; D014851:Wakefulness