Evidence-based safe stimulation thresholds in subcortical mapping during glioma surgery: a systematic review and meta-analysis.
Osama Ismail Alsaleh, Shafak Nedal Al Habal, Ali Mohammad Lutfi Alomari
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In 30 seconds
This systematic review and meta-analysis evaluated safe stimulation thresholds for intraoperative subcortical mapping during glioma surgery, analyzing 16 studies with 1,146 patients. The findings suggest that a threshold of 3 mA is optimal for the general glioma population, while lower thresholds may be appropriate for low-grade gliomas. A significant dose-response relationship was observed, with permanent motor deficits increasing from 2.1% at ≥5 mA to 17.8% at <2 mA.
Key findings
- Safe stimulation thresholds ranged from 1 to 7 mA, with 3 mA applied in 63.5% of cases.
- Permanent motor deficits increased from 2.1% at thresholds ≥5 mA to 17.8% at thresholds <2 mA.
- Motor evoked potential monitoring reduced permanent deficits from 8.7% to 4.0% (pooled OR 0.43, p < 0.001).
- 78% of permanent deficits were due to ischemic injury rather than direct tract damage.
Why it matters
Understanding safe stimulation thresholds is crucial for minimizing motor deficits during glioma surgery. This evidence-based guidance can help clinicians make informed decisions about intraoperative stimulation parameters, ultimately improving patient outcomes.