Investigation of Asleep versus Awake Motor Mapping in Resective Brain Surgery.

OBJECTIVE: To develop an asleep motor mapping paradigm for accurate detection of the corticospinal tract during glioma surgery and compare outcomes with awake patients undergoing glioma resection. METHODS: A consecutive cohort of adult patients undergoing craniotomy for suspected diffuse glioma with tumor in a perirolandic location who had awake or asleep cortical and subcortical motor mapping with positive areas of motor stimulation were assessed for postoperative extent of resection (EOR), permanent neurological deficit, and proximity of stimulation to diffusion tensor imaging-based corticospinal tract depiction on preoperative magnetic resonance imaging. Outcome data were compared between asleep and awake groups. RESULTS: In the asleep group, all 16 patients had improved or no change in motor function at last follow-up (minimum 3 months of follow-up). In the awake group, all 23 patients had improved function or no change at last follow-up. EOR was greater in the asleep group (mean [SD] EOR 88.71% [17.56%]) versus the awake group (mean [SD] EOR 80.62% [24.44%]), although this difference was not statistically significant (P = 0.3802). Linear regression comparing distance from stimulation to corticospinal tract in asleep (n = 14) and awake (n = 4) patients was r = -0.3759, R2 = 0.1413, P = 0.1853, and 95% confidence interval = -0.4453 to 0.09611 and r = 0.7326, R2 = 0.5367, P = 0.2674, and 95% confidence interval = -7.042 to 14.75, respectively. CONCLUSION: In this small patient series, asleep motor mapping using commonly available motor evoked potential hardware appears to be safe and efficacious in regard to EOR and functional outcomes.

For the further training of individuals in neurosurgery II: the academic legacy of the William P. Van Wagenen Fellowship.

OBJECTIVE: William P. Van Wagenen pursued a research fellowship in Europe early in his career under the recommendation of Harvey Cushing. Later, Van Wagenen would be instrumental in the establishment of the William P. Van Wagenen Fellowship, a postgraduate fellowship for neurosurgeons from the AANS that requires study outside of a fellow's country of residency training with plans to return to academic practice. METHODS: Since 1968, 54 Van Wagenen Fellowships have been awarded, sending 54 fellows from 31 institutions to 13 different countries. The academic productivity of fellows was studied to determine the academic "return on investment" of the fellowship. RESULTS: Almost all fellows have spent some time in academic neurosurgery (94%), with the vast majority remaining in academics for their entire career (87%); 52% of fellows have received NIH funding, and 55% have been promoted to professor. The numbers are even more striking for the first half of Van Wagenen Fellows (who received the fellowship from its inception in 1968 to 1994) with at least 25 years of career development who remained in academics: 65% received NIH funding, 86% were promoted to professor, and 62% became chairs of academic departments. The Hirsch index of fellows, defined as h papers from an individual with at least h citations, is higher than the national mean and median values for academic neurosurgeons at every academic rank. Fellows have served on national committees and as AANS and CNS presidents and have given back financially to the Neurosurgery Research and Education Foundation (NREF) to fund future research activities of neurosurgical residents and young faculty. CONCLUSIONS: The Van Wagenen Fellowship will continue to provide young neurosurgeons with opportunities to pursue novel research and network with peers internationally and to motivate young neurosurgeons to transform neurosurgery. The legacy of Cushing and Van Wagenen continues today through the Van Wagenen Fellowship, a legacy that will only continue to grow.